Dear Professor Brook...

5th December 1998

Professor C. Brook
Institute of Child Health
Hospital for Sick Children
Great Ormond Street
London WC1

Dear Professor Brook,

In the reporting of the case of Joella Farmer you have been widely quoted as saying of her “it had not been explained properly to the relevant authorities and so they got it muddled up with transsexuals and all that rubbish”. Having suffered from the mis-quoting of the press, both tabloid and serious, I am quite happy to believe that this is nothing like what you actually said, and if that is the case I would be delighted to assist in disseminating any correction or retraction which you have issued.

However if you were accurately reported, I do feel that it is unfortunate that you dismiss transsexualism as “rubbish”, especially when the condition is, if analysed generically, very similar to that suffered by Joella.

There is now no significant divergence of opinion that transsexualism is a medical condition or syndrome. It has been included in the last several editions of the International Classification of Diseases-10 (ICD-10) and the American equivalent, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). There is also now good evidence for a causation of the condition, see Zhou, Hofman, Gooren and Swaab in the article in Nature (Vol 378, 2 November 1995 @ p. 68).

The extent of the physical divergence from the norm was undoubtedly more in Joella’s case, and certainly requiring of immediate care, whereas the male to female (MtF) transsexual’s problems will not start to emerge until gender becomes apparent five to ten years after birth. However the MtF has just the same XY chromosomes as Joella — from the newspaper reports it did not appear that she was one of the true intersexed.

Further, transsexualism is not curable, as such. The methods which have been tried, and duly failed, include psycho-analysis and therapy, massive doses of male hormones, aversion therapy and even ECT. As there is no cure, treatment, with hormones and surgery, is the only alternative.

And yet despite this evidence you dismiss the condition, the 1 in 10,000 who suffer from it, as well as the dedicated professionals who help them as “that rubbish”. At a time when there is a welcome move in the public mind to more tolerance and acceptance, this is not helpful. To cite just two, very different, examples there is someone at the top of your own profession, Sarah Muirhead Allwood, an orthopaedic surgeon, who is successfully continuing her career following transition. There is also the representation of “Haley” on Coronation Street, who although introduced for a short period had become established as one of the most popular characters.

Against this background I would venture to suggest a criticism of your own actions in relation to Joella. Without criticising the fact of her immediate surgical treatment, I would question the decision which was made to raise her as a girl at a time when there was no overt indication on her part as to her gender. This was surely against what is now the received wisdom and preferred practice in such matters, as evidenced by an article such as “Sex Reassignment at Birth: A Long Term Review and Clinical Implications” by Milton Diamond, Ph.D. and H. Keith Sigmundson, M.D. from the Archives of Pediatric & Adolescent Medicine, March 1997 (vol. 151. pp.298-304). To quote from the conclusions:

“We believe that any 46-chromosome, XY individual born with a normal nervous system, in keeping with the psychosexual bias thus prenataly imposed, should be raised up as a male. Surgery to repair any genital problem, while difficult, should be conducted in keeping with this paradigm. This decision is not simple and analysis should continue.

As parents will still want their children to be and look normal as soon after birth as possible, physicians will have to provide the best advice and care, consistent with present knowledge. We suggest this means referring the parents and child to appropriate and periodic long term counselling rather than immediate surgery and sex reassignment just because that seems a simpler immediate solution to a complicated problem.”

So far as appears Joella is a “46-chromosome, XY individual born with a normal nervous system”. At present, she seems to be entirely happy to be a girl. One can only hope that this state continues as she develops further.

I look forward to hearing from you with any comment which you may have. Perhaps for the sake of good order I ought to declare an interest, insofar as I am also one of those you have condemned as rubbish, a partner in a firm of solicitors in central London, having been living and working as a woman for 18 months, after suffering 35 years of angst and unhappiness whilst I came to terms with my condition, prior to seeking treatment.

Yours sincerely
Claire Bowden-Dan

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