By now, it was impossible for the local treatment team to ignore the obvious. After almost four years of fruitlessly trying to implement Dr. Money’s plan, several physicians experienced a change of heart. Among those who believed that Joan would never submit to vaginal surgery was Dr. McK., a particularly empathetic female psychiatrist, then in semi-retirement, who had taken over Joan’s case in the winter of 1979. Joan’s endocrinologist, Dr. W., was among the last holdouts for the surgery, since he remained certain that it was the appearance of Joan’s uncompleted vagina that formed the stumbling block to her psychological acceptance of herself as a girl. But now, even he began to waver. “Early on I had . . . pushed for early surgery,” he wrote in a letter to Dr. McK. “I am not as convinced now that this is a good idea and therefore at the present time have no specific plans or opinions as to the proper time for the operation.”

Ultimately, Joan forced the endocrinologist to come down off the fence. During an appointment in his office, Joan refused to remove her hospital gown for a breast exam. The doctor asked again. She refused. The standoff lasted 20 minutes. “It comes to a point in your life where you say, ‘I’ve had enough,’ ” John says. “There’s a limit for everybody. This was my limit.”

But Dr. W. had reached his limit, too. “Do you want to be a girl or not?” he demanded. It was a question Joan had heard before – a question that Money had been asking her since the dawn of her consciousness, a question the local doctors had badgered her with for four years, a question she’d heard once too often.

She raised her head and bellowed into his face: “No!”

The doctor left his office for a moment, then returned. “OK,” he said. “You can get dressed and go home.”

Only later would John learn that Dr. W. had, in stepping out into the hallway, spoken with Dr. McK. He told her that in his opinion, it was time that the teenager was told the truth of who she was and what had happened to her.

It was Frank’s custom to pick up Joan in the car after her weekly sessions with the psychiatrist. The afternoon of March 14, 1980, was no exception. But when Joan climbed into the car that day, Frank said that instead of driving straight home, they should get an ice-cream cone.

Immediately, Joan was suspicious. “Usually, when there was some kind of disaster in the family, good old dad takes you out in the family car for a cone or something,” John says. “I was thinking: ‘Is mother dying? Are you guys getting a divorce? Is everything OK with Kevin?’ ”

“No, no,” Frank said to Joan’s nervous questioning. “Everything’s fine.”

And, indeed, he couldn’t find the words to explain until Joan had bought her ice cream and Frank had pulled the car into the family’s driveway.

“He just started explaining, step by step, everything that had happened to me,” John says.

“It was the first time,” Linda says, “that John ever saw his father cry.”

Joan herself remained dry-eyed, staring straight ahead through the windshield, the ice-cream cone melting in her hand.

“She didn’t cry or anything,” Frank says almost two decades after this extraordinary encounter between father and child. “She just sat there, listening, real quiet. I guess she was so fascinated with this unbelievable tale that I was telling her.”

Today, John says that the revelations awoke many emotions within him anger, disbelief, amazement. But he says that one emotion overrode all the others. “I was relieved,” he says, blinking rapidly, his voice charged. “Suddenly it all made sense why I felt the way I did. I wasn’t some sort of weirdo.”

Joan did have a question for her father. It concerned that brief, charmed span of eight months directly after her birth, the only period of her life that she ever had been, or ever would be, fully intact.

“What.” she asked. “was my name?”

Joan’s decision to undergo a sex change was immediate. She changed her name to John and demanded male-hormone treatments and surgery to complete her metamorphosis back from girl to boy. That fall, he had his breasts surgically excised; the following summer, a rudimentary penis was constructed. The operation was completed one month prior to his 16th birthday.

Socially, John says, it proved relatively easy to effect the change to his true status. Joan’s lifelong social rejection had guaranteed that no one had ever gotten close enough to her to remark on her sudden vanishing. Still, John did take the precaution of lying low for several months in his parents’ basement. “Watching TV, that’s all I did,” says John. “I wasn’t really happy; I wasn’t really sad.” But gradually he began to emerge, hanging out at the local fast-food joints, the roller rink and bars with Kevin and his friends, who immediately accepted him as one of the guys.

It was in John’s relations to girls that complications developed – and they were only exacerbated by the fact that by age 18 he was not merely a passably attractive young man but an arrestingly handsome one. His sudden popularity with what was now the opposite sex introduced a terrible dilemma, because he knew that his penis neither resembled nor performed like the real thing (it was incapable of becoming erect). “How do you even start dating?” John says, recalling this period of his life. “You can’t. You’re in such an embarrassing situation. At the same time, if you’re not honest with them . . . they’re gonna want to start getting frisky with you.”