But the children did not enjoy these enforced activities, which they were instructed to perform sometimes in front of Dr. Money, sometimes with as many as five or six of his colleagues in attendance. But to resist Money’s requests was to provoke his ire. “I remember getting yelled at by Money because I was defiant,” John says. “He told me to take my clothes off, and I just did not do it. I just stood there. And he screamed, ‘Now!’ Louder than that. I thought he was going to give me a whupping. So I took my clothes off and stood there, shaking.” In a separate conversation with me, Kevin recalls that same incident. “ ‘Take your clothes off – now!’ ” Kevin shouts.

As early as age 8, Joan began to resist going to Baltimore. Dr. Money suggested to Linda and Frank that they sweeten the pill of the annual visits by blending the trip to Hopkins with a family vacation. “Soon,” Linda says, “we were promising Disneyland and side trips to New York just to get her to go.”           

It was also around Joan’s eighth birthday that Dr. Money began increasingly to focus on the issue of vaginal surgery. At the time of her castration at 22 months, Joan was left with only a cosmetic exterior vagina; the surgeon had elected to wait until Joan’s body was closer to full grown before excavating a full vaginal canal. For Dr. Money, there was now an urgent need for Joan to prepare for this operation. Because genital appearance was critical to Money’s theory of how one “learns” a sexual identity, Money believed that Joan’s psychological sex change could not be complete until her physical sex change was finished.

There was only one problem: Joan was determined not to have the surgery – ever. The child’s increasingly stubborn refusal was not only a result of her deep-seated fear of hospitals, doctors and needles. It also had to do with the realization that she’d made around the time of grade two – that she was not a girl and never would be, no matter what her parents, her doctor, her teachers or anyone else said. For when Joan daydreamed of an ideal future, she saw herself as a 21-year-old male with a mustache and a sports car, surrounded by admiring friends. “He was somebody I wanted to be,” John says today, reflecting on this childhood fantasy. By now Joan was ever more certain that submitting to vaginal surgery would lock her into a gender in which she felt increasingly trapped.

She quietly told Dr. Money that she did not want to have the surgery. But the psychologist did not seem to want to hear this. Instead, Dr. Money would once again break out his cache of photographs of naked women. He would focus Joan’s gaze on the labia, vulva, clitoris. “Can’t you see that you’re different?” he would say. “That’s why you need the surgery.”

Joan, frightened but adamant, would simply refuse to lift her eyes. “Don’t you want to be a normal girl?” Dr. Money would ask repeatedly. “Don’t you want to be a normal girl?”

Dr. Money also continued to probe for the content of Joan’s sexual fantasies. She tried to keep this information secret from the psychologist, and she believed herself successful. But, according to Frank and Linda, she was wrong. By the time Joan turned 9, Dr. Money had informed them that something had come up in his private sessions with Joan. “Money told us that he had asked Joan what partner she would rather have, a boy or a girl,” Frank recalls. “Joan had said, ‘A girl.’ ” Frank recalls that Dr. Money wanted to know how they felt about raising a lesbian. At a loss as to how to respond to this news but relieved that Money did not seem to think it significant, Frank said what he honestly believed about homosexuality: “It’s not the most important thing in life.”

Money evidently agreed, for this clinical finding was not included in his next report on the twins, which appeared in 1975, when they were 10 years old. Published in the Archives of Sexual Behavior, the update was, if anything, a more glowing report than the one from three years before. After recapping the earlier findings and adding a new example of the girl’s happy femininity, Money concluded: “No one [outside the family] knows [that she was born a boy]. Nor would they ever conjecture. Her behavior is so normally that of an active little girl, and so clearly different by contrast from the boyish ways of her twin brother, that it offers nothing to stimulate one’s conjectures.”

That same year, Money published yet another account of Joan’s successful metamorphosis. But this time the intended audience was not only Money’s scientific and medical colleagues but also the general public. Sexual Signatures, co-authored with journalist Patricia Tucker, was Money’s bid for a wider audience. Stripped of the often-impenetrable psychological jargon that characterizes his earlier reports of the sex reassignment, the book offered Money’s most unrelievedly upbeat, almost triumphant, account of the case yet. Describing Joan’s sex reassignment as “dramatic proof that the gender-identity option is open at birth for normal infants,” Money went on to say of baby John’s castration as an infant, “The girl’s subsequent history proves how well all three of them [parents and child] succeeded in adjusting to that decision.”

Up to the age of 11, Joan’s only psychological therapy was her annual visits to Dr. Money at John Hopkins. But this changed in the fall of 1976, when she entered a new school, where her anxiety, social isolation and fear immediately drew the attention of teachers, who, once again, notified the Child Guidance Clinic. “Joan’s interests are strongly masculine,” a teacher wrote in her report. “She has marvelous plans for building treehouses, go-carts with CB radios, model gas airplanes . . . and appears to be more competitive and aggressive than her brother and is much more untidy both at home and in school.” A session with the clinic’s psychologist revealed that Joan had “strong fears that something [had] been done to her genital organs” and that she had had “some suicidal thoughts.”