Medicine: Change of Sex

“Good! It is good! A woman? Bah. . . . She is nothing. A man? Hah. … He is everything. There is not anything in the world that is not open to him.” So said comely, blue-eyed Zdenek Koubek last week, through an interpreter, as he sat cross-legged on the deck of the lie de France.Because of his curious medical history, he was journeying to Manhattan to appear in a cabaret. Born in Bohemia 23 years ago, the child was pronounced a girl, christened Zdenka Koubkova. She grew up as a sturdy, sport-loving maiden. She set Czechoslovak women’s records in the broad jump, high jump, a half-dozen sprint and middle-distance runs; a women’s world record for the 800-metre run in 1934. Few months ago she asked her provincial government to change her on the records from female to male. An operation was performed and onetime Zdenka Koubkova was pronounced a man. Although he still crosses his legs and shows his ankle like a woman, Zdenek Koubek has sturdy shoulders, big biceps, shaves. He is one of the two cases which worry-ridden Avery Brundage, chaperon of the U. S. Olympic athletes in Berlin, had in mind when he demanded examination for sex ambiguities in all women competitors (TIME, Aug. 10).

Mr. Brundage’s other case was Mark Weston. Mary Edith Louise Weston was born in England 30 years ago. Among Englishwomen she was the best shotputter from 1924 to 1930, the best javelin thrower in 1927. Miss Weston had a close friend, named Alberta Bray. Two months ago Dr. L. R. Broster of London’s Charing Cross Hospital performed two operations to complete Mary Weston’s metamorphosis into masculinity. Said Dr. Broster: “Mr. Mark Weston, who was always brought up as a female, is male, and should continue life as such.” As to whether Mark Weston could have sexual intercourse or achieve paternity, Dr. Broster did not publicly hazard a guess. Last week in Plymouth, Mr. Mark Weston revealed that he had married Miss Alberta Bray week before.

Such cases of “sex change” fascinate not only tabloid editors but also serious students of the tremendous complexity and almost infinite variations of human hermaphroditism. To sober medical men, it does not seem strange that Nature some times blurs sexual development in men & women. Biologists say there is no such thing as absolute sex. Anatomists recognized a consistent parallelism between the genital structures of male & female. Recent research on such female sex hormones as theelin reveals that the corresponding male hormones are chemically almost identical. Normal men generate traces of female hormones, and vice versa. Thus, being male or female is not a matter of one element completely excluding the other, but rather of one ele ment dominating the other. If the domi nance is too weak to prevent confusion, the individual is a hermaphrodite.

In true hermaphrodites, which are very rare, there are glands of both sexes, either ovaries and testicles or a mixed gland called an ovario-testis. In a case which came to the attention of William Blair-Bell of England, a girl of 17 began to develop masculine characteristics. Examination disclosed an ovary on one side, an ovario-testis on the other. Eight months after the mixed gland was removed, the girl resumed her feminine appearance almost entirely.

Pseudo-hermaphrodites are much more frequent than true ones. In them the glands are of a sex opposite from the person’s general character and configuration. The genitalia may be a confusion of imperfect male & female parts. These defects may sometimes be remedied by surgeons to bring the pseudohermaphrodite into line with its glandular sex. In no case on record, though, has the patient subsequently succeeded in producing a child. In glandular males, undescended testicles are brought from the abdomen into the scrotum. If a phallus exists, bound down by adhesions or imbedded in flesh, delicate plastic work may free it sufficiently for male sex activity. That was the procedure in the case of Czechoslovakia’s Zdenka Koubkova.

In female (ovarian) pseudo-hermaphrodites, after removal of the male-like appendages, the usual problem is to correct the vagina if it is rudimentary, or to create one if it is missing. The late Dr. L. Grant Baldwin of Columbus, Ohio, solved this difficult problem by cutting a channel into the pelvis, lining it with a narrow U-shaped loop of the patient’s own intestine. After some time the inner loop of the U was removed, leaving the outer wall to form a mucous membranal tract resembling the normal vagina.

It sometimes happens in the case of a person brought up as a girl who turns out to be equipped with testes, that the physician deems it best for psychological reasons that she continue life as a female despite her male glands. A case history reported by Dr. Emil Novak, Johns Hopkins gynecologist: A college girl of 19, considered normal in childhood, had grown tall (6 ft. i in.), angular, flat-chested, hairy, deep-voiced. Examination revealed no womb, a rudimentary vagina, an overdeveloped clitoris, male gonads. Dr. Novak saw at once that it was impossible to adapt the clitoris for male activity. Moreover, the patient had a strong, deep-rooted feminine psychology to upset which he thought would be disastrous. Therefore he removed the testes and the clitoris, tried to restore female features by administrations of female hormone. This medication was partly successful.

When a child’s sex is ambiguous at birth, it is almost always thought to be a female, sometimes rightly, sometimes wrongly. A wrong guess is usually the basis of “sex changes” which make headlines. At puberty the increased production of male hormones from the glands causes the alarming “change.” Then the girl changes clothes and assumes the sex which, glandularly speaking, he actually had from the beginning. It sometimes happens, however, that a normal girl suddenly begins to acquire virile features. Medical men are convinced that this is due to tumorous growths which take root on the normal sex glands, rouse to activity the dormant, vestigial male cells. When the growths are extirpated, the girl usually reverts to femininity.

In a Baltimore jail recently was discovered a person with both male and female genitalia fairly well developed. That the prisoner had indulged in sex practices as both man and woman was apparent from the fact that it had two separate venereal diseases, one in the male apparatus, one in the female. Nevertheless, although true hermaphrodites harbor both ovarian and testicular tissue, none has been recorded who produced both ova and spermatozoa. Doctors scout the story from Canada of a woman who bore children, changed to a man, fathered more children.