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Most people are obviously one gender or the other. However, there are quite a significant number who are born with ambiguous anatomical features. Most of these are surgically assigned to one gender or the other in infancy, and a few are left alone phsyically but fairly randomly assigned to be raised as "female" or "male" (usually female, because a fully functioning penis is often viewed as essential to being male). And in a few really awful cases, infant boys who have suffered serious complications from circumcision have the problem "corrected" in infancy by being surgically turned into girls.

In my opinion, people who are perfectly normal physically should be left that way by responsible physicians. But at least some of the people who seek surgical and hormonal gender reassignment were born with some real problems in this area, and may have had some questionable decisions made without their input when they were infants. They should have our full sympathy and compassion, even if they make some choices which sound unwise to the rest of us.

A couple of years ago there was a story in Time or Newsweek about a 15-year-old who was physically male, but who, with his parents support, had been living as a girl for many years. If you just read the story, you'd think the parents were off their rockers for going along with this. But the picture of this "male" told another story -- he was an absolutely feminine knock-out blonde. No matter how hard I squinted at that picture, I just couldn't imagine him as a normal male. Something was clearly wrong there, and it would have taken lifelong hormone therapy to make him feel male or look male to anyone else. So I wouldn't have argued with the decision he and his parents had made to have him live as girl until he was older and adolescence had sorted itself out, and then, if things were still the same, go ahead with reassignment surgery. He was attending a private Christian school, which had discovered his peculiarity, and announced its intention to expel him if he continued dressing as a girl (this is what gave rise to the publicity). Interestly, even in this conservative environment, other students and their parents were defending him, and asking the school to reconsider.

Now as for twenty-somethings who are pursuing careers in the sex toy industry in San Francisco, I'm a lot more skeptical. Gotta think that living in a normal environment for a while would be worth a try, before resorting to irreversible hormone treatments and/or surgery.