Pam Crawford first saw M.C. nine years ago, on an adoption website for kids with special needs. The photo showed a toddler in a chair, curly black hair pulled tight into pigtails, staring at the camera with a dead-serious expression. A short bio noted that the 18-month-old didn’t like getting her fingers sticky and that she needed a family to help realize her full potential.
While many of the other kids on the site had visible health problems, Pam was unclear what this baby’s special needs could be. “Here was just this perfect little girl,” Pam said recently.
When she called the South Carolina Department of Social Services to find out more, she learned that M.C. was born with a rare condition that produced a patchwork of male and female anatomy.
At birth, M.C.’s external genitalia included a 2-centimeter penis, a small vaginal opening, an undescended testicle on the left side, both ovarian and testicular tissue on the right side, and blood testosterone levels deemed normal for male babies of the same age. The technical name for this condition is “ovotesticular disorder of sexual differentiation.” Some of M.C.’s medical records used the more archaic term: “true hermaphroditism.”
Roughly 1 in every 2,000 babies in the U.S. are born, like M.C., with a range of traits that fall somewhere along the wide spectrum between male and female. Some doctors argue that the number of these so-called intersex babies is even higher — as many as 1 in 100 — depending on what biological markers are used to draw the line where nature hasn’t.
For babies with M.C.’s condition, doctors look at genetic, hormonal, and anatomical factors likely to play a role in whether the baby will grow up to identify as a boy or a girl. Then, if the parents agree, they’ll often perform surgery to make their anatomy fit that gender assignment.
In 2012, the most recent year that data is available, surgeons at U.S. hospitals performed various intersex procedures at least 2,991 times on children under 18 years of age, and 1,759 of those surgeries were on children younger than 5.
But many intersex patients, parents, legal experts, and bioethicists are opposed to surgical fixes, which they argue are often medically unnecessary, riddled with consent issues, and physically and psychologically harmful.
One of these critics is Pam. After hearing about M.C.’s condition, the first thing she remembers saying was, “Oh, I hope they haven’t done a surgery!”
But they had. Just two months before she saw that first photo, surgeons had removed all of M.C.’s male anatomy. “We were just like, OK, let’s deal — we’ll deal with what we gotta deal with,” Pam said. Two months later, they brought home a baby girl.
Now M.C. is a 10-year-old boy. (And because M.C. identifies as male, this article will refer to him with male pronouns.) As he begins the anguish of adolescence, Pam and her husband, Mark, are waging a landmark lawsuit against the hospitals and state guardians who decided to put their son through sex-assignment surgery.
The trial, slated for November, is the first public lawsuit to come out of a long-running scientific debate: Should intersex babies be operated on to make them “boys” and “girls”?
For decades, medical professionals have performed genital surgeries on intersex babies in the name of allowing them to lead more normal lives — knowing whether to pee in the boys or girls restroom, being able to eventually reproduce as either a man or a woman, and, in rare cases, removing the risk of dangerous tumors. They claim that the majority of people who undergo surgery, as well as their parents, never look back.
But in a cultural moment when trans celebrities such as Caitlyn Jenner, Laverne Cox, and Janet Mock are shining a spotlight on the fact that gender isn’t a simple binary, intersex advocates are fighting to get that same recognition.
Surgeries on intersex babies, these advocates argue, often cause the very shame and stigma that they claim to prevent later on in life, all in the name of sticking to social expectations around sex and gender. Let babies grow up, they say, and then decide for themselves how — and whether — to change their bodies in such dramatic ways.
The idea that sex can be assigned comes from work done in the 1950s by a psychologist and sexologist named John Money.
A fierce champion of open marriage and sexual exploration at a time when sex was taboo, Money is best known for his ideas about what shapes our personal sense of gender identity — a concept that didn’t exist before his work threw it under the spotlight.
Babies, Money argued, are not born with a predetermined gender. Instead, their gender identity develops within the first two and a half years of life, depending on how their parents decide to raise them.
"You have a person with ambiguous genitals, which society does not accept, and as a surgeon you can change it into something that looks completely normal."
Money’s research put him at the helm of the world’s first intersex clinic, at Johns Hopkins Hospital, which started a new treatment of surgically assigning sex to infants. Despite the stellar reputation of his institution, Money was considered a radical, far outside of the medical mainstream. To get his ideas to spread, he needed a landmark case.
That case was handed to him in 1967, when a Canadian couple came to Money desperately seeking help with their infant twin boys. Both were born healthy, but a botched circumcision had burnt off one boy’s penis. Under Money’s supervision, the 8-month-old was castrated and then raised as a girl.
For the next decade Money heralded the twins as living proof that his theory held true. The so-called John/Joan case was declared a success in magazines, newspapers, and on television segments. Johns Hopkins became the center of a treatment paradigm that was quickly taken up by hospitals across the country.
The twins’ story was largely forgotten until 1997, when a reproductive biologist named Milton Diamond tracked them down — only to find that the twin who had undergone surgery had never lived happily as a girl, and in fact had undergone a painful switch to living as a boy again at the age of 14.
When Diamond found the man, named David Reimer, he had been married to a woman for four years and had undergone multiple sex reversal surgeries. The discovery sent shockwaves through the medical community.
By the time the story broke, doctors were already facing public scrutiny from a small but increasingly vocal group of adult intersex patients, speaking out for the first time against the surgeries they’d had as babies. They described lives filled with shame and secrecy, as well as physical pain, scarring, and loss of sexual sensation. Some did not identify with the gender they had been assigned at birth.
In 2004, when Reimer was 38, he shot himself. It’s unclear why: He had been prone to depression, his brother had recently died, and his marriage was failing. But his mother claimed he would not have been pushed to such an extreme if it hadn’t been for the experiment that ruined his life. “I think he felt he had no options,” she told the New York Times shortly after his death. “It just kept building up and building up.”
Six months later, M.C. was born.
M.C.
Courtesy of SPLC / Advocates for Informed Choice
M.C. was born on Nov. 20, 2004, in a hospital in Greenville, South Carolina. Shortly afterward, South Carolina’s Department of Social Services started looking into possible neglect by his biological parents.
At M.C.'s birth, doctors recorded his sex as male. But they soon noted the infant’s ambiguous genitalia, and the presence of a “rudimentary” uterus that, they believed, could one day be used to bear children. His hormonal levels, however, were in the normal range for male babies, which raised the possibility that during prenatal development his brain had bathed in the high levels of testosterone that are typical for boys.
In his medical files, M.C.’s condition was initially described as “confusing,” though otherwise he was a healthy baby. After a DNA test found that he had two X chromosomes — the genetic definition of female — M.C. was described as such. But the verdict was still out on whether he should be raised as a girl.
By February 2005, when M.C. was 3 months old, his biological father abandoned the family. Shortly after, the state of South Carolina determined that his mother was an unfit parent, and he was taken into state custody. Decisions about M.C.’s medical care from there on out were supposed to be made by social workers as well as his biological mother, whose parental rights had not yet been formally terminated.
In January 2006, M.C.’s case was referred to two doctors at the Medical University of South Carolina (MUSC): a pediatric urologist whose expertise was in genital surgery, and a pediatric endocrinologist who focused on hormone signaling.
In the doctors’ notes, sex-assignment surgery was almost always presented as a given, according to the legal complaint filed on behalf of Pam and Mark by the intersex advocacy group Advocates for Informed Choice and the Southern Poverty Law Center.
“Either sex of rearing is possible with appropriate surgery,” Yaw Appiagyei-Dankah, the endocrinologist, reportedly explained to the foster mom and social worker.
“My bias at the moment is towards female, although I have raised the possibility ... that there may have been sufficient testosterone imprinting to question ultimate gender identity,” Ian Aaronson, the pediatric surgeon who ultimately performed M.C.’s surgery, wrote in his notes on Feb. 27, 2006.
Though both Aaronson and Appiagyei-Dankah said it was possible that M.C.’s hormones may have already set the course for the development of a more male identity, they eventually agreed that the infant should undergo genital surgery to live as a girl.
M.C.’s biological mother signed the consent form, but according to the Crawfords' lawyers, she attended only one of M.C.’s three medical appointments, hadn’t spoken to his physicians in two months, and missed his surgery. Social services signed off as well.
In April, Aaronson cut off 16-month-old M.C.’s penis to reduce it to the size of a clitoris, removed all testicular tissue, and turned his scrotal tissue into the folds of a vagina.
Neither doctor would comment to BuzzFeed News about the particulars of the case. But Heather Woolwine, a spokesperson from MUSC, did.
“You have to remember, there are things we know now in medicine that we may not have known then,” Woolwine said. “Hindsight is always 20/20.”
The Crawfords live in a big brick house on the edge of a lake, worlds away from the bustle of college students and dive bars in South Carolina's downtown Columbia. Their tree-shrouded corner of suburbia is the kind of place where kids can run wild on seemingly endless yards of grass, which is the main reason Pam and Mark decided to move there.
I met Pam, Mark, and their lawyer at their home in May, while M.C. was still at school for the day. They didn’t want me to meet him. Despite the fact that their lawsuit has spurred a very public discussion about their son and what was done to his body, they want to shield him from as much of it as possible.
A psychiatrist by profession, Pam is forward and effusive; Mark a timid and self-deprecating stay-at-home dad to their five kids. They met in California in the '90s, while Mark was studying law at Stanford University and Pam was in the Air Force, then moved to the South to start a big family.
After their first two children, the couple decided to adopt and to focus on kids with special needs. “I guess we felt pretty privileged,” Pam told me. “We were like, we have the means, we have the desire for a bigger family, and so we said maybe we should do this.”
They brought M.C. home at 20 months old. From that moment on, he ran wild with energy. “You could tell that he was gonna be kind of an explorer,” Mark said. M.C.’s first complete sentence was “It is a bug,” Mark added, laughing. “I’m sorry to say that it was in the kitchen.”
M.C. idolized his father. “He’s his number one,” Kelly Stanton, a close family friend and former vice principal of M.C.’s school, told me when Pam and I visited her home.
Getting the gender “right” isn’t the real issue.
Stanton used to live across the street from the Crawfords. On weekends she’d sometimes look out the window to see Mark walking to their pool, equipment in hand, with 3-year-old M.C. trudging along behind in a dress and work boots, carrying a toy shovel. “You’d see them marching down the street: There goes Mark, and there goes little M.C.,” Stanton said.
Pam and Mark say there was no single point at which they knew M.C. was a boy. Their oldest daughter, Abby, had always been a tomboy, and neither of them put too much stock in the stereotypical preferences that divide the genders. “He always liked trucks and cars and whatever, but still it was like, so what — so did Abby!” Pam said.
But as M.C. grew older, he began to assert his own preferences more overtly. Once he could dress himself, he eschewed his girlier clothing in favor of jeans and plaid shirts. When boys and girls divided into teams for sports, M.C. wanted to be on the boys’ side.
Most memorable for his parents was the day, at 6 years old, when M.C. asked to have his hair cut “like Dad’s.” Pam talked to him about how people might think he was a boy. M.C. said that was fine, and he got a buzz cut.
Mark struggled more than Pam did with embracing M.C.’s boyish assertions. “Strangely enough, as the stay-at-home dad, a lot of this story Pam is more in on,” Mark told me quietly, pushing back his round tortoiseshell glasses and folding his hands between his legs. “See, I didn’t want him to get his hair cut actually, very much.”
Shortly after the pivotal haircut, the family went on a trip to the Great Wolf Lodge, a kitschy indoor water park 100 miles north of their home. According to Pam, M.C. was particularly taken with the fact that, away from his school friends, no one would know anything about him.
“He wanted to go as a boy, and he really wanted a boy name,” Pam said. “I think he was kind of checking, ‘Is it OK if I do this? Is it OK?’”
Pam said all right, and M.C. passed the weekend happily, and easily, as a boy.
A few months later, while in the first grade, M.C. decided he wanted to be a boy all the time. Pam and Mark talked to his teacher at the small Jewish day school he attended, and the principal sent out a letter to all of the other first-grade parents. When the big day came, M.C. stood at the front of his class, told them he was born “in-between,” and explained to his classmates that he was a boy.
His parents weren’t there, but Stanton, M.C.’s vice principal at the time, was standing at the back of the classroom. “It was emotional, but he was just so confident,” Stanton said. “He was ready.”
As we were leaving Stanton’s house, Pam walked me back to my car. She giddily scrolled through dozens of photos on her iPhone: M.C., now a 10-year-old, whipping sticks around while sword-fighting his younger brother at a playground; M.C., flashing a toothy grin while proudly wearing Army fatigues he dug up on his own at a neighborhood costume shop.
She and Mark never cared about or believed in gender stereotypes, Pam said. “But then sometimes you just see those stereotypes coming out on their own anyway.”
In many ways, M.C. has so far had it easy. He has been embraced as a boy by his family and his community, many of whom felt the transition was totally natural. But Pam and Mark are firm on one point: If they had been his legal guardians when he was a baby, they would not have chosen surgery. Which is why, in May 2013, they decided to sue those who did.
