GIDjapan.org

「思春期ブロッカー」についての真実

The FDA hasn’t approved them for gender dysphoria, and their effects are serious and permanent.

FDAは性別違和に対してそれらを承認しておらず、その影響は深刻かつ永続的です。

The fashion for transgenderism has brought with it a new euphemism: “gender-affirming care,” which means surgical and pharmacological interventions designed to make the body look and feel more like that of the opposite sex. Gender-affirming care for children involves the use of “puberty blockers”: one of five powerful synthetic drugs that block the natural production of sex hormones.

The Food and Drug Administration has approved those medications to treat prostate cancer, endometriosis, certain types of infertility and a rare childhood disease caused by a genetic mutation. But it has never approved them for gender dysphoria, the clinical term for the belief that one’s body is the wrong sex.

トランスジェンダー主義の流行は、「性別肯定的ケア」という新たな婉曲表現をもたらしました。これは、身体の見た目や感触を異性のものに近づけるために設計された外科的および薬理学的介入を意味します。 子どもの性別を肯定するケアには、「思春期ブロッカー」の使用が含まれます。これは、性ホルモンの自然な生成をブロックする 5 つの強力な合成薬物のうちの 1 つです。
食品医薬品局は、前立腺がん、子宮内膜症、ある種の不妊症、遺伝子変異によって引き起こされる稀な小児疾患の治療にこれらの医薬品を承認した。 しかし、性同一性障害（自分の身体が間違った性別であるという信念を指す臨床用語）を認めることは一度もなかった。

Thus the drugs, led by AbbVie’s Lupron, are prescribed to minors “off label.” (They are also used off-label for chemical castration of repeat sex offenders.) Off-label dispensing is legal; some half of all prescriptions in the U.S. are for off-label uses. But off-label use circumvents the FDA’s authority to examine drug safety and efficacy, especially when the patients are children. Some U.S. states have eliminated the need for parental consent for teens as young as 15 to start puberty blockers.

Proponents of puberty blockers contend there is little downside. The Department of Health and Human Services claims puberty blockers are “reversible.” It omits the evidence that “by impeding the usual process of sexual orientation and gender identity development,” these drugs “effectively ‘lock in’ children and young people to a treatment pathway,” according to a report by Britain’s National Health Service, which cites studies finding that 96% to 98% of minors prescribed puberty blockers proceed to cross-sex hormones.

したがって、アッヴィのリュープリンが主導するこれらの薬は未成年者に「適応外」で処方されている。 （それらは、常習性犯罪者の化学的去勢にも適応外で使用されます。）適応外の調剤は合法です。 米国のすべての処方箋の約半分は適応外使用のためのものです。 しかし、適応外使用は、特に患者が小児の場合、医薬品の安全性と有効性を調査するFDAの権限を回避することになる。 米国の一部の州では、15歳の十代の若者が思春期ブロッカーを開始する際に親の同意を必要としなくなった。
思春期ブロッカーの支持者らは、マイナス面はほとんどないと主張する。 保健福祉省は、思春期ブロッカーは「回復可能」であると主張しています。 英国国民保健サービスの報告書によると、これらの薬は「性的指向と性同一性の発達の通常のプロセスを妨げることにより」「子供や若者を治療経路に効果的に『閉じ込める』」という証拠を省略している。 研究によると、思春期ブロッカーを処方された未成年者の96%から98%が、性を超えたホルモン剤を使用するようになっています。

Gender advocates also falsely contend that puberty blockers for children and teens have been “used safely since the late 1980s,” as a recent Scientific American article put it. That ignores substantial evidence of harmful long-term side effects.

The Center for Investigative Reporting revealed in 2017 that the FDA had received more than 10,000 adverse event reports from women who were given Lupron off-label as children to help them grow taller. They reported thinning and brittle bones, teeth that shed enamel or cracked, degenerative spinal disks, painful joints, radical mood swings, seizures, migraines and suicidal thoughts. Some developed fibromyalgia. There were reports of fertility problems and cognitive issues.

The FDA in 2016 ordered AbbVie to add a warning that children on Lupron might develop new or intensified psychiatric problems. Transgender children are at least three times as likely as the general population to have anxiety, depression and neurodevelopmental disorders. Last year, the FDA added another warning for children about the risk of brain swelling and vision loss.

The lack of research demonstrating that benefits outweigh the risks has resulted in some noteworthy pushback in the U.S. and abroad. Republican legislatures in a dozen states have curtailed or banned gender-affirming care for minors. Finland, citing concerns about side effects, in 2020 cut back puberty blockers and cross-sex hormones to minors. Sweden followed suit in 2022 and Norway this year. Britain’s National Health Service shuttered the country’s largest youth gender clinic after 35 clinicians resigned over three years, complaining they were pressured to overdiagnose gay, mentally ill, and autistic teens and prescribe medications that made their conditions worse.

Still, the U.S. and most European countries embrace a standard of care that pushes youngsters toward “gender-affirming” treatments. It circumvents “watchful waiting” and talk therapy and diagnoses many children as gender dysphoric when they may simply be going through a phase.

最近のサイエンティフィック・アメリカンの記事にあるように、ジェンダー擁護者らはまた、子供や十代の若者向けの思春期阻止薬は「1980年代後半から安全に使用されてきた」と誤って主張している。 これは、有害な長期副作用の実質的な証拠を無視しています。
調査報告センターは2017年、身長を伸ばす目的で小児期に適応外のリュープリンを投与された女性からFDAが1万件以上の有害事象報告を受け取ったと明らかにした。 彼らは、骨が薄くなりもろくなる、エナメル質が剥がれたりひび割れたりする歯、椎間板変性、関節の痛み、激しい気分の変動、発作、偏頭痛、自殺願望などを報告した。 線維筋痛症を発症した人もいました。 不妊の問題や認知の問題が報告されています。
FDAは2016年にアッヴィに対し、リュープリンを服用している子供は新たな精神疾患や精神疾患の悪化を引き起こす可能性があるという警告を追加するよう命じた。 トランスジェンダーの子供たちは、不安症、うつ病、神経発達障害を患う可能性が一般人口の少なくとも 3 倍です。 FDAは昨年、脳の腫れと視力喪失のリスクについて、子供たちに対する新たな警告を追加した。
利益がリスクを上回ることを証明する研究が不足しているため、米国内および海外で注目に値する反発が生じています。 十数の州の共和党議会は、未成年者に対する性別を肯定するケアを縮小または禁止している。 フィンランドは副作用への懸念を理由に、2020年に未成年者への思春期阻害薬と異性間ホルモンの投与を削減した。 スウェーデンも2022年に、ノルウェーも今年に続いた。 英国の国民保健サービスは、3年間で35人の臨床医が同性愛者、精神障害者、自閉症の十代の若者たちを過剰診断し、症状を悪化させる薬を処方するよう圧力をかけられているとして辞職したことを受け、同国最大の若者向けジェンダークリニックを閉鎖した。
それでも、米国とヨーロッパのほとんどの国は、若者に「性別を肯定する」治療を促す標準治療を採用しています。 これは、「注意して待つ」ことやトークセラピーを回避し、多くの子供たちが単に段階を通過している可能性があるときに性別違和であると診断します。

Gender-affirming care for children is undoubtedly a flashpoint in America’s culture wars. It is also a human experiment on children and teens, the most vulnerable patients. Ignoring the long-term dangers posed by unrestricted off-label dispensing of powerful puberty blockers and cross-sex hormones, combined with the large overdiagnosis of minors as gender dysphoric, borders on child abuse.

Mr. Posner is author of “Pharma: Greed, Lies and the Poisoning of America.”

ジェンダーを肯定する子どもたちのケアが、アメリカの文化戦争の火種であることは間違いありません。 これは、最も脆弱な患者である子供や十代の若者たちに対する人体実験でもある。 強力な思春期ブロッカーや異性間ホルモン剤の無制限の適応外投与と、性別違和としての未成年者の大規模な過剰診断がもたらす長期的な危険性を無視することは、児童虐待につながる。
ポズナー氏は『Pharma: Greed, Lies and the Poisoning of America』の著者です。

Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth

Abstract

BACKGROUND

Cloacal exstrophy is a rare, complex defect of the entire pelvis and its contents that occurs during embryogenesis and is associated with severe phallic inadequacy or phallic absence in genetic males. For about 25 years, neonatal assignment to female sex has been advocated for affected males to overcome the issue of phallic inadequacy, but data on outcome remain sparse.

バックグラウンド

総排出腔外体症は、胚発生中に発生する骨盤全体とその内容物のまれな複雑な欠損であり、遺伝的男性における重度の男根機能不全または男根欠損と関連しています。 約25年間、男根機能不全の問題を克服するために、新生児の性別を女性に割り当てることが、男性器欠乏の問題を克服するために提唱されてきたが、結果に関するデータはまだ少ない。

METHODS

We assessed all 16 genetic males in our cloacal-exstrophy clinic at the ages of 5 to 16 years. Fourteen underwent neonatal assignment to female sex socially, legally, and surgically; the parents of the remaining two refused to do so. Detailed questionnaires extensively evaluated the development of sexual role and identity, as defined by the subjects’ persistent declarations of their sex.

方法

私たちは、総排出腔外体症クリニックの5歳から16歳の遺伝的男性16人全員を評価しました。 14人は新生児期に社会的、法的、外科的に女性の性別への割り当てを受けた。 残りの2人の両親はそうすることを拒否した。 詳細なアンケートは、被験者の持続的な性別の宣言によって定義される性的役割とアイデンティティの発達を広範囲に評価しました。

RESULTS

Eight of the 14 subjects assigned to female sex declared themselves male during the course of this study, whereas the 2 raised as males remained male. Subjects could be grouped according to their stated sexual identity. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. Follow-up ranged from 34 to 98 months.

結果

女性の性別に割り当てられた被験者 14 人のうち 8 人は、この研究の過程で自分が男性であると宣言しましたが、男性として育てられた 2 人は男性のままでした。 対象者は、表明された性的アイデンティティに従ってグループ化できます。 5人の被験者は女性として生活していた。 3人は性的アイデンティティが不明瞭なまま暮らしていたが、3人のうち2人は自ら男性であると宣言していた。 そして8人は男性として生きており、そのうち6人は男性の性別に再割り当てされていた。 16人の被験者全員が、典型的な男性と考えられる中程度から顕著な興味や態度を持っていました。 追跡期間は34か月から98か月でした。

CONCLUSIONS

Routine neonatal assignment of genetic males to female sex because of severe phallic inadequacy can result in unpredictable sexual identification. Clinical interventions in such children should be reexamined in the light of these findings.

The concept of sexual identity in persons with genital malformations has intrigued the medical world since Money and colleagues’ pioneering studies of intersex in the 1950s.^1,2 They later reasoned that an infant’s sex could be assigned if corresponding genitalia were constructed during infancy and the child’s upbringing corresponded to that sex.³ This concept of sex assignment was especially important for clinicians who were caring for aphallic genetic males, in whom the construction of a functional penis was not feasible.^1,4-10

Androgens have long been thought to influence prenatal brain development as well as postpubertal activity, interests, and libido.^1,10-13 The ability of androgen to act on target tissues in utero could affect subsequent sexual identity. For example, genetic males with androgen resistance, who cannot respond to androgens, identify themselves as female after puberty, whereas genetic males with 5α-reductase deficiency often see themselves as male, irrespective of whether they were raised as males or females.^10,14 Genetic females exposed to prenatal androgen are reported to have variable sexual-role behaviors yet rarely develop a male identity.^12,15 However, follow-up data on sexual identity in children with surgically reassigned sex have been sparse.

Studies of genetic males with cloacal exstrophy may provide insight into the influence of androgen on sex. A devastating developmental defect in pelvic embryogenesis, with an incidence of 1 per 400,000 live births, cloacal exstrophy includes an omphalocele with short-gut syndrome; exstrophy of the bladder, in which a hindgut segment is interspersed with two bladder segments (the “cloaca”); a diminutive hindgut; intussuscepted ileum; wide pubic–symphyseal diastasis; and severe genital inadequacy or atresia. Treatment is medically and surgically demanding, and substantial improvements in critical care and surgery over the past four decades have led to the survival of children with cloacal exstrophy.^7,16 Neonatal surgical procedures have included separation of the hindgut from bladder components, reconstruction of the bladder, ileostomy, closure of abdominopelvic defects, and in genetic males, female-sex assignment socially, legally, and surgically, including orchiectomy and construction of vulvae. However, the testes are histologically normal,¹⁷ and the phallic atresia occurs despite the presence of normal prenatal androgen levels. Neonatal orchiectomy induces a hypogonadal endocrine disorder that precludes postnatal and pubertal androgen surges. The manner in which children with cloacal exstrophy have been treated provides unique opportunities to assess prenatal androgen influences on sexual development in genetic males with female-sex assignment and feminized genitalia in a uniform population of patients.

結論

男根の重度の欠陥により、新生児が遺伝的に男性を女性に割り当てることが日常的に行われると、予測できない性的同一化が生じる可能性があります。 このような小児に対する臨床介入は、これらの所見を踏まえて再検討されるべきである。

生殖器奇形のある人の性的アイデンティティの概念は、1950 年代にマネーとその同僚がインターセックスに関する先駆的な研究を行って以来、医学界の関心を集めてきました。1,2 その後、彼らは、対応する生殖器が乳児期に形成され、 子供の育成はその性別に対応していた。3 この性別割り当ての概念は、機能的な陰茎の構築が不可能な無性器の遺伝的男性を治療する臨床医にとって特に重要であった。1,4-10

アンドロゲンは、出生前の脳の発達だけでなく、思春期後の活動、興味、性欲にも影響を与えると長い間考えられてきました 1,10-13 。アンドロゲンが子宮内の標的組織に作用する能力は、その後の性的アイデンティティに影響を与える可能性があります。 たとえば、アンドロゲンに反応できないアンドロゲン耐性を持つ遺伝的男性は、思春期以降に自分を女性だと認識しますが、5α-リダクターゼ欠損症を持つ遺伝的男性は、男性として育てられたか女性として育てられたかに関係なく、自分を男性だと認識することがよくあります。10,14 出生前にアンドロゲンに曝露された遺伝的女性は、さまざまな性的役割行動を持つが、男性としてのアイデンティティを発現することはほとんどないと報告されている 12,15 。しかし、外科的に性別が再割り当てされた子供の性的アイデンティティに関する追跡データはまばらである。

総排出腔外体性を持つ遺伝的男性の研究は、セックスに対するアンドロゲンの影響についての洞察を提供する可能性があります。 骨盤胚形成における壊滅的な発達障害で、発生率は出生 40 万人に 1 人で、総排出腔外屈症には短腸症候群を伴う臍ヘルニアが含まれます。 膀胱の外拡張。後腸部分に 2 つの膀胱部分 (「総排泄腔」) が点在しています。 小さな後腸。 腸重積回腸。 広い恥骨結合離隔。 重度の生殖機能不全または閉鎖。 治療は医学的にも外科的にも要求が厳しく、過去 40 年間にわたる救命救急と手術の大幅な改善により、総排出腔外屈症の小児の生存がもたらされました。7,16 新生児の外科手術には、膀胱の構成要素から後腸を分離すること、膀胱の再建が含まれます。 膀胱、回腸瘻造設術、腹部骨盤欠損の閉鎖、および遺伝的男性の場合は、睾丸摘出術と外陰部の構築を含む、社会的、法的、外科的に女性の性別の割り当てが行われます。 しかし、精巣は組織学的には正常であり 17 、出生前アンドロゲンレベルが正常であるにもかかわらず男根閉鎖が発生します。 新生児の精巣摘出術は、生後および思春期のアンドロゲンの急増を妨げる性腺機能低下内分泌障害を誘発します。 総排出腔外体症の小児の治療方法は、均一な患者集団において、女性の性別割り当てと女性化された生殖器を持つ遺伝的男性の性的発達に対する出生前アンドロゲンの影響を評価するユニークな機会を提供します。

Methods

The families of all 16 genetic males in our cloacal-exstrophy clinic who were 5 to 16 years old between 1993 and 2000 agreed to participate. The age range was selected on the basis of the study methods used. Parents provided written informed consent, and subjects provided informed assent. The institutional review board at Johns Hopkins Hospital approved the protocol. Participants were informed that the study assessed psychosocial development in children with the epispadias–exstrophy complex. No subjects were given information about their clinical histories. The study was conducted from June 1, 1993, to August 3, 2001.

Parents had been educated in accordance with the concept that prevention of severe psychosexual dysfunction required reassignment of their genetic male infant to female sex in the neonatal period.^4,7,8 Fourteen subjects were assigned to female sex at birth: legally, socially, and surgically by means of orchiectomy and construction of vulvae by 2 weeks of age in 13 subjects and by 12 weeks of age in 1 subject. The testes were histologically normal in all 14 when examined after orchiectomy. Parents were instructed to avoid revealing information on their child’s sex to anyone at any time, especially to the subject, and were instructed that disclosure of such information might harm the subject’s psychosexual development. Two subjects were reared male because the parents refused to have them reassigned to female sex. Table 1 details associated anomalies and the current medical status of all 16 subjects. Follow-up from the time of the initial assessment in the study ranged from 34 to 98 months.

The assessment included six detailed questionnaires that evaluated the subjects’ psychosexual development and sexual identity retrospectively and currently. The actual questions overlapped extensively among the questionnaires and assessed multiple topics concerning sexual role, such as the subjects’ interest in toys, dolls, clothing, and infants; interest and time spent playing games and participating in various activities; athleticism; aggressive behaviors; career interests; sexual interests; sex of friends; and whether and to what degree the parents focused on expected behaviors for a daughter.

Questionnaires completed independently by the parents included Bates’ Child Behavior and Attitude Questionnaire and the Child Game Participation Questionnaire, each with masculinity and femininity subscores, validated according to the method of Meyer-Bahlburg et al.^18-21 Two questionnaires administered to the parents were semi-structured and probing in style and included the Gender-Role Assessment Schedule (parent version), validated according to the methods of Meyer-Bahlburg et al. and Lish et al.,^22-24 and a psychosexual-history questionnaire written by the first author, which was not validated but which provided further clarification of the parents’ and subjects’ responses to the study instruments. Questionnaires administered to subjects included Grellert’s structured Childhood Play Activities Questionnaire^22-25 and the psychosexual-history questionnaire. The Gender-Role Assessment Schedule and the psychosexual history evaluated, in addition to sexual role, the subjects’ sexual preference and stated sexual identity. Questionnaires included from 69 to 90 questions, largely according to the details a given questionnaire assessed. The marked overlap among the questionnaires plus the psychosexual history provided some internal validity for the assessment. Questions have shown good differentiation between male and female responses.

Initial assessment interviews took place over a period of one or two days, lasting about six hours for subjects and four hours for parents. Follow-up clinical information obtained at least yearly through telephone, e-mail, or personal interviews with parents focused on the subjects’ sexual identity and preference; children were generally not present when the follow-up telephone calls occurred. Although the follow-up questions were not systematic, in that the number and order of the questions varied considerably among subjects and between follow-up interviews, all included some form of the following questions: “How is your child’s health?” “Do you think she or he is happy about being a girl or boy?” “Has she or he mentioned gender preference spontaneously?” “Has she or he stated she or he will grow up as a man or a woman?”

Results
Sexual identity varied among the subjects assigned to female sex. Five persistently declared unwavering female identity. One other subject refused to discuss sexual identity with anyone. Eight declared unwavering male identity: four of these subjects declared male identity spontaneously, at the ages of 7, 9, 9, and 12 years, although the parents of two persistently rejected these declarations. Four others declared male identity after their parents revealed to them that their birth status was male, at ages 5, 7, 7, and 18 years. Two subjects were reared male and identified themselves as male. Table 2 shows neonatal sexual assignment, sex at initial assessment, and present sex. All subjects were in medically stable condition, although they had had various health problems. All attended regular schools.

Assessments revealed moderate-to-marked male-typical behaviors in all 16 subjects. Table 3 gives examples of the questions in the questionnaires as well as the responses provided by the subjects or their parents. Scores for individual subjects ranged from 1, the most typical female response, to 5, the most typical male response. Only one subject stated that she had never wished to be a boy, and only one subject — who later adopted a male identity — stated a very strong interest in marriage, with interest in marriage being more typical of female responses in childhood.^23,24 All 16 subjects denied ever having had fantasies about weddings. At the initial assessment, the parents of only four subjects assigned to female sex reported that their child had never stated a wish to be a boy.

The parents of each of the five subjects who were living as females felt that the child in each case was happy being a girl, and occasionally commented about growing up to be a woman. The parents of each of the eight subjects living as male — including the two raised as male — felt that their child was happy living as a boy. The parents of the six subjects who had transitioned to male sex after having been assigned to female sex at birth stated that each child had been much happier since the transition. All eight subjects living as male occasionally mentioned growing up to be a man. The parents of the three children with unclear sexual identity were uncertain about how their children felt about growing up in either sex, although Subject 8, who was living as a female, had occasionally mentioned growing up to be a man. Only the parents of the subjects who were living as males stated that their child mentioned sexual preference spontaneously.

The parents of all 14 subjects assigned to female sex stated that they had reared their child as a female. Twelve of these subjects have sisters: parents described equivalent child-rearing approaches and attitudes toward the subjects and their sisters. However, parents described a moderate-to-pronounced unfolding of male-typical behaviors and attitudes over time in these subjects — but not in their sisters. Parents reported that the subjects typically resisted attempts to encourage play with female-typical toys or with female playmates or to behave as parents thought typical girls might behave. These 14 subjects expressed difficulties fitting in with girls. All but one played primarily or exclusively with male-typical toys. Only one played with dolls; the others did so almost never or never. Only one ever played house. Each of the three exceptions represents a different subject. Parents noted substantial difficulty attempting to dress the subjects — but not their sisters — in clearly feminine attire after about four years of age.

Thus, subjects sorted themselves into three groups: those living as females, those living with unclear sexual identity, and those living as males. Subjects 1 through 5, who were living as females, were 9 to 19 years old at the end of follow-up (Table 1). All used unambiguously female names and female restrooms consistently. None had knowledge of her birth status. Four had been taking estrogen for two to six years, although their parents were unclear whether the hormone had any behavioral effects. None had dated. None discussed sexual activity or sexual attractions (whereas three adolescent genetic females with cloacal exstrophy did). Parents noted in follow-up interviews that these subjects were generally content. However, the parents did not want these children to participate in follow-up interviews and answered all follow-up questions themselves.

Three subjects (Subjects 6, 7, and 8) had apparently unclear sexual identity. Identifying herself as a female at the initial assessment at the age of 10 years, Subject 6 subsequently angrily refused to discuss her sexual identity with anyone after learning, at the age of 12, that her birth status was male. After 2 1/2 years of suggestions from her physician, she recently began taking estrogen but continues to refuse to discuss sex. Subjects 7 and 8 have persistently and spontaneously declared their sexual identity as males since the age of nine years, before the initial assessment. They live as females because their parents have rejected their declarations. Both stated during the initial assessment that they wanted a penis. Both take exogenous estrogen and are intermittently compliant with treatment, and both state that they would prefer to receive testosterone. Both identified themselves as male and used male restrooms when they were away from their families and school.

Eight subjects (Subjects 9 through 16) (Table 1) were living as males. All eight used unambiguous male names and male restrooms consistently. Two were reared as male from birth. The six subjects assigned to female sex as infants who subsequently reassigned themselves to male sex legally changed their birth certificates and school registration to male. Subjects 9 and 10 spontaneously declared themselves male without knowledge of their birth status, at the ages of 12 and 7 years, respectively. Subjects 11, 12, 13, and 14 assumed a male identity after their parents informed them of their birth status, at ages 5, 7, 7, and 18 years, respectively. All eight living as males discussed sexual interests and activity; the four adolescents stated that they were attracted to girls. The three adolescents initially assigned to female sex take testosterone and are compliant with treatment. Because of a severely dysfunctional family, Subject 9 received no testosterone until he was incarcerated in a maximum-security prison for armed robbery at the age of 17 years, yet he dated and was sexually active with girls from the age of 15 years. Two of the three subjects over 17 years of age date girls. All eight subjects desire to undergo surgical construction of a penis.

All subjects living as female expressed difficulty fitting in with female peers (genetic females with cloacal exstrophy did not), although those converting to male sex reported few subsequent social problems with females. All 16 subjects described few difficulties fitting in with males.

Discussion

Cloacal exstrophy is not an intersex condition: aphallia and phallic inadequacy are structural anomalies.^6-9,16 In 1975, Money reported successful reassignment to female sex of a male toddler who suffered traumatic penile loss.²⁶ The concept of neonatal sexual neutrality subsequently developed, emphasizing postnatal, nonhormonal influences.^{4,5,7,8,15,26} Partly on the basis of this concept, the clinical paradigm of sex assignment in neonates was fully established by the end of the 1970s, including assignment to female sex of genetic males with severe phallic inadequacy. Yet Imperato-McGinley et al.¹⁴ and Bin-Abbas et al.²⁷ presented case series that appeared to refute this paradigm in children with other diagnoses. In addition, in 1997 Diamond and Sigmundson reported that Money’s subject had reassigned himself to male sex after years of marked personal and family conflict.²⁸ The results of other case studies have been contradictory.^14,27,29-31 Information about the sexual preferences of genetic males with cloacal exstrophy who were assigned to female sex as neonates is sparse. Schober et al. reported their clinical impression that their 14 female-assigned subjects with cloacal exstrophy “all have a feminine typical core [but] masculine childhood role behavior.”³² The data of Schober et al. are limited, the ages of their subjects are expressed only as “too young” to be used to determine sexual interests or orientation, and the methods they used are not provided.

In our subjects with cloacal exstrophy, the finding of histologically normal testes at orchiectomy in the neonatal period would imply that the brain developed within a male-typical prenatal hormonal milieu.¹⁷ The neuronal properties associated with Y-chromosome–specific transcription factors SRY and ZFY should be typical for such genetic males as well.^33,34 However, because of sex-reassignment surgery, postnatal androgen surges could not occur in 13 subjects, occurred for only the first three months of life in Subject 14, and should have been normal only in the 2 subjects raised as males with their gonads in place. Only the two raised as males with gonads in place should have normal pubertal androgen surges. Subjects 1 through 14 were raised as females socially and legally, with surgically feminized external genitalia. The ultimate sexual identity of the 14 subjects assigned to female sex in the neonatal period was unpredictable. The sexual behavior and attitudes of all 16 subjects appeared to reflect strong male-typical characteristics, irrespective of whether they were raised as males or females. Five subjects assigned to female sex at birth maintain this identity and appeared generally content. The sexual identity of the one subject who has angrily refused all discussions on this topic since being told of her male status at birth is concerning. Eight subjects assigned to female sex in infancy declared themselves male, four spontaneously and four others after learning that they were born male. None have veered from these declarations. Thus, some subjects appear to be able to recognize their male sexual identity regardless of environmental mediators to the contrary — a point that recalls the study by Imperato-McGinley et al. of 18 males with 5α-reductase deficiency who were raised female but, typical of the syndrome, virilized at puberty, with 17 of the 18 subsequently transitioning to male identity.

The divergent sexual outcomes of our subjects highlight issues of clinical concern. First, how might subjects who remained female react if they discover their birth status in the future? Can such information be kept secret? Second, subjects who are living as males or transitioning to male sex appear to be more likely to discuss their sexuality. Third, because nearly all genetic males and females with cloacal exstrophy have normal gonads but require genital construction, castration of males requires lifelong administration of exogenous hormones coupled with the loss of potential fertility. Fourth, the absence or presence of genitalia had no discernible influence on the sex of our subjects. Fifth, probably all males with cloacal exstrophy will need (and want) complete penile construction to function sexually with their chosen partner; such need as well as such function — incomplete as it must be for male orgasm — currently has uncertain implications for psychosexual development during adolescence and adulthood. Finally, no genetic females in our cloacal-exstrophy clinic have demonstrated atypical sexual behavior or sexual confusion.

Several other issues are important in interpreting our data. Medical interventions for cloacal exstrophy vary, are usually complex, and sometimes occurred at subjects’ local hospitals rather than at Johns Hopkins. Follow-up interviews were not systematic in that, except for the four questions listed in the Methods section, the content and order of the questions varied among the subjects and between follow-up sessions. Although genetic females with cloacal exstrophy were observed clinically, none were included in the study. Spontaneous sex reassignment in children is very rare, however. Finally, the assessment of phenotypic sex itself may have altered parenting: at various times after the initial study assessment, the parents of four subjects assigned to female sex revealed the subjects’ birth status to the subjects, contrary to clinic teaching.

Parental attitude toward child rearing based on sex assignment and parental effectiveness are imponderable variables. Thus, conclusive and retrospective determination of factors that were specific to individual parents is not possible. Parents provided assurances that they raised their genetic males as girls as well as possible, given behavior that was often seen as being more typical of boys. That 12 subjects had genetically female sisters who did not have atypical sexual behaviors offers some evidence that parents did use female sex-of-rearing practices. The scope of the subject matter and topics addressed by the questionnaires, the consistency of parents’ and subjects’ responses over a period of years, and longitudinal persistence of the subjects’ declarations of their sexual identity suggest the reliability of outcome data.

Prenatal androgens appear to be a major biologic factor in the development of male sexual identity in the absence of postnatal or pubertal androgen surges, but we cannot assert that they are the only factor. The specific actions of androgen on the developing brain as well as the specific mechanisms of the development of male sex itself remain largely unknown, and the epigenetic processes as well as socially mediated influences remain indeterminate.^5,10,15 The implications of our findings for intersex conditions require further investigation. However, our findings suggest that children who are born genetically and hormonally male may identify themselves as males despite being raised as females and undergoing feminizing genitoplasty at birth. Reassignment of genetic males to female sex because of phallic inadequacy may complicate already complex neonatal conditions. Clinical interventions for such neonates should be reconsidered in the light of these findings.

Supported in part by a grant (5 K08MH01777-02) from the National Institute of Mental Health and by a Johns Hopkins Hospital Children’s Center grant.

We are indebted to Dr. H.F. Meyer-Bahlburg for invaluable assistance in this study.

https://www.nejm.org/doi/full/10.1056/NEJMoa022236

From Wikipedia, the free encyclopedia
For the aeronaut, see John Money (aeronaut).
John Money
John Money.jpg
Born John William Money
8 July 1921
Morrinsville, New Zealand
Died 7 July 2006 (aged 84)
Towson, Maryland, U.S.
Alma mater Victoria University of Wellington
Harvard University
Awards James McKeen Cattell Fellow Award (1992)
Scientific career
Fields Psychology
Institutions Johns Hopkins University
Influenced Richard Green, Kenneth Zucker
John William Money (8 July 1921 – 7 July 2006) was a New Zealand American psychologist, sexologist and professor at Johns Hopkins University known for his research on human sexual behavior and gender. He was one of the first researchers to publish theories on the influence of societal constructs of gender on individual formation of gender identity. Money introduced the terms gender role and sexual orientation and popularised the terms gender identity and paraphilia.

Working with endocrinologist Claude Migeon, Money established the Johns Hopkins Gender Identity Clinic, the first clinic in the United States to perform sexual reassignment surgeries.

A 1997 academic study criticised Money’s work in many respects, particularly in regard to the involuntary sex-reassignment of the child David Reimer, and Money’s abuse of Reimer and his brother when they were children. Some of Money’s “therapy” sessions involved Money forcing the two children to perform sexual activities with each other, which Money then photographed, “for research”. David Reimer lived a troubled life, eventually committing suicide at 38; his brother died of an overdose at age 36.

Money pioneered drug treatment for sex offenders to extinguish their sex drives. He began testing anti-androgen medications on offenders as early as 1966, a practice which proved successful.

Money’s writing has been translated into many languages and includes around 2,000 articles, books, chapters and reviews. He received around 65 honours, awards and degrees in his lifetime. He was also a patron of many famous New Zealand artists, such as Rita Angus and Theo Schoon.

フリー百科事典ウィキペディアより
飛行士については「ジョン・マネー (飛行士)」をご覧ください。
ジョン・マネー
ジョン・マネー.jpg
ジョン・ウィリアム・マネー生まれ
1921 年 7 月 8 日
モリンズビル、ニュージーランド
2006 年 7 月 7 日に死亡（84 歳）
米国メリーランド州タウソン
母校 ビクトリア大学ウェリントン校
ハーバード大学
受賞歴 ジェームズ・マッキーン・キャテル・フェロー賞 (1992)
科学者のキャリア
心理学分野
機関 ジョンズ・ホプキンス大学
リチャード・グリーン、ケネス・ザッカーに影響を与えた
ジョン・ウィリアム・マネー（John William Money、1921年7月8日 – 2006年7月7日）は、ニュージーランド系アメリカ人の心理学者、性科学者、ジョンズ・ホプキンス大学の教授であり、人間の性行動とジェンダーに関する研究で知られている。 彼は、ジェンダーの社会構造が個人のジェンダー・アイデンティティの形成に及ぼす影響に関する理論を発表した最初の研究者の一人です。 マネーは性役割と性的指向という用語を導入し、性同一性とパラフィリアという用語を普及させました。

マネー氏は、内分泌学者のクロード・ミジョンと協力して、米国で性転換手術を行う初のクリニックであるジョンズ・ホプキンス性同一性クリニックを設立した。

1997年の学術研究は、マネーの研究を多くの点で批判しており、特にデビッド・ライマーという子供に対する非自発的な性別適合と、幼少期のライマーとその兄弟に対するマネーによる虐待に関して批判している。 マネー氏の「セラピー」セッションの中には、マネー氏が二人の子供たちに性行為を強要し、その様子をマネー氏が「研究のために」撮影するものも含まれていた。 デビッド・ライマーは波瀾万丈の人生を送り、最終的には38歳で自殺した。 彼の兄は過剰摂取により36歳で亡くなった。

性犯罪者の性欲を消すための薬物治療はマネーが先駆けとなった。 彼は 1966 年にはすでに犯罪者に対する抗アンドロゲン薬の試験を開始しており、これは成功していることが証明されました。

Money の著作は多くの言語に翻訳されており、約 2,000 の記事、書籍、章、レビューが含まれています。 彼は生涯で約 65 の栄誉、賞、学位を受賞しました。 彼はまた、リタ・アンガスやテオ・スクーンなど、多くの有名なニュージーランドのアーティストの後援者でもありました。

Books on sexology

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Further information: Sexual identity, Gender identity, and Gender role
Money co-edited a 1969 book Transsexualism and Sex Reassignment, which helped bring more acceptance to sexual reassignment surgery and transsexual individuals.

Money introduced numerous definitions related to gender in journal articles in the 1950s, many of them as a result of his studies of intersex morphology. His definition of gender is based on his understanding of sex differences among human beings. According to Money, the fact that one sex produces ova and the other sex produces sperm is the irreducible criterion of sex difference. However, there are other sex-derivative differences that follow in the wake of this primary dichotomy. These differences involve the way urine is expelled from the human body and other questions of sexual dimorphism. According to Money’s theory, sex-adjunctive differences are typified by the smaller size of females and their problems in moving around while nursing infants. This then makes it more likely that the males do the roaming and hunting.

Sex-arbitrary differences are those that are purely conventional: for example, colour selection (baby blue for boys, pink for girls). Some of the latter differences apply to life activities, such as career opportunities for men versus women. Finally, Money created the now-common term gender role which he differentiated from the concept of the more traditional terminology sex role. This grew out of his studies of intersex people. According to Money, the genitalia and erotic sexual roles were now, by his definition, to be included under the more general term “gender role” including all the non-genital and non-erotic activities that are defined by the conventions of society to apply to males or to females.

In his studies of intersex people, Money alleged that there are six variables that define sex. While in the average person all six would line up unequivocally as either all “male” or “female”, in hermaphrodites any one or more than one of these could be inconsistent with the others, leading to various kinds of anomalies. In his seminal 1955 paper he defined these factors as:

assigned sex and sex of rearing
external genital morphology
internal reproductive structures
hormonal and secondary sex characteristics
gonadal sex
chromosomal sex
and added,
“Patients showing various combinations and permutations of these six sexual variables may be appraised with respect to a seventh variable: 7. Gender role and orientation as male or female, established while growing up.”

He then defined gender role as;

“all those things that a person says or does to disclose himself or herself as having the status of boy or man, girl or woman, respectively. It includes, but is not restricted to sexuality in the sense of eroticism. Gender role is appraised in relation to the following: general mannerisms, deportment and demeanor; play preferences and recreational interests; spontaneous topics of talk in unprompted conversation and casual comment; content of dreams, daydreams and fantasies; replies to oblique inquiries and projective tests; evidence of erotic practices, and, finally, the person’s own replies to direct inquiry.”

Money made the concept of gender a broader, more inclusive concept than one of masculine/feminine. For him, gender included not only one’s status as a man or a woman, but was also a matter of personal recognition, social assignment, or legal determination; not only on the basis of one’s genitalia but also on the basis of somatic and behavioural criteria that go beyond genital differences. In 1972, Money presented his theories in Man and Woman, Boy and Girl, a college level textbook. The book featured David Reimer as an example of gender reassignment.

性科学に関する本

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詳細情報: 性的アイデンティティ、ジェンダー・アイデンティティ、およびジェンダーの役割
マネーは 1969 年の著書「性転換と性転換」を共同編集し、性転換手術と性転換者への受け入れを促進しました。

マネーは 1950 年代の雑誌論文でジェンダーに関連する多数の定義を導入しましたが、その多くはインターセックスの形態学の研究の結果でした。 彼のジェンダーの定義は、人間間の性差についての彼の理解に基づいています。 マネーによれば、一方の性別が卵子を生成し、もう一方の性別が精子を生成するという事実は、性差の縮小できない基準です。 しかし、この主な二分法に続いて、他の性派生的な違いも存在します。 これらの違いには、尿が人体から排出される方法や、性的二型に関するその他の問題が含まれます。 マネーの理論によると、性別による差異は、メスの体格が小さいことと、乳児を授乳する際に動き回るのが難しいという点に代表される。 これにより、オスが徘徊したり狩りをしたりする可能性が高くなります。

性別による任意の違いは、純粋に従来のものです。たとえば、色の選択 (男の子はベビーブルー、女の子はピンク) です。 後者の違いの一部は、男性と女性のキャリアの機会など、人生活動に当てはまります。 最後に、マネーは、より伝統的な用語である性役割の概念から区別する、現在では一般的な用語である性役割を作成しました。 これはインターセックスの人々に関する彼の研究から生まれました。 マネー氏によれば、彼の定義によれば、生殖器とエロティックな性的役割は、社会の慣例によって適用されると定義されている非性器および非エロティックな活動すべてを含む、より一般的な用語「ジェンダー役割」に含まれることになったという。 男性にも女性にも。

マネー氏は、インターセックスの人々を対象とした研究の中で、性別を定義する変数が 6 つあると主張しました。 平均的な人では、6 つすべてが明確に「男性」または「女性」として並びますが、雌雄同体では、これらのうちの 1 つまたは複数が他のものと矛盾する可能性があり、さまざまな種類の異常が引き起こされます。 1955 年の独創的な論文で、彼はこれらの要因を次のように定義しました。

割り当てられた性別と飼育の性別
外生殖器の形態
内部生殖構造
ホルモンと第二次性徴
生殖腺のセックス
染色体の性別
そしてこう付け加えた
「これら 6 つの性的変数のさまざまな組み合わせや順列を示す患者は、7 番目の変数に関して評価される可能性があります。7. 成長過程で確立される、男性または女性としての性別の役割と方向性。」

次に、彼は性別役割を次のように定義しました。

「ある人が、それぞれ少年、男性、少女、女性という立場を持っていることを明らかにするために言動するすべてのこと。それには、エロティシズムの意味でのセクシュアリティが含まれますが、それに限定されません。ジェンダーの役割は、さまざまな方法で評価されます。」 以下との関係：一般的なマナー、立ち居振る舞い、態度、遊びの好みと娯楽への興味、自発的な会話や何気ないコメントにおける自発的な話題、夢、白昼夢、空想の内容、遠回しな質問や投影テストへの返答、性的行為の証拠、 そして最後に、直接の問い合わせに対して本人が回答します。」

貨幣のおかげで、ジェンダーの概念は、男性性/女性性の概念よりも広く、より包括的な概念になりました。 彼にとって、ジェンダーには男性または女性としての地位だけでなく、個人の認識、社会的割り当て、または法的決定の問題も含まれていました。 それは、人の性器に基づくだけでなく、性器の違いを超えた身体的および行動的基準にも基づいています。 1972年、マネーは大学レベルの教科書である『男と女、少年と少女』で自身の理論を発表した。 この本では、性別適合の一例としてデビッド・ライマーを取り上げています。

This section may be confusing or unclear to readers. In particular, there are terms in this section that require explanation as they are technical jargon used in Money’s theoretical conceptualising and do not have broad understanding. Please help clarify the section. There might be a discussion about this on the talk page. (March 2016) (Learn how and when to remove this template message)
In his book Gay, Straight and In-Between: The Sexology of Erotic Orientation, Money develops a conception of “bodymind”. “Bodymind” is a way for scientists, in developing a science about sexuality, to move on from the platitudes of dichotomy between nature versus nurture, innate versus the acquired, biological versus the social, and psychological versus the physiological. He suggested that all of these capitalise on the ancient, pre-Platonic, pre-biblical conception of body versus the mind, and the physical versus the spiritual. In coining the term “bodymind”, in this sense, Money wishes to move beyond these very ingrained principles of our folk or vernacular psychology.

Money also developed a view of “Concepts of Determinism” which, transcultural, transhistorical, and universal, all people have in common, sexologically or otherwise. These include pairbondage, troopbondage, abidance, ycleptance, foredoomance, with these coping strategies: adhibition (engagement), inhibition, explication. Money suggested that the concept of “threshold” – the release or inhibition of sexual (or other) behavior – is most useful for sex research as a substitute for any concept of motivation. Moreover, it confers the distinct advantage of having continuity and unity to what would otherwise be a highly disparate and varied field of research. It also allows for the classification of sexual behavior. For Money, the concept of threshold has great value because of the wide spectrum to which it applies. “It allows one to think developmentally or longitudinally, in terms of stages or experiences that are programmed serially, or hierarchically, or cybernetically (i.e. regulated by mutual feedback).”

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マネー氏は著書『ゲイ、ストレート、そしてその中間: エロ指向の性学』の中で、「ボディマインド」の概念を展開しています。 「ボディマインド」は、科学者がセクシュアリティに関する科学を開発する際に、自然と育ち、先天と後天、生物学と社会、心理と生理というありきたりな二分法から脱却するための方法です。 彼は、これらすべてが、身体対心、物質対霊的という古代、プラトン以前、聖書以前の概念を利用していると示唆しました。 この意味で、マネーは「ボディマインド」という用語を作り出すことで、私たちの民族心理や地域心理に深く根付いた原理を超えていきたいと考えています。

マネーはまた、異文化的、超歴史的、そして普遍的な、性科学的またはその他の観点から、すべての人々が共通に持つ「決定論の概念」の見方を発展させました。 これらには、ペアボンデージ、軍隊ボンデージ、アビダンス、イクレプタンス、フォードゥマンスが含まれ、これらの対処戦略には、抑制（関与）、抑制、説明が含まれます。 マネーは、性的（またはその他の）行動の解放または抑制である「閾値」の概念が、動機の概念の代わりとしてセックス研究に最も役立つことを示唆しました。 さらに、それがなければ非常に異質で多様な研究分野となるであろうものに、連続性と統一性を持たせるという明確な利点をもたらします。 また、性的行動の分類も可能になります。 お金の場合、しきい値の概念は適用される範囲が広いため、非常に価値があります。 「これにより、人は、連続的、階層的、またはサイバネティックに（つまり、相互フィードバックによって制御される）プログラムされた段階や経験の観点から、発達的または長期的に考えることができます。」

Controversies
Institutionalization of Janet Frame
Main article: Janet Frame
Author Janet Frame attended some of Money’s classes at the University of Otago, as part of her teacher’s training. Frame was attracted to Money, and eager to please him. In October 1945, after Frame wrote an essay mentioning her thoughts of suicide, John Money convinced Frame to enter the psychiatric ward at Dunedin Public Hospital, where she was misdiagnosed as suffering from schizophrenia. Frame then spent eight years in psychiatric institutions, during which she was subjected to electroshock and insulin shock therapy. Frame narrowly missed being lobotomized. In Frame’s autobiography, An Angel at My Table, Money is referred to as John Forrest.

Sex reassignment of David Reimer
Main article: David Reimer
During his professional life, Money was respected as an expert on sexual behavior, especially known for his views that gender was learned rather than innate. However, it was later revealed that his most famous case of David Reimer, born Bruce Reimer, was fundamentally flawed. In 1966, a botched circumcision left eight-month-old Reimer without a penis. Money persuaded the baby’s parents that sex reassignment surgery would be in Reimer’s best interest. At the age of 22 months, Reimer underwent an orchiectomy, in which his testicles were surgically removed. He was reassigned to be raised as female and his name changed from Bruce to Brenda. Money further recommended hormone treatment, to which the parents agreed. Money then recommended a surgical procedure to create an artificial vagina, which the parents refused. Money published a number of papers reporting the reassignment as successful. David Remier was raised under the “optimum gender rearing model” which was the common model for sex and gender socialization/medicalization for intersex youth, the model was heavily criticized for being sexist, and for assigning an arbitrary gender binary.

According to John Colapinto’s biography of David Reimer, starting when Reimer and his twin Brian were six years old, Money showed the brothers pornography and forced the two to rehearse sexual acts. Money would order David to get down on all fours and Brian was forced to “come up behind [him] and place his crotch against [his] buttocks”. Money also forced Reimer, in another sexual position, to have his “legs spread” with Brian on top. On “at least one occasion” Money took a photograph of the two children performing these acts.

When either child resisted Money, Money would get angry. Both Reimer and Brian recall that Money was mild-mannered around their parents, but ill-tempered when alone with them. Money also forced the two children to strip for “genital inspections”; when they resisted inspecting each other’s genitals, Money got very aggressive. Reimer says, “He told me to take my clothes off, and I just did not do it. I just stood there. And he screamed, ‘Now!’ Louder than that. I thought he was going to give me a whupping. So I took my clothes off and stood there shaking.”

Money’s rationale for his treatment of the children was his belief that “childhood ‘sexual rehearsal play'” “at thrusting movements and copulation” was important for a “healthy adult gender identity”.

論争
ジャネットフレームの制度化
詳細は「ジャネット・フレーム」を参照
著者のジャネット・フレームは、教師の研修の一環として、オタゴ大学で行われたマネーのクラスの一部に参加しました。 フレームはマネーに惹かれ、彼を喜ばせたいと熱望していました。 1945年10月、フレームが自殺願望についてエッセイを書いた後、ジョン・マネーはフレームを説得してダニーデン公立病院の精神科病棟に入院させたが、そこで彼女は統合失調症と誤診された。 その後、フレームさんは精神病院で8年間を過ごし、その間、電気ショック療法とインスリンショック療法を受けました。 フレームはロボトミー手術を九死に一生を得て逃した。 フレームの自伝『An Angel at My Table』では、マネーはジョン・フォレストと呼ばれている。

デビッド・ライマーの性転換
詳細は「デビッド・ライマー」を参照
職業生活中、マネーは性行動の専門家として尊敬されており、特にジェンダーは先天的なものではなく学習されるという見解で知られていました。 しかし、後に、彼の最も有名なデヴィッド・ライマー、本名ブルース・ライマーの事件には根本的な欠陥があったことが判明した。 1966年、割礼手術が失敗し、生後8か月のライマー君にはペニスがなくなってしまった。 マネー氏は、性転換手術がライマー君の最大の利益になると赤ちゃんの両親を説得した。 ライマーさんは生後22カ月で睾丸摘出術を受け、睾丸を外科的に切除した。 彼は女性として育てられるように再割り当てされ、名前もブルースからブレンダに変わりました。 マネーはさらにホルモン治療を勧め、両親はそれに同意した。 その後、マネー氏は人工膣を作る外科手術を勧めたが、両親はこれを拒否した。 マネーは、再割り当てが成功したと報告する多数の論文を発表した。 デヴィッド・レミエは、インターセックスの若者に対するセックスとジェンダーの社会化/医療化の一般的なモデルである「最適なジェンダー養育モデル」の下で育てられたが、このモデルは性差別的であり、恣意的な性別二項対立を割り当てているとして強く批判された。

ジョン・コラピントのデヴィッド・ライマーの伝記によると、ライマーと双子のブライアンが6歳の頃から、マネーは兄弟にポルノを見せ、性行為のリハーサルを強要したという。 マネーはデヴィッドに四つん這いになるよう命令し、ブライアンは「[彼の]後ろに来て、[彼の]尻に股間を当てる」ことを強制された。 また、お金のせいで、ライマーさんは別の性的体位で、ブライアンを上にして「脚を広げる」ことを余儀なくされた。 「少なくとも1回」、マネーはこれらの行為を行っている2人の子供たちの写真を撮った。

どちらかの子供がマネーに抵抗すると、マネーは怒るでしょう。 ライマーもブライアンも、マネーは両親の前では温厚だったが、両親と二人きりになると機嫌が悪くなったと回想している。 また、金銭のため、2人の子供は「性器検査」のために服を脱ぐことになった。 お互いの性器を検査することに抵抗すると、マネーは非常に攻撃的になった。 ライマーさんは、「彼は私に服を脱ぐように言いましたが、私は服を脱ぎませんでした。私はただそこに立っていました。すると彼は『今だ！』と叫びました。」 「もっと大きな声でした。彼が私を殴りつけるのではないかと思いました。それで私は服を脱いで、震えながらそこに立っていました。」

マネー氏が子供たちを扱う根拠は、「突き出す動きや交尾における子供時代の『性的リハーサル遊び』」が「健全な成人の性同一性」にとって重要であるという信念だった。

Both Reimer and Brian were traumatized by the “therapy”, with Brian speaking about it “only with the greatest emotional turmoil”, and David unwilling to speak about the details publicly. At 14 years old and in extreme psychological agony, David Reimer was finally told the truth by his parents. He chose to begin calling himself David, and he underwent surgical procedures to revert the female bodily modifications.

Despite the pain and turmoil of the brothers, for decades, Money reported on Reimer’s progress as the “John/Joan case”, describing apparently successful female gender development and using this case to support the feasibility of sex reassignment and surgical reconstruction even in non-intersex cases.

By the time this deception was discovered, the idea of a purely socially constructed gender identity and infant Intersex medical interventions had become the accepted medical and sociological standard.

David Reimer’s case came to international attention in 1997 when he told his story to Milton Diamond, an academic sexologist, who persuaded Reimer to allow him to report the outcome in order to dissuade physicians from treating other infants similarly. Soon after, Reimer went public with his story, and John Colapinto published a widely disseminated and influential account in Rolling Stone magazine in December 1997. This was later expanded into The New York Times best-selling biography As Nature Made Him: The Boy Who Was Raised as a Girl (2000), in which Colapinto described how—contrary to Money’s reports—when living as Brenda, Reimer did not identify as a girl. He was ostracised and bullied by peers (who dubbed him “cavewoman”), and neither frilly dresses nor female hormones made him feel female.

In July 2002, Brian was found dead from an overdose of antidepressants. In May 2004, David committed suicide by shooting himself in the head with a sawed-off shotgun at the age of 38. According to his mother, “he had recently become depressed after losing his job and separating from his wife.”

Money argued that media response to Diamond’s exposé was due to right-wing media bias and “the antifeminist movement.” He said his detractors believed “masculinity and femininity are built into the genes so women should get back to the mattress and the kitchen”. However, intersex activists also criticised Money, stating that the unreported failure had led to the surgical reassignment of thousands of infants as a matter of policy. Privately, Money was mortified by the case, colleagues said, and as a rule did not discuss it.

Researcher Mary Anne Case wrote that Money made “fraudulently deceptive claims about the malleability of gender in certain patients who had involuntarily undergone sex reassignment surgery” and that this fueled the anti-gender movement.

Opinions on paedophilia
Money participated in debates on chronophilias, especially paedophilia. He stated that both sexual researchers and the public do not make distinctions between affectional paedophilia and sadistic paedophilia. Colapinto reported that, Money told Paidika, a Dutch journal, of pedophilia:

If I were to see the case of a boy aged 10 or 12 who’s intensely attracted toward a man in his 20s or 30s, if the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way.

ライマーさんとブライアンさんはともに「セラピー」によってトラウマを抱えており、ブライアンさんは「最大の感情的動揺を伴ってのみ」そのことについて話しており、デビッドさんはその詳細について公に話すことを望まなかった。 14歳で極度の精神的苦痛にさらされていたデビッド・ライマーは、ついに両親から真実を告げられた。 彼は自分自身をデビッドと呼び始めることを選択し、女性の身体改造を元に戻す外科手術を受けました。

兄弟の苦痛と混乱にもかかわらず、マネーは何十年にもわたってライマーの進歩を「ジョン/ジョーン事件」として報道し、女性の性発達が明らかに成功していると述べ、この事件を非性別であっても性別適合と外科的再建の実現可能性を支持するために利用した。 インターセックスのケース。

この欺瞞が発見されるまでに、純粋に社会的に構築された性同一性と乳児のインターセックスの医療介入という考えが、医学的および社会学的標準として受け入れられていました。

デビッド・ライマーさんの事件は、1997年に性科学学者のミルトン・ダイアモンド氏に自分の話をした際に国際的な注目を集めた。ミルトン・ダイアモンド氏は、医師が他の乳児を同様に治療するのを思いとどまらせるために、結果を報告することを許可するようライマー氏を説得した。 その後間もなく、ライマーは自分の話を公表し、ジョン・コラピントは 1997 年 12 月にローリングストーン誌に広く影響力のある記事を掲載しました。これは後にニューヨーク・タイムズ紙のベストセラー伝記『自然が作った少年: 自然が作った少年』に発展しました。 『Raid as a Girl』（2000年）では、コラピントは、マネー誌の報道に反して、ブレンダとして生きていたとき、ライマーがいかに女の子であるかを自覚していなかったのかを語った。 彼は仲間たち（彼を「穴居女」とあだ名した）から排斥され、いじめられ、フリルのドレスも女性ホルモンも彼に女性らしさを感じさせなかった。

2002 年 7 月、ブライアンは抗うつ薬の過剰摂取により死亡しているのが発見されました。 2004年5月、デイビッドさんは38歳で、切断された散弾銃で頭を撃ち自殺した。母親によると、「彼は仕事を失い、妻と別居した後、最近鬱状態になっていた」という。

マネー氏は、ダイアモンド氏の暴露に対するメディアの反応は右翼メディアの偏見と「反フェミニスト運動」によるものだと主張した。 同氏を批判する人々は「男らしさと女らしさは遺伝子に組み込まれているので、女性はマットレスやキッチンに戻るべきだ」と信じていると述べた。 しかし、インターセックス活動家らもマネーを批判し、報告されていない失敗が政策として何千人もの乳児の外科的配置転換につながったと述べた。 同僚らによると、マネー氏はプライベートではこの事件に屈辱を感じており、原則としてこの件については議論しなかったという。

研究者のメアリー・アン・ケースは、マネー氏が「不本意に性転換手術を受けた特定の患者の性別の順応性について不正に欺瞞的な主張」をし、これが反ジェンダー運動を煽ったと書いた。

小児性愛に関する意見
マネーは、時間性愛、特に小児性愛に関する議論に参加しました。 彼は、性的研究者も一般大衆も、愛情的な小児性愛とサディスティックな小児性愛を区別していないと述べた。 コラピントは、マネーがオランダの雑誌『パイディカ』に小児性愛について次のように語った、と報じた。

20代か30代の男性に激しく惹かれる10歳か12歳の少年のケースを見たとしたら、その関係が完全に相互的であり、絆が本当に完全に相互的であれば、私はそれを病的とは決して言わないでしょう。 道。