Htut Lin and Htut Win (originally posted 6/27/07)

At the time I wrote this article I did not know that David Reimer (John/Joan Theissen) had taken his own life. However, I feel that this sad fact reinforces my argument.

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Some background: A Toronto paper is doing a feature, "Ten Things Canadians Do Best". I'm sure nine of those things are perfectly legitimate. If "have progressive environmental policies" and "have a very low murder rate" are on there, I'm totally in agreement. But, #1 on the list is "separate conjoined twins".

The reference is to the Hospital for Sick Children in Toronto. They've dealt with a dozen or so sets of conjoined twins since the '60s. The case that garnered the most media attention, however, was the highly experimental 1984 separation of Htut Lin and Htut Win, two-year-old conjoined twins from Burma. The Htut brothers had separate upper bodies by shared three legs (two "good" ones and one that was considered to be vestigial). They also shared one penis and one pair of testicles.

Apparently, gender and its determinants happened to be a hot issue in the medical world around the time the Htut boys were flown from their tiny Burmese village to the Toronto hospital. Conveniently, this surgical team found itself with the perfect opportunity to test hypotheses about the biology and sociology of gender.

So, Htut Win was "made into" a girl. I also found out that Lin didn't get both testicles, only one. The other, it seems, went into the wastebasket. At the time of the operation, the surgical team swore that the sex change was absolutely necessary for the twins' separation - but I find this impossible to believe, given that Win was "castrated" (as one press release states with a chilling nonchalance) and the gonad that was rightly his went to waste. The opportunity existed to preserve Win's maleness, yet it was overlooked in the interest of the experiment.

Back to "Ten Things..." I penned this angry letter to a feature writer with the Toronto paper. She was not a player in the Lin and Win case, and I can only imagine the look on her face when she found my lengthy diatribe in her inbox. As I was hitting "Send", I realize it was probably going to the wrong person, but she's been a good sport about it so far.

Anyway, here's the letter.

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Dear [journalist],

Having read your article "Twin Peaks", I am writing to convey my shock and distaste that Toronto's Hospital for Sick Children - and, apparently, journalists who give publicity to the hospital - still tout the 1984 surgical separation of Htut Lin and Htut Win, conjoined twins from Burma, as among their greatest accomplishments. On the very basest level, yes, the Htut twins separation was a "success" - that is, both twins left the operating room alive. Yet to give a forced sex reassignment surgery to a two-year-old is medical barbarity at its very worst.

Are you aware of the "John/Joan" case, in which an infant boy lost most of his penis in a botched circumcision and was "turned into" a girl at Maryland's Johns Hopkins Hospital? This was in 1967. Although "she" was dressed in girl's clothes and reared as a girl, "Joan" grew up incredibly conflicted and eventually shed the female identity that had been forced upon "her". John is now a grown man with a wife and family, and he is an activist for the intersexed who speaks against the convention of "normalizing" intersex babies at birth. I urge you to read this article, published in The Rolling Stone in 1997, if you are unfamiliar with this case.

And, are you aware that "John/Joan" is just one of myriad cases where a child whose gender was arbitrarily assigned at birth has rejected his or her chosen gender and come to regret his or her parents' decision to have him or her "normalized"? The book One of Us: Conjoined Twins and the Future of Normal by Dr. Alice Dreger delves more deeply into the practice of surgical normalization of intersex babies, conjoined twins and other people born with unusual bodies. The consensus, among people who are born intersex and even among a growing number of doctors, is that such surgeries are detrimental.

Which brings us to little Htut Win, who would be 23 now. "Her" gender was chosen for her at the age of two, rather than at infancy. Two-year-olds already have the beginnings of an identity, including gender. Win would've known he was a boy at the time the surgery took place. And yet, the Htut twins disappeared back to Burma as the media fanfare accompanying their "successful" separation disappeared as well. We (the public) do not know what became of Win, if "she" is still living as a female, or, like John (aka "Joan") Theissen, he has rejected his false female identify and tried to make a life for himself as a young man. Then there is the problem of the fact that both twins had one leg each and, as I recall, colostomies. The whole purpose of separating the twins was to quell insults and abuse from superstitious, rural Burmese villagers - yet wouldn't a pair of one-legged twins, who couldn't use a toilet, and one of whom was in essence a hermaphrodite, bring just as much suspicion? I do not know much of Burmese culture; perhaps a double-child is seen as a particularly bad omen while two disfigured children can pass unnoticed. Presumably someone at the hospital has contact with the Htut family, but in my years of research I have never found an update on the what became of the twins, especially unfortunate little Win.

The archaic and, dare I say, sexist implications in the surgical team's press releases at the time were shocking to me as well. Htut Lin was chosen to be "the boy" because he was "more aggressive" than Win. Apparently, vaginas are easier to "make" than penises - Win's was made out of a piece of his large intestine, which does not possess the same nervous structure as normal vaginal tissue. Even if Win was able to function sexually, "she" wouldn't have been able to enjoy it.

It was also distressing to learn that a similar surgical abomination took place in Portugal in 1999. Jose and Joao Omar were born in Mozambique sharing a single penis. Their separation led to the renaming of little Joao as "Helena". Again, no update was ever given on how "she" - now a six- or seven-year-old - adjusted to "her" new identity. The Portuguese case was not nearly as publicized as Lin and Win's - perhaps the surgical team knew they had committed an act of unspeakable cruelty against little "Helena".

However, attitudes have changed somewhat, and I am pleased to report that in 2004 a pair of twin boys from Sudan, joined at the back and sharing a penis, were both boys when they left the operating room. I am still saddened that such a fate was not bestowed upon Htut Win or "Helena" Omar.

Thank you for your time.

Sincerely,
[my name]
Austin, Texas

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My subsequent exchanges with this writer have cleared up some of my lingering questions about Htut Win. The twins apparently returned to Toronto on several occasions for physical therapy and to receive prosthetic legs. Though the doctors had always planned for Win to receive female hormones, but such treatments were not available in Burma. Thus, Win's long hair, pink ruffled dress and hair ribbons were gone when he returned for a follow-up visit.

At the age of 10, Win told his mother that he was a boy. The parents complied with their son's wishes and chose to let him live as a male.

A recent (2005) update quotes Win as saying that the transition caused him no distress and he did not resent the surgeons' decision. (I can only imagine his sincere forgiveness is due to the fact that he is a Buddhist. An American in the same situation would've buried his doctors in lawsuits.)

The article, however, did point out that Win was feminine in his features and manners. This is no doubt the result of a lack of male hormones at puberty, caused by the boy's castration. Presumably, too, he still has the crude vagina cobbled together from a piece of gut - an operation the surgeons describe so casually you'd think they were talking about sewing a purse. And Win is still registered as a female by the Myanmar government.

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I learned some new (to me) details about another case the Toronto doctors worked on. Shiva and Meera Ramkhalawan were brought to the hospital from Trinidad at the age of a few days. They were ischiopagus tetrapus twins, meaning they had four legs but were very closely joined in the lower abdominal region. There was only one set of genitalia. Shiva is a male name, Meera is a female - the parents had been told only one of their twins would get to "keep" the penis, while the other would suffer a fate similar to Win's. However, the Ramkhalawan twins were more fortunate than the Htuts. The surgeons were able to half the penis and reconstruct each of the two halves into a functioning member. Meera was renamed Heera.

That it was possible to save Heera's maleness makes it, in my opinion, even harder to exonerate the Toronto surgical team. So, too, does the fact that the hospital still speaks of the Htut case as an act of profound charity and even heroism. My research on conjoined twins over the years has shown time and again that surgeons such as these do not admit mistakes. The Singapore doctors whose appalling act of hubris ended the lives of Laleh and Ladan Bijani still defend their actions, two years after the tragedy. Johns Hopkins Medical Center has not apologized for killing the infant Lakeburg twins in 1994. Yet the doctors and hospitals involved continue to prosper, proudly displaying even these failed cases on their resumes.

Htut Win has forgiven the men who mutilated his body when he was a child. So why can't I forgive them?