Tn 1958, a young woman named Agnes appeared at the Department of Psy-
chiatry of the University of California, Los Angeles, seeking plastic surgery
..... to remedy an apparent endocrine abnormality.l At the time, a group at the
medical center was involved in a study of intersexed patients.2 By all accounts,
Agnes was a "feminine" woman with predictably female secondary sex char-
acteristics: developed breasts, wide hips and small waist, long hair, smooth
skin.3 Nevertheless, rather than a vagina, labia, and
she had a fully
developed penis and atrophic scrotum. She had no female internal organs; a
laparotomy demonstrated "the presence of all male anatomic structures:'" She
had been brought up as a boy but insisted that she had always felt female. Dur-
ing puberty, she claimed, her female secondary sex characteristics developed
Clearly disturbed by this "natural mistake," Agnes sought corrective plastic
surgery. The
researchers, including psychoanalyst Robert Stoller, sociolo-
gist Harold Garfinkel, and psychologist Alexander Rosen, worked with Agnes
to determine the cause of her abnormality and to investigate its effects upon
her gender role and personal management skills.5 The medical team found no
phYSiological reason for the genital aberration but hypothesized that Agnes
suffered from "testicular feminization syndrome, that is, extreme feminization
of the male body (breasts, no body and facial hair, feminine skin and subcuta-
neous fat distribution) due to cestrogens produced by the testes."6 This diag-
nosis seemed to be confirmed after surgical removal of the penis and testes:
Agnes experienced menopausal symptoms postoperatively? The specific cause
of her feminization remained in doubt, however, since the evidence was cir-
cumstantial: only signs of the effects of testicular feminization syndrome were
present, and the supposed originating condition was read back from them.
There was no absolute evidence that Agnes's testes were producing estrogen.
After the surgery, Agnes was given estrogen replacement therapy, since the
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