This post is based off a chapter of a book. It’s a rather obscure book called ‘Studies in Ethnomethodology’, which may be among the least catchy possible titles for a book, even given that the chapter was originally published as a paper in 1967. Bear in mind that much of the way in which this story is discussed will be reflecting on attitudes held widely on gender in the 1950s and 1960s.
Don’t give up on me just yet, as the contents are rather unexpectedly fascinating.
The paper was written by one Dr. Garfinkel and his experience treating a patient called Agnes, whom he first met in November of 1958. Agnes had sought medical attention in her home town, been referred to a doctor in Los Angeles, who referred her to a colleague of Dr. Garfinkel who saw her with him.
The nineteen year old Agnes was the youngest of four children, supported by her mother who worked in an aircraft plant. Her father died when Agnes was a child. She was raised Catholic, but no longer believed in God.

These particular sisters may not have put Agnes back on the path to righteousness…
She also had a penis, and testes.
Agnes was presenting with what nowadays would be referred to as an intersex condition – in that she possessed physiology typically associated with the social categories of ‘male’ and ‘female’ at the same time. To quote from Dr. Garfinkel’s account directly:
Agnes’ appearance was convincingly female. She was tall, slim, with a very female shape. Her measurements were 38-25-38. She had long, fine dark-blonde hair, a young face with pretty features, a peaches-and-cream complexion, no facial hair, subtly plucked eyebrows, and no makeup except for lipstick. At the time of her first appearance she was dressed in a tight sweater which marked off her thin shoulders, ample breasts, and narrow waist. Her feet and hands, though somewhat larger than usual for a woman, were in no way remarkable in this respect. Her usual manner of dress did not distinguish her from a typical girl of her age and class. There was nothing garish or exhibitionistic in her attire, nor was there any hint of poor taste or that she was ill at ease in her clothing, as is seen so frequently in transvestites and in women with disturbances in sexual identification. Her voice, pitched at an alto level, was soft, and her delivery had the occasional lisp similar to that affected by feminine appearing male homosexuals. her manner was appropriately feminine with a slight awkwardness that is typical of middle adolescence.
As tempting as it is to pick apart the frankly amazing number of problems there are with anyone, let alone a doctor scrutinising someone in such terms, this isn’t actually the focus of where this is going. Please feel free to pick it apart in your own delicious, juicy minds.

This is a fairly common intersex (and more generally, trans) pride symbol. To think that being intersex is to be a ‘mix’ of male and female (rather than its own state of being, not framed in terms of a binary) as the stereotypical pink-purple-blue colour scheme suggests may be a bit simple.
Agnes wanted to get treatment for what she regarded as a very problematic condition. She thought of her penis and scrotum as being nothing more than a tumour that she wished to have removed so she could get on with living a ‘normal female life’. The fact that she had been born with a penis had meant that for the first 17 years of her life she had been treated and socialised as a boy by her family others who knew her. When she was around 12 years old, she was delighted when she noticed breasts beginning to develop, and other female secondary sex characteristics associated with the onset of puberty.
After much medical scrutiny, it was decided Agnes had a rare disorder known as ‘testicular feminisation syndrome’ , where the testicles, rather than producing testosterone, instead produce lots of oestrogens, causing an XY fetus to develop female genitalia and female traits at puberty. Agnes was seen to be a unique variation on this, in that she had a penis and scrotum and no vagina, and also no ovaries or womb. The doctors were a bit confused by this, but it was the best they could come up with – particularly given how ‘obviously female’ Agnes was to them in all other respects.
Agnes considered herself to be entirely apart from feminine homosexuals, “transvestites” (n.b. I put this in inverted commas because this was the term Dr. Garfinkel and Agnes herself were using at the time to refer to cross-dressers. The term ‘transvestite’ may be considered offensive, and it’s important that this be borne in mind), or any other gender variant individuals, considering them to be “freaks”, and nothing like her whatsoever. She went to an incredible amount of trouble to ensure that she was never scrutinised as being anything other than a ‘normal female’. To again quote directly from Garfinkel’s account:
“I’m not like them” she would continually insist. “In high school I steer clear of boys that acted like sissies … anyone with an abnormal problem … I would completely shy away from them and go to the point of being insulting just enough to get around them … I didn’t want to feel noticed talking to them because somebody might relate them to me. I didn’t want to be classified with them.”
Just as normals frequently will be at a loss to understand “why a person would do that, i.e. engage in homosexual activities or dress as a member of the opposite sex, so did Agnes display the same lack of “understanding” for such behavior, although her accounts characteristically were delivered with flattened affect and never with indignation. When she was invited by me to compare herself with homosexuals and transvestites she found the comparison repulsive.

Agnes was also very anxious about how her situation may affect her relationship with her boyfriend, Bill. Agnes met bill in April of 1958, seven months before she received medical scrutiny. Her refusal to let him allow his hands to wonder below her waist was met with much frustration by him, only temporarily alleviated by claims of her modesty and virginity. Agnes disclosed her situation to him in June, and whilst Bill accepted that it was “like an abnormal growth”, he found it difficult to understand why Agnes attended sessions every Saturday to discuss the condition with the doctors (over 70 hours of interviews were recorded and analysed). This was because Bill did not know that Agnes had been raised as a boy, and she sure as hell wasn’t intending for him to find out. She was also somewhat scared about the fact that Bill might himself be ‘abnormal’ (i.e. homosexual…) due to staying with her after disclosure – though she put this worry to rest after remembering that he took interest in her before he ever knew.
In March 1959, Agnes received a castration operation, where her penis and scrotum were removed, and a vagina constructed in their place. Before the surgery, she was scared that the doctors would make the decision that she was ‘actually’ male, and would amputate her breasts without telling her – but was reassured when told this definitely would not happen. With some time for healing and the use of a penis shaped mould, she was able to acclimatise her new genitals such that she was able to have vaginal sex.
After surgery, Agnes was well accepted by her immediate family and Bill. This was because the doctor’s treatment legitimised her claims of having been ‘female all along’, and that her being raised as male was simply an unhappy mistake due to a condition. The medical justification also meant that her “man-made vagina” was seen as ‘legitimately deserved’ by her, unlike individuals making claims of being women, whilst being ‘unambiguously’ physiologically and genetically ‘male’. Sorry for all the inverted commas, but I hope you see I’m illustrating the beliefs of Agnes and wider society at the time, rather than my own.

PRIDE SHARKTOPUS. I swear, coming up with images to break up the text of this post in a relevant way has been nearly impossible. But I could not resist this badass. For anyone wondering, they’re brandishing the (from bottom left going clockwise): the STRAIGHT ALLY flag, the ASEXUAL flag, the BISEXUAL flag, the PANSEXUAL flag, the GENDERQUEER flag, the INTERSEX flag, the TRANSGENDER flag, and the rather more common LGBT flag. This link is the best I could do towards crediting.Â
Five years after her surgery and consultation sessions had finished, Agnes returned to catch up with the doctors who had helped her. Whilst she was no longer with Bill, none of the men she had been with sexually since him had ever given any reason to think they found her in any way out of the ordinary. She was still worried however, so Garfinkel arranged for her to see an expert urologist, who confirmed that “her genitalia were quite beyond suspicion”.
Agnes then dropped a massive bombshell.
During the hour following the welcome news given her by the urologist, after having kept it from me for either years, with the greatest casualness, in mid-sentence, and without giving the slightest warning it was coming, she revealed that she had never had a biological defect that had feminised her but that she had been taking estrogens since age 12. In earlier years when talking to me, she had not only said that she had always hoped and expected that when she grew up she would grow into a woman’s body but that starting in puberty this had spontaneously, gradually, but unwaveringly occurred. In contrast, she now revealed that just as puberty began, at the time her voice started to lower and she developed public hair, she began stealing Stilbestrol from her mother, who was taking it on prescription following a panhysterectomy. The child then began filling the prescription on her own, telling the pharmacist that she was picking up the hormone for her mother and paying for it with money taken from her mother’s purse. She did not know what the effects would be, only that this was a female substance, and she had no idea how much to take but more or less tried to follow the amounts her mother took. She kept this up continuously throughout adolescence, and because by chance she had picked just the right time to start taking the hormone, she was able to prevent the development of all secondary sex characteristics that might have been produced by androgens  and instead to substitute those produced by estrogens. Nonetheless, the androgens continued to be produced, enough that a normal-sized adult penis developed with capacity for erection and orgasm till sexual excitability was suppressed by age 15. Thus, she became a lovely looking young ‘woman’, though with a normal sized penis…
This 19 year old girl with no medical training, by sheer, unadulterated luck, and using a method that now would be essentially impossible, managed to achieve the treatment and recognition she desired in a time when any gender or sexuality variance was seen near-universally as sickness and/or criminal.
Try reading all that again, bearing in mind what you now know about Agnes. Do you find yourself thinking of her in any way differently? It’s quite amazing how even today, many people still consider legitimacy in gender identity to require the green light from the medical establishment. Agnes’ genius manipulation of the system gives a great big middle finger to anyone who would try and question or prevent her legitimacy. For her, being transgender wasn’t an identity she felt any connection with. She had no interest in waging a political fight, or in challenging any aspect of social norms. There’s no way to really comment on whether her disgust at gender and sexual minorities was an act or real. She got what she needed.
Respect.
The original chapter can be read here (at least in part), through Google books.