When you joined the Johns Hopkins faculty in 1975, Dr. John Money had been there for nearly 25 years. How much of an opportunity did you have to interact with Dr. Money?

Oh, I had multiple opportunities. He was a member of my department, and I was responsible ultimately for [oversight] of his publications at the end of his life because the university had decided they were untrustworthy.

Were there opportunities to achieve a fairly direct exchange of worldviews?

I had enough of a fight putting an end to sex-change operations and saying that we were no longer going to teach sexuality to the medical students the way he was teaching it. It became clear that I was going to confront [Money's] approach, and he would have to come and present his material at our grand rounds ... but we didn't have a public debate. He didn't want to have anything publicly to do with my confrontation, as I was restricting more and more his enterprises. By the way, I certainly had plenty of support within [Johns Hopkins], and that could not have been done without some evidence that the patients weren't any better for [gender reassignment surgery]. And there continues to be plenty of evidence.

While Money's work significantly shaped Johns Hopkins' reputation as an institution focused on progressive care for intersex and transgender conditions, your influence led to a decline in surgical intervention and seriously eroded earlier theories of the plasticity of gender identity.

That's right. [Evidence from longitudinal studies such as Framingham suggests] that gender identity disorder may well be something imposed upon people out of their wish to live the roles, and the lives, within their social cluster.

How do you view the popular assumption that science has somehow proven that sexual orientation is determined early in childhood, if not before birth?

Well, as I have said, there is no gay gene. And there are factors more influential than biology. The best data, of course, [comes from the Framingham Study]. If you are a man and you grow up in a rural environment, you are four times less likely to have homosexual relationships than if you grow up in a metropolitan area. That's not left-handedness. If you are a lesbian, you are much more likely to be college-educated. That's not something that happens at conception. My point is that we now know that the environment is very important.

On another front, as the sexuality debate within mainline churches seems to have shifted so profoundly in favor of the left, how do you see the debates of the broader culture changing in the next five to ten years?

It really is amazing ... I mean, 50 years ago [homosexual behavior] was a crime, and now we're talking about [same-sex marriage]. Anyone who wants to stick with the tradition is accused of being a biblical literalist or a homophobic racist, because, in part, of the more fundamental change in our society towards permissiveness, that is, easy divorce, cohabitation and concubinage, abortion, pornography ... and euthanasia. The issue of the homosexual is not separate ... it's all part and parcel of the pandemonium that the permissive movement has brought. We have just licensed all kinds of behavior."

You have noted the critical influence of social behavior clusters on sexual development. You also mentioned that, early on in your medical training, you knew there were certain things that would disqualify you from becoming a doctor, including poor grades, a criminal record or a failed marriage.

Yes, that's right. Fundamentally, I expected that, if I did marry, I was supposed to make it a go.

Now, wouldn't some argue that those were societal expectations which were imposed upon you and your generation?

Yes, and they were good ones - and biblically based, and part and parcel of my commitment to really what amounts to loving relationships. You see, what has happened with the permissive movement is that it has picked up the Freudian confusion of desire and love, making them the same. And with the implication, for example, that I must desire my mother. I don't desire my mother. I love my mother. Now the fact is that in my marriage, of course, I desired this woman and I felt love for her. Now, 50 years into marriage with her, I still desire her, but now I love her. She's irreplaceable. There is this thing that has come and it's different. This person exists for me as irreplaceable. So, there is this confusion of desire and love. [Homosexuality] is erroneous desire.

Much of what you have said seems to underscore the pivotal role that the ecclesial and parish family plays as a behavioral cluster. What more influential environment might there be than the Church?

This is the point. You've got to get the churches ... not just the Anglican churches, but the Roman Catholics and the Presbyterians ... they've got to start talking again about their foundational opinions. There's an idea of there being different kinds of laws in our world: the natural law, the law of desire ... but there is scriptural law that comes out of the Old Testament. And they've got to get all of this straight.

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