The Doctor, II   By Melissa Tawn   Identical twins raised apart, both of whom turn out to be transsexual -- what can this mean?

Let me introduce myself first. I am Dr. Catherine Gold. I am a psychologist, specializing in problems of gender dysphoria. I work at the clinic of Dr. Jayne Mautner, the famous surgeon working in the field of sexual reassignment surgery and the associated plastic surgery. I have a Ph.D. from Columbia University and have done postdoctoral work both at the University of Toronto and the University of Heidelberg in Germany. I am a member of the American Psychological Association, the International Association of Gender Researchers, and Federation of American Behavioral Scientists. I have published over 30 papers in leading peer-reviewed scientific journals and have presented a dozen talks at international scientific conferences, as well as participating in several panels at such conferences and, indeed, chairing two of them. It would not be immodest of me to say that I have an international reputation as an expert in the field.

The reason I felt it necessary to trot out all of my scientific credentials is that I am about to relate a story which, had it come from a less reputable source, would certainly be dismissed as impossible. I hope, though, that you will believe that I am a trained and sincere professional and be willing to take this seriously.

Before I begin my story, I need to say a few words — in layman’s language -- about identical twins or, more importantly, about the role of identical twins in psychology. When we are confronted with a behavioral trait, say a fear of heights or mathematical genius, we do not know if it is a result of the person’s genetic makeup or a consequence of the environment in which that person was raised. However, if we have a pair of identical twins, raised apart in different environments, both exhibiting the same trait, the probability that the trait is genetic is certainly much greater. Therefore, psychologists have always seen the existence of such pairs of twins as a godsend on which to test their theories. The first person to emphasize the importance of studying twins was the 19th-century behavioral genetics pioneer, Sir Francis Galton. The most famous, or infamous if you wish, example of the use of twins was in the work of the British educational psychologist Cyril Burt, who exhibited data which supposedly came from 53 pairs of identical twins raised apart, to support his hereditarian theories of intelligence. Unfortunately, after Burt’s death, his data was questioned and it is now generally assumed to have been, at least partially, fraudulent. Another, more reputable, twins researcher is Thomas J. Bouchard, whose work you can surely look up if you are interested.

I should also say a few words about Dr. Mautner, in whose clinic I work. Dr. Mautner is a plastic surgeon extraordinaire, but, more importantly, is a firm believer that the Latin saying “Mens sana in corpore sano” (A healthy mind in a healthy body) implies that there must also be harmony between mind and body in order to have health. When a person suffers from gender dysphoria, an irreconcilable difference between their perceived gender and the gender implied by their physical sex organs, one can achieve such harmony only after comprehensive psychological counseling along with the appropriate surgery. This realization has come not only from many years of practice in the field, but also from personal experience, since she, herself, began her life as a male. The key to her theory is that while the physical makeup of sexual organs is, of course, a matter of genetics, gender identity is not. This is the commonly-accepted explanation. The more religious practitioners talk about it as a classical example of the body/soul dichotomy. The more philosophical tend to talk in terms of the mind/body problem, and emphasize the dualistic theories going back to Plato, as opposed to the monism of Parmenides.

Nobody has ever tested this theory on identical twins, since there has been no known case of such twins, one of whom had gender dysphoria. (One should note, in passing, that there have been several published studies of identical twins, one of whom was homosexual and the other wasn’t, but they are not considered relevant to gender dysphoria.) That is, no case was known until Ellen Caine (born Alan) walked into my office.

Ellen was a shy young lady, in her late twenties, pretty though not beautiful, a graphic artist by profession. She had been undergoing gender counseling for several years in Chicago and had been living full-time as a woman for the past three years. She had now saved enough money to be able to afford the rather stiff fees of Dr. Mautner’s clinic and so came to us, with the appropriate reference letters from her counselors, for sexual reassignment surgery. I conducted the preliminary interview and, as I leafed through her folder, I noticed that she had one sibling. I asked her about it, and she said that she had an identical twin, from whom she had been separated as a very young child and only recently made renewed contact. The story was a sad one. Ellen’s parents had come from Estonia, and had entered the United States with tourist visas, staying on illegally and under a false name. They could be deported, were they were ever found out. Her father earned an honorable but meager living as a delivery-truck driver, and they settled down as best they could. Ellen and her twin were born in the US. Tragedy stuck when the babies were less than two years old — both parents were killed in a traffic accident. Since they had no relatives in the US, and indeed nobody knew who their relatives in Estonia were, the Cook County welfare department put the babies up for adoption. However, few people are willing to adopt a pair of twins, and so there was no choice but to separate them. Ellen (then Alan) was adopted by the family of an insurance salesman from Skokie, while Ellen’s brother Marshall was adopted by the family of a teacher in Evanston. It was agreed by both sets of parents that, when the children came of age, the authorities would notify them of their sibling’s existence, but would provide contact information only on the condition both of them agreed to it.

The rest of Ellen’s story followed the usual path of transsexuals. At an early age, she realized that, “internally”, she was really female and maintained that belief despite the usual family and social pressures to conform to the male stereotype. Her adopted parents never really understood her, but, on the other hand, somehow felt that this “perversion” was inherited from her biological parents and so felt less guilt than is usually the case with the parents of transsexuals. Ellen, who loved her parents and did not want to cause them grief, remained pretty much a closet cross dresser (or at least a housebound one — her parents did know about it and she wore dresses around the house, when nobody could see her) and never tried to go beyond that until she moved into her own apartment. After finishing an graphic arts course at the Chicago Art Institute, and obtaining her own independent living, she felt freer to dress in public and even at work (her employers, one of whom was a very overt lesbian, prided themselves as being “open”). She then decided to embark on the road to full transition.

Until then, she had been reluctant to contact her twin, but upon starting her transition, she suddenly felt a distinct need to do so, and so contacted the social services authorities. As it turned out, her twin had also written them with a similar request a few weeks earlier, and so the contact information was sent to both of them. Hesitantly, Ellen phoned the number given her and asked for Marshall. The person on the other end of the line responded with a giggle — “That must be you, Alan. Let me shock you: I am not Marshall any more, I am in the process of turning myself into the girl I always knew myself to be. My name is now Marsha.” “And mine is now Ellen", she replied, "we MUST get together, sister, as soon as possible.”

They agreed to meet the next day in Millennium Park. There was no question of recognizing each other — identical they were born and identical they remained. Though their taste in makeup and clothes was a bit different, as were their hair styles, they knew each other immediately and ran into each other’s arms. Then they talked and talked and talked. Marsha had a bit harder life than Ellen. Her adoptive parents were less tolerant than Ellen’s, and actively tried to force her to be more masculine. She ended up running away from home after she graduated from high school and, since then, had been living in a rented room on the South Side and supporting herself as a rather low-paid waitress. Nonetheless, she had managed to start her transition as well, and was looking forward to being able to have SRS, though she realized that it would take a miracle to be able to afford it.

Ellen invited Marsha to come live with her, and she of course had accepted. They now wore the same hairstyles and shared clothes, just as if they had grown up together as the closest of twin girls.

At this point, I asked Ellen why Marsha had not come with her, and she told me that they had one crisis. Ellen had been saving up money for SRS ever since she had been a teenager, and now barely had enough for herself. Marsha had no savings at all. However, she absolutely insisted that Ellen go ahead with her own plans as soon as possible. “My time will come, sister, don’t worry” she assured her. At this point, our hour came to an end and so I told Ellen that we would have to continue tomorrow. When she left, and before my next client came in, I phoned Dr. Mautner’s secretary and told her that I must see Dr. Mautner urgently and privately, that afternoon, before the scheduled staff conference.

When Ellen returned the next day, I was very glad to be able to tell her that I had a solution to Marsha’s problem, and hers, if both of them were willing. First of all, I explained the role of identical twins in psychological research and the fact that no identical twins with gender dysphoria had ever been studied. I then offered her and her sister a deal, with Dr. Mautner’s consent: if both of them would agree to undergo a series of psychological tests, and allow us to publish the results (without identifying them, of course) for scientific research purposes, then the entire treatment for both of them, including SRS and any other cosmetic surgery, would be provided pro bono — that is, at no charge to either of them. Ellen was overwhelmed, and of course agreed. She immediately contacted Marsha on her cell phone and, of course, Marsha also agreed. We arranged for Marsha to fly out to the clinic as soon as possible and for both of the sisters to stay in a rented apartment near us. In the meantime, the clinic’s lawyers would draw up the necessary paperwork.

After a week, everything was sorted out, and we were ready. For part of the day, the twins were with Dr. Mautner and her staff, who checked them physiologically and prepared them for their operations. For the rest, they were with me. I began by administering a standard battery of tests, beginning with the standard Minnesota Multiphasic Personality Inventory (MMPI) and continuing through a series of more specialized tests, some of which of my own invention. We performed certain brain scans, since one of the etiological theories of gender dysphoria puts the “blame” for it on insufficient or inappropriate androgenization of the brain at a critical stage of embryonic development and we wanted to see if signs of that could be detected in our twins. We also checked the 5-Alpha Reductase level in each of the twins, since another theory of gender dysphoria is based on 5-Alpha Reductase deficiency. Unfortunately, we had neither the facilities nor the budget to perform a complete DNA check.

The physiological tests revealed no significant differences, but then I really didn’t expect any. The psychological tests revealed slight variations — the girls had been brought up differently after all — but nothing significant other than what could be attributed to their upbringing. Again, I didn’t really expect that there would be much here. I must admit that I am not sure what I was looking for. How does one figure out why people identical genetically also have identical souls, or at least souls having identical aspects?

Jews believe that the soul does not enter the embryo immediately, but only after a certain lapse of time (the common time span given is 40 days). Christians, however, are split on the matter. Some say that the soul enters immediately at the time of conception, others say, following Saint Thomas Aquinas , it does later. If the first case is assumed, then it would indeed be expected that identical twins would have identical gender identities, since the soul would have entered the zygote before it split. If the second case is assumed, then that would not be so. Even among Catholics, however, there is no established dogma on the subject.

Psychologists will admit that identical twins are “soul mates”, they often seem to know what the other is thinking, and even, according to some researchers, exhibit certain telepathic tendencies among themselves, and can communicate with each other over distances. There have been several published stories of one twin knowing of an incident which occurred to the other, even at a great distance. Many identical twins claim to have a psychic bond of one sort or another. Ellen and Marsha were extensively questioned on the subject, but neither of them could recall feeling any such bond. If they had been in any way connected telepathically, it was not at a conscious level. If they influenced each other’s lives before finally meeting, they were not aware of the fact.

Meanwhile, Ellen and Marsha had both completed their surgery. Dr. Mautner had done her usual wonderful job in creating two charming ladies, still physically identical, down to the last intimate detail. But I was getting nowhere.

Does the existence of identical twins, both of whom suffer from gender dysphoria, necessarily mean that gender dysphoria is a genetic phenomenon? One could of course argue that there are other influences on fetuses in the womb, having to do with the mother’s diet and perhaps drugs which she took. Also, most psychologists would acknowledge that a fetus can “learn” while still in the womb. Such influences would affect both twins in the same way, and hence would result in the same conclusion. However, the same would be true for fraternal twins as well, and we do know of several examples of fraternal twins, one of which is transsexual and the other is not.

I was ready to concede. Against all of my professional experience, and all of my personal feelings, it seemed that there had to be a genetic aspect to transsexuality. That was the gist of the preliminary report I prepared for Dr. Mautner. A day after I submitted it, she suggested that we have dinner together at one of her favorite restaurants, and talk about my findings. When I met her there, I was still very depressed. Surprisingly, she was in an extremely good mood.

“Do you really feel that one case is sufficient to undermine twenty years of experience and research?” she asked. “There is no choice”, I replied. “That is how science works. A theory has to cover all instances of data, and even one counterexample is enough to topple it.” “But do we have a counterexample, here?” she asked. “Yes, we do” I replied. "Have you checked all of the variables?" she queried. "Are you sure that they are really identical twins, as they claim to be?" "Do you doubt it?" I asked.

“Long before my transition,” Dr. Mautner said thoughtfully, “when I was still a boy, I was addicted to practical jokes, and would sometimes go to great lengths preparing them. As I grew up, and certainly after I transitioned, I gave it all up. I am afraid, however, that the urge to pull off a really big one never completely died, it just hid in the background. So, six months ago, when two second cousins came to me about SRS, I just couldn’t help myself. They looked very much alike, and it took only a few nips and tucks to make them look absolutely identical. I then sent one of them to you, with a story we concocted …”

I gasped.

"Lately, you have been getting too involved with abstract scientific theory," she explained, "and have stopped trusting your experience and intuition -- something which is fatal for a practitioner. You needed a good wakeup call. Besides," she smiled, “you must have played similar tricks too, back when you were a boy.”