During our visit to Le Musée des Moulages at l’Hôpital Saint-Louis, we got to see casts of everything from syphilis to eczema, bone tumors to blood cancer. The accuracy of each condition was a little eerie, but it was also really cool to see the attention to detail. The casts were developed to teach dermatology students about the varying diseases that plagued the French people in the 19th century. Though that was neat to see, the categorization of some conditions would be considered incorrect by today’s standards. One ‘mistake’ that caught my eye was the ‘hermaphrodite’ cast. The figure 1 caption below describes what doctors in 1883 thought of the condition, but it strikes some discord with newer findings.
Firstly, ‘hermaphrodite’ is the wrong term for incomplete sexual differentiation of reproductive organs because it insinuates that the patient can reproduce with themselves. In my Behavioral Neuroendocrinology of Sex class, the terms we used to describe genitalia that differs from the usual binary were ‘masculinized’ and ‘feminized.’ The reason I mention this is because physical abnormalities in genitalia are largely governed by variations in hormone presence. Again, I would not expect doctors of the 19th century to know that hormones can affect genital development – I will explain why. It wasn’t until 1959 that a group of behavioral neuroendocrinologists discovered that the administration of androgens in prenatal female guinea pigs had an organizational effect on ‘tissues mediating mating behavior’ (Phoenix, et al. 1959). What the authors were saying (indirectly) was that androgens change the organization of the brain and therefore effected the behavioral patterns of the animal. They were able to induce male mating behaviors in biological females simply by exposing them to androgens during gestation(!). At the time that the study was published, biological sex and their associated behaviors were believed to be unmalleable, so Phoenix, et al. (1959) were careful not to make grandiose, albeit true, claims about their findings.
So how does this relate to a cast of hermaphroditism? Well, the discovery that hormones can change brain organization as well as behavioral activation was ground breaking and didn’t happen until the 20th century. Out of this research came the widely accepted ‘organizational hypothesis’ that is applicable in a lot of brain development research today. This knowledge may have encouraged French doctors to take a closer look at the patients’ behavior with ‘hermaphroditism’ to see if it aligned with their gender identity, as opposed to solely relying on genital presentation for classification.
Figure 1. “Masculine hermaphroditism. Man of 29 years, whose sex has been unknown since birth. Penis partially developed. Hypospadias urethra; the two halves of the scrotum divided, resembles a vulva, contains two recognizable testicles, irreducible. The pubis was covered in hair [1883].” This is the direct translation of the plaque. Note that the doctors relied heavily on the genitalia to determine the sex of the man, not behavior or identity.
Figure 2. Believe it or not, this is a group of genotypic males that have female presentations in all respects other than gonads. They have complete androgen insensitivity (CAIS) so, although they carry an XY genotype, they cannot respond to androgens to induce masculinization and therefore develop as female in gender and self-identity.
Works Cited
Phoenix, C. H., Goy, R. W., Gerall, A. A., & Young, W. C. (1959). ORGANIZING ACTION OF PRENATALLY ADMINISTERED TESTOSTERONE PROPIONATE ON THE TISSUES MEDIATING MATING BEHAVIOR IN THE FEMALE GUINEA PIG. Endocrinology, 65(3), 369–382. https://doi.org/10.1210/endo-65-3-369