In Memoriam: Professor Emeritus Dr. Milton Diamond PhD

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dr. milton diamond

Dr. Milton Diamond PhD, Professor Emeritus of Anatomy and Reproductive Biology at the University of Hawaiʻi at Mānoa, John A. Burns School of Medicine, died in Honolulu, Hawai’i, on March 20, 2024 at the age of 90 from cardiac arrest.  He was internationally known for investigating the case of David Reimer, which had been claimed to show that a child's gender could be formed by nurture rather than nature; Dr. Diamond proved this claim to be false, and his subsequent work in this area caused doctors and parents around the world to think again before authorizing cosmetic surgical intervention on the sexual organs of babies.

Takashi Matsui, MD, PhD Professor and Chair of JABSOM’s Department of Anatomy, Biochemistry & Physiology said Dr. Diamond will be remembered as a passionate gender advocate.

"Dr. Milton Diamond was well known for his advocacy and impact on gender studies. His consistent and tremendous efforts in preserving equity and diversity around gender identity have empowered and saved lives on a global scale. Dr. Diamond will surely be missed as his legacy continues to live on."

Dr. Diamond was born in New York City on March 6, 1934, the third and youngest child of Jewish Ukrainian immigrants.  His lifelong nickname of Mickey was given to him by his schoolmates, many of whom were Irish and had never come across the name Milton.  Mickey was a lackluster student, given to playing hooky, but on his own initiative he applied to the recently-founded Bronx High School of Science, where he flourished (often crediting its rigorous curriculum with “saving his life”).

In 1951, aged 17, he entered the City College of New York (now the City University of New York); as a public college, it was the only one which his family could afford.  He took up wrestling, and learned the guitar and banjo (emulating Pete Seeger with a troubadour’s repertoire of bluegrass and folk songs); he also joined the ROTC, which helped to fund his studies.  Before long he switched from his major of physics to biophysics.  He was eligible for graduation in January 1955, but being not yet 21 years old he was too young for an ROTC commission, so he undertook a further semester, studying endocrinology and animal behavior.

On graduation, a newly-commissioned Lieutenant Diamond joined the Corps of Engineers and was assigned to Tokyo, Japan, as a topographic engineering officer involved in the analysis and production of maps.  This led to his lifetime love of Japan and the Japanese people.

After three years in Japan, Captain Diamond was recommended by his CCNY teachers to undertake his graduate study under William C. Young at the University of Kansas, focusing on a combination of anatomy, endocrinology and psychology.  In 1962 he was awarded his PhD in Anatomy and Psychology, for a thesis on "Differential Responsiveness of Pregnant and Non-pregnant Guinea Pigs to the Masculinizing Action of Testosterone Propionate."  This area of study, of the effects of in-utero hormones on the sex, gender, and sexual behavior of animals and humans, would inform most of his future career.

Dr. Diamond began his professional career as an Instructor and Assistant Professor of Anatomy at the University of Louisville School of Medicine, in Kentucky, where he continued his research into the effects of hormonal intervention in guinea-pigs and other rodents.  In 1967 he became Associate Professor of Anatomy at the recently-established John A. Burns School of Medicine at the University of Hawaiʻi at Mānoa.  In 1971 he was appointed Professor of Anatomy and Reproductive Biology, and from 1985 until his retirement he was also Director of the Pacific Center for Sex and Society within the School of Medicine.

In 1967 Dr. John Money of Johns Hopkins University was consulted by the parents of a twin baby boy, Bruce Reimer, whose penis had been accidentally destroyed during circumcision in 1965. Dr. Money advised that the child should be reared as a girl, with surgery to remove the testes and fashion a vagina, and a program of female hormones. The child (now named Brenda) and his twin, also male, were closely studied over the years, and Money published papers in the 1970s claiming that Brenda was being successfully raised as a girl.

This case had a powerful effect, as many publications in fields including medicine, psychology, sociology, and women's studies used the case to support the contention that sex roles and sexual identity are not in-born but basically learned. Based on this, doctors routinely operated on infants with ambiguous genitalia to make them resemble girls, even when their chromosomes were XY, confident that being brought up as a girl would mean that they would think, feel and act like a girl.

Dr. Diamond disagreed with Money's theory, and his own studies of clinical cases, hormones, the imprinting phenomenon and learning theory led him to the conclusion that, although inherent gender was not necessarily manifest at birth, it nevertheless provides a built-in nervous system "bias" with which the individual interacts with their environment.  He had published various papers on the subject in between 1965 and 1979.  Because of this, a BBC team which sought to interview Money for a documentary on the now famous case invited Dr. Diamond to be a consultant on the program, presenting the opposing view.

In the course of their research, the BBC program makers interviewed the team of psychiatrists now working with Reimer who, still a teenager, was not identified for the program, which first aired in 1980 in the UK.  The program made it clear that the attempted reassignment to female had been a complete failure, despite Money's papers claiming success.  In fact, when Brenda – who had struggled against being a girl from the start – was told by his parents at the age of 14 what had happened to him, he had promptly resumed his male gender identity, took the name David Reimer, and began surgical and hormone treatment to reverse the mis-assignment to female.

Over subsequent years Dr. Diamond spent considerable time and effort trying to identify and locate Reimer in order to talk to him, establish whether he still felt the same way as reported in the BBC program, and get his permission to publicize the case further in order to dissuade doctors from treating similar infant cases surgically.  In 1994 he achieved this goal, and Reimer (then a married man in his late 20s) agreed to the publication of his story.

Dr. Diamond, along with Reimer's psychiatrist H. Keith Sigmundson M.D., worked on and published (in 1997; it took a long time to find a journal willing to publish the controversial paper) not only a clear account of the truth behind the case (with David anonymized as "John/Joan"), but a comprehensive set of guidelines recommended to doctors and parents dealing with infants with ambiguous genitalia, strongly advising against genital surgery for cosmetic reasons. Diamond further worked with Dr. Kenneth Kipnis, a philosopher-ethicist, to publish in 1998 clear recommendations that there should be a general moratorium on such surgery when done without the consent of the patient.

Dr. Diamond continued to study the development of psychosexual differences in response to hormonal actions on the fetus, concluding that successful adjustment to a gender role at odds with the sexual organs takes place only where the individual firmly considers themselves to be of the target gender.  Studies showed that children, from a very early age, compare themselves to others and become aware that they are like, or unlike, the standard groups of male or female, long before they have any awareness of differences of genitalia.  If, as they grow, they discover that the gender which they feel themselves to be differs from that which their parents and others assign to them, they are likely to declare very firmly that they do not agree with that assignment.

Other workers in the field have been inspired to undertake further research and increase pressure in this area, and in 2013 the United Nations Special Rapporteur on Torture issued a statement calling for an end to genital-normalizing surgeries without the consent of the affected person.

It is impossible to estimate how many intersex people around the world who would otherwise have gone through this process have been saved from infant genital mutilation, and enabled to live in their preferred gender (and in some cases later to make a mature decision to request transsexual genital surgery to match their physical appearance to their instinctive gender); what is known is that very many of them have expressed their gratitude to and appreciation of Dr. Milton Diamond, who made it possible for them to live their lives in the gender which their instincts demanded.

As a renowned expert on gender issues involving trans- and intersexuality and ambiguous genitalia, Dr. Diamond was a guest speaker/lecturer at medical conferences worldwide.  He received many honors and awards throughout his long and eminent career, including:

·         1999: the British GIRES (Gender Identity, Research and Education Society) International Prize for research on gender and intersex concerns;
·         2000: the Magnus Hirschfeld Medal for sexual science from the German Society for Social-Scientific Sex Research;
·         2005: the Norwegian Diversity Prize for research efforts on behalf of transsexual and transgender people worldwide;
·         2008: award made by the German Intersex Society (Intersexuelle Menschen e.V.) "for his decades-long commitment to the benefit of intersex people";
·         2009: the Regents' Medal for Excellence in Research by the University of Hawaiʻi;
·         2010: the Kinsey Award for 2011, made by the Midcontinent Region of the Society for the Scientific Study of Sexuality;
·         2015: the World Association for Sexual Health gold medal. 

Dr. Diamond’s extensive work product, including research materials and photography, will be preserved in an archival library to be established in his honor.  The library will also house a lifetime collection of ethnic masks, another facet of his omnibus interests.

Dr. Milton Diamond, March 6, 1934 to March 20, 2024, was predeceased by his parents, Aaron and Jennie Arber Diamond, siblings, Bernard and Sylvia, and first wife, Dr. Grace Whitney Diamond.  He is survived by his second wife, Dr. Constance Brinton-Diamond; daughters Hinda, Irene, Sara and Leah Diamond, their spouses, and six grandchildren; and step-children Dr. Maia James Tidwell, Kristina, and Andrew Brinton, their spouses, and eight grandchildren.  Services will be conducted by his son-in-law Rabbi Kenneth Aronowitz.  He will be inurned with full military honors at the National Memorial Cemetery of the Pacific at Punchbowl Crater, in Honolulu, Hawaiʻi.