When he was 8 months old, in the late ’60s, John suffered a terrible accident. A surgeon mistakenly removed most of his penis during an operation to repair some fused foreskin [actually a circumcision — Info-circ editors]. Concerned that he could never become a well-adjusted male, the doctors persuaded John’s parents to raise him as a girl. They bought him dresses, gave him dolls and taught him how to put on lipstick. Surgeons created a vagina from his remaining male genitalia. At 12, John – now called Joan – received estrogen treatments to grow breasts. Medical reports said he had “easily and fully” accepted his life as a woman. The case became an often cited example of the power of nurture over nature in developing gender roles.

Now it appears that John’s transition from boy to girl wasn’t so seamless. An article published last week in the Archives of Pediatrics & Adolescent Medicine reports that, despite his feminized body and upbringing, John in fact rejected his new gender. He tore off the dresses, dreamed of becoming a mechanic and even tried to urinate standing up – despite his reworked anatomy. “I thought I was a freak or something,” he told the study’s authors. When John was 14, a doctor finally told him about his past. “For the first time, everything made sense,” he says. He proceeded to have his breasts removed and his penis rebuilt. At 25 he married a woman and adopted children.

Researchers say that John’s case, though unusual, has far-reaching implications for the way we understand the power of environment in influencing sexuality. “You can’t magically decide somebody is either male or female,” says Elizabeth Rice Allgeier, editor of The Journal of Sex Research. “Hormones, culture, parents, genetics – they’re all interacting and modifying one another.”

John’s case may also affect the way doctors treat children born with ambiguous sexuality – some chromosomes and anatomy of both sexes. In the past, doctors have usually converted these babies to girls, because that surgical procedure is easier. John’s case shows that, regardless of a child’s upbringing and anatomy, some boys will always be boys.