Joella's Journey

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    • 00:29


    • 00:42

      NARRATOR: It's September.Joella and her brother are starting back at school.Joella is only 9 years old, and she faces a terrible dilemma.In the coming years, she's going to have to make the hardestdecision of her life.[CHILDREN SINGING]Joella is soon going to have to decidewhether to have major surgery.

    • 01:02

      NARRATOR [continued]: Surgery which will continue her transformation into a girl.Joella was intersex, not clearly male or female.This once rare condition is now warningly on the increase.

    • 01:20

      JULIA FARMER: She's a little girlthat's supposedly in a boy's body, which is not true.The first question I asked was what have I got?Is it a boy?Is it a girl?And I think that's every mother's first question.And the nurse that delivered came upand she put her arm around me and said, I don't know.

    • 01:41

      PROFESSOR IEUAN HUGHES: There certainlyis an increase in intersex occurring,and we have to address the problem asto why is that happening.And one of the areas that we're addressingand many people are addressing around the world nowis whether the environment has changed over the last 50 years.

    • 01:60

      PROFESSOR CHARLES BROOK: means that at the time of birth whenthe first question a mother and father askis it a boy or a girl, there is a hideous silence.And they say we're not sure, because the genital appearanceis somewhere between entirely male and entirely obviously

    • 02:21

      PROFESSOR CHARLES BROOK [continued]: female.

    • 02:22

      DR. PHILIP RANSLEY: Joella shouldknow the nature of her underlying condition,and I think that Joella is remarkableand that she can cope with it.But I know many children who couldn't.

    • 02:32

      JOELLA: On my birth certificate it says Joel David Holiday,but that isn't my name.The reason I've got that name is because they thoughtI was going to die when I was little, because of allthe things I had wrong.But then, I survived and they made me a proper girl

    • 02:55

      JOELLA [continued]: and be able to live.

    • 02:57

      NARRATOR: One in every 1,000 British babieshave intersex symptoms.Sometimes they have testicles and ovaries.Joella was born in a local hospitalwhere no one knew what she was.Fearing she would die, her parentshastily christened her Joel.

    • 03:12

      JEAN IVES: When I got to the hospital,the chaplain was there.And when I saw him I thought the baby's dead.And Julia said they've had to christen him.Joel David Holiday, I baptize you in the name of the Father,and of the Son--

    • 03:29

      JEAN IVES: They said what are you going to call him?She'd got a boys name, but she hadn't got a girls names.And the vicar said, anything will do.So she christened him Joel.

    • 03:42

      JULIA FARMER: I never really understoodwhat was wrong with Joel.I understood that this baby needed a colostomy bag.I understood that he had no anus.I understood that the stomach was on the outside,but I'd never understood to what degree.

    • 03:60

      NARRATOR: Desperate for answers, Juliawent to Great Ormond Street Hospital for sick children.Here she met Mr. Ransley, a leading authority on intersexwho gave her some startling news.

    • 04:11

      JULIA FARMER: When we got to Great Ormond Street,Dr. Ransley said to me that if this child, with this child,he would strongly advise that we rear Joel as a little girl.

    • 04:24

      DR. PHILIP RANSLEY: Well, I firstsaw Joella when she was a baby, and shewas suffering with cloacal exstrophy, whichis a very rare and very severe condition affecting the lowerabdominal wall, the bladder, the bowel, and the genitalia.We don't know its precise cause, but it'sa problem of development of the lower part of the abdomen

    • 04:45

      DR. PHILIP RANSLEY [continued]: so that all the instructions for development are there,all the tissues are there, but they'vebeen put together incorrectly.

    • 04:55

      NARRATOR: Strange though it may seem,whatever sex it may be genetically every embryohas the potential to grow up lookinglike either a boy or a girl.For the first few weeks of life, nothing's decided.Only at about seven weeks under the influence of hormonesdo you develop either ovaries or testes.It's still not clear exactly what

    • 05:16

      NARRATOR [continued]: happened to Joella's tiny growing body,but what finally grew was a complete muddle.

    • 05:23

      JULIA FARMER: We made this decision that we'd definitelychange Joel's sex then Joella.I put Joel to bed on the eve of his first birthday.And then, I set about with a bin bag.And I took everything that was blue,everything that was vaguely boyish awayand I put in a new wardrobe, which was pink.

    • 05:44

      JULIA FARMER [continued]: I had denim dresses and not denim jackets.

    • 05:47

      DR. PHILIP RANSLEY: And it was probablymost difficult day of my life.But by the time we went into Great Ormond Street,Joella then was Joella.And I could never, ever imagine her being Joel any more.I think because the way that Joella was constructed,

    • 06:10

      DR. PHILIP RANSLEY [continued]: that she had no phallus, it wouldhave been impossible with current surgical techniquesand current science to raise her as a functional boy.We had to close her bladder, providean opening for her bowel onto the abdominal wall,and a passageway for the way out for the urineand to remove the testicles.

    • 06:39

      NARRATOR: Turning Joella into a girlis not only a major medical challenge but a legal one.British law does not allow you to change sex.For eight years, Joella's solicitor, Diane Miller,has been trying to persuade the Registrar General of Birthsto change Joella's birth certificate.

    • 06:59

      DIANNE MILLER: As British law stands,you cannot change a birth certificate so far as the sexof the child is concerned.And we are fighting against that.It really should be revised to take account particularlyof cases like Joella's, because the situation for heris absolutely impossible.She's registered as a man.If she goes for a passport, it will register her as the man.

    • 07:22

      DIANNE MILLER [continued]: She obviously can't marry.Locally, it's going to be a difficulty for her,because we still have grammar schools in Spalding.If she goes to grammar school, is shegoing to go to the boys school or is she goingto go to the girl's school?

    • 07:36

      JULIA FARMER: Everyone needs an identity,and a little girl that's poorly, they need one even more.It's just legal red tape that shouldn't be there.And I can't understand why it's takingall this to just get a little girl registered as who she is.

    • 07:57

      NARRATOR: You might think you know which sex you are,but you could be wrong.Joella's sexual parts were incomplete and a muddle.But intersex can also happen in more subtle ways.There are people walking around who,though they look female and think they're female,are actually genetically male.

    • 08:19

      NARRATOR [continued]: [MUSIC PLAYING]

    • 08:23

      JULIA FARMER (CALLING): Joella.Joella.

    • 08:37

      NARRATOR: In the past, children like Joelladid not survive or were not talked about.Not surprisingly, intersex with taboo.Even today, there are very few familieslike Joella's who are prepared to talk openlyabout their dilemma.

    • 08:50

      JULIA FARMER: How do you want it?Do you want it all back or a little bit?

    • 08:53

      JEAN IVES: A little bit.

    • 08:54

      NARRATOR: Julia has always tried to honestly answerJoella's questions.But now that Joella is 10 and fast approaching puberty,she feels out of her depth and thinks it's timeto once again get advice from the medical experts at GreatOrmond Street.Joella is getting ready for her appointment with Mr. Ransley.

    • 09:16

      JULIA FARMER: All right.You ready?

    • 09:18

      JOELLA: Ready.

    • 09:23

      DR. PHILIP RANSLEY: Hi Joella.

    • 09:24

      JOELLA: Hi.

    • 09:25

      DR. PHILIP RANSLEY: How are you?

    • 09:26

      JOELLA: OK.

    • 09:27

      DR. PHILIP RANSLEY: OK?You're looking good.

    • 09:28

      NARRATOR: She's here to find out about the complicated surgerythat will help her to be like other girls.

    • 09:33

      DR. PHILIP RANSLEY: We met a little while ago,and we were talking about doing some more surgery for you.And you weren't terribly keen on that.

    • 09:42

      JOELLA: No.

    • 09:43

      DR. PHILIP RANSLEY: Why was that?

    • 09:46

      JOELLA: I don't know.I just wasn't really keen on that.

    • 09:50

      DR. PHILIP RANSLEY: No.I mean, you know that the problem we face at this momentis that there's absolutely nowhere inside youto store your urine.What we can do is we can fix that for you,and we can build you a bladder.And the only problem with that is

    • 10:11

      DR. PHILIP RANSLEY [continued]: that it doesn't work quite like a normal bladder,so you can't pee in the ordinary way.OK.And at the same time, we have to put a vagina in therebecause the vagina again is not well-formed.And you've been through a lot already.How do you think about coming into hospital?

    • 10:32

      JOELLA: I haven't made up my mind yet, but--

    • 10:36

      DR. PHILIP RANSLEY: There is no future, I don't think,in staying as she is.And we can build her a better lifeif she will allow us to go ahead and offerher the sort of reconstructive proceduresthat we have available to us today.I mean, for her wearing a nappy and being wet is normal.That's what life has always been like, since we

    • 10:58

      DR. PHILIP RANSLEY [continued]: met when she was this big.For her, it's been like that all the time.

    • 11:06

      NARRATOR: One of Joella's problemsis that she doesn't have a proper bladderand has to wear nappies all the time.Mr. Ransley has arranged for her to meetHannah Stuart, a little girl he's recently operated on.

    • 11:17

      BRID CARR: It was really good that Hannahwas able to come today to help you to understand a little bitmore about the operation, wasn't it?Because that makes it-- that's much easier for youto understand than adults telling you.Yeah?And what I want you to remember isthat no matter what we discuss today,it's just about making sure that youand your mom understand what the operation involves

    • 11:40

      BRID CARR [continued]: and what it will mean afterwards.And that's why it was really nicethat Hannah was able to come because Iknow she won't mind telling you about her operation.But at the moment, Joella's not really sick from hers.She has a problem that needs to be sorted outif and when she's ready to catheterize and emptyher bladder just like you.

    • 11:58

      JULIA FARMER: Every day of my lifeI keep thinking I don't want her to have this done.I know she needs to get rid of her nappies,but Joella I think like everybody elseneeds to look as normal and feel as normal as she possibly can.

    • 12:16

      BRID CARR: Just show her where it goes first.If you just stand back a little bityou can see it's just like another belly button.

    • 12:22

      NARRATOR: Hanna is pushing a small plastic tubethrough a hole in her tummy and into a bladderthat Mr. Ransley has surgically constructed.Because Hannah can empty her bladder this way,she no longer has to wear nappies.

    • 12:36

      BRID CARR: And whoopee, there it is.

    • 12:40

      HANNAH: Still going.

    • 12:42

      BRID CARR: The other thing about doing it regularlyis that it's very important that all the wee wee is emptied outevery few hours, because if you don't whatmight happen, Hannah, other than you being wet?You might get an infection.And that can make you quite ill and need antibiotics and stuff.OK, so she's searching for the last little drops now.

    • 13:04

      BRID CARR [continued]: You can see that Hannah knows her way of doing it.Well done.OK, now.All right.Just throw it in the--

    • 13:15

      HANNAH: Bin.

    • 13:19

      BRID CARR: Well done.Well done.Now, let's wash our hands and thenyou can-- What do you think?Not too bad, is it?

    • 13:31

      HANNAH: Not too bad for me.

    • 13:35

      NARRATOR: Joella was born without a bladder, vagina,or ovaries.She can't produce the estrogen that sheneeds to develop breasts and to grow normally.

    • 13:43


    • 13:44

      NARRATOR: She's already much smaller than her friends.

    • 13:46

      PROFESSOR CHARLES BROOK: Come and sit down here, Joella.Hello.

    • 13:49

      NARRATOR: She's here to meet Professor CharlesBrook to see if he can help.

    • 13:54

      PROFESSOR CHARLES BROOK: Now, todayyou measure 128.6 centimeters.And so we are aiming for a final height for you around about 5'2" or 3", something like that.Is that all right.Now, in order to get there we oughtnot to let Joella go much longer without just

    • 14:19

      PROFESSOR CHARLES BROOK [continued]: a tiny smidgen of estrogen.

    • 14:21

      JULIA FARMER: No.And this is all just done by a tablets?

    • 14:24


    • 14:25

      JULIA FARMER: Really?I was expecting it to be so much more complicated.

    • 14:29

      PROFESSOR CHARLES BROOK: Well, I mean,there's no reason why it should be.I mean, although it seems ridiculous to say so,there is not really a huge differencebetween a man and a woman.

    • 14:42

      NARRATOR: Joella's met the expertsand made a great friend in 5-year-old Hannah.Although the doctors are keen to get on with thingsand do the operation, her mother thinksit should be up to Joella to decide when she is ready.And at the moment, Joella still needs timeto get used to the idea.

    • 15:03

      NARRATOR [continued]: No one really knows what causes intersex.It's likely that genes are partly to blame,and a team at the University of Cambridgeis studying intersex families to see if they canpinpoint changes in the DNA.This might explain why such terrible birth defect happened.But increasingly, they're worried

    • 15:24

      NARRATOR [continued]: that chemicals in the environmentmay also play a part.

    • 15:28

      PROFESSOR IEUAN HUGHES: In this department,we now have identified the precise change in the DNA.It is important not only to tell the parentsand try to explain to the parentswhy this has happened to their child,but many of these conditions are genetic in nature.In other words, there's a risk of it happening again.We can make a test during the pregnancy

    • 15:50

      PROFESSOR IEUAN HUGHES [continued]: to find out whether a similar child has been affected,but also there may be members of the family whoactually carry the mutation.In other words, they don't have the condition,but clearly if you are a carrier then thereis a chance of perhaps passing on the abnormalityto another generation.

    • 16:09

      NARRATOR: The increase in intersex casesisn't just happening to humans.The same thing seems to be happening to other animals,and it's particularly affecting animalsthat live in polluted streams like fish and alligators.Perhaps something in the water is to blame.

    • 16:25

      PROFESSOR IEUAN HUGHES: There is evidencethat in amphibian and reptiles there areintersex problems occurring.Quite profound incidences and problems as well.And also quite recently there havebeen reports about polar bears displayingafter abnormalities consistent with some form of intersex.

    • 16:46

      PROFESSOR IEUAN HUGHES [continued]: So what may be happening here is that in the Arcticof all places there is now exposure to toxic chemicals,these so-called gender-benders.And one can invoke, well, perhapsif it's working in animals is the same phenomenona danger to humans?

    • 17:06

      HANNAH: Oh, that's my chair.Although, there's a [INAUDIBLE].Ben [INAUDIBLE] is mine.Definitely mine.

    • 17:15

      JOELLA: Mine.Mine.

    • 17:17

      HANNAH: Mine.

    • 17:18

      PROFESSOR CHARLES BROOK: I think to accepta condition of intersex is extremelydifficult for everybody.About the most fundamental difference between peopleis whether they're male or female.

    • 17:30

      JOELLA: Girls like to be looking in the mirror a lot outof the way of boys so they can talk about girly things,make-up and nail varnish and boys just get boys with that.They just like to talk about motorcars and things like that.

    • 17:47

      PROFESSOR CHARLES BROOK: They're are fully developed maleson one hand and fully developed females on the other,but there are all degrees in between.There are undoubtedly people walkingabout appearing to be entirely normal women whohave male chromosomes, and there may wellbe people who don't know it.

    • 18:08

      NARRATOR: If what Professor Brooks suggests is true,then there may be many more cases of intersexthan are ever diagnosed.

    • 18:16

      HANNAH: I wonder what we're going to be like when we're 18.A life that is just so full.If you had a choice, who would you go out with?

    • 18:26

      JOELLA: I don't know.[INAUDIBLE]

    • 18:29

      HANNAH: Do you think there's any decent boys in our school's?

    • 18:34

      JOELLA: No.

    • 18:34

      HANNAH: You said you're friend with died?

    • 18:36

      JOELLA: Did.

    • 18:38

      HANNAH: Did?

    • 18:39

      JOELLA: I want to get my writ and I want to have a good job.And I just want to be like a normal woman.I can't have babies, but I could adopt and fosterchildren that don't have any homes.I really like that.

    • 19:07

      NARRATOR: Professor Brook is helpingJoella fight her legal case.He's written a letter to the Registrar Generalexplaining why in the confusion around her birthJoella was christened and registered as a boy.Joella's solicitor is hoping the authorities will see sense.

    • 19:25

      DIANNE MILLER: I trust that they will see senseand without any further proceedings willchange Joella's male registrationto female registration.But if we continue to have a refusalto alter the registration, then if judicial review does notsucceed we've got to go to the European Court of Human Rights.

    • 19:53

      JOELLA: My birth certificate is in a different name.My name is Joella, and on that birth certificate it says Joel.The other thing where it says male,all that's got to be changed is an f and an e,but they just won't do it.But I need mine changed so that Ican be a girl more than everyone thinking I'm a boy.

    • 20:16

      NARRATOR: Adults who've had sex changeoperations have tried to get the law changed and failed.Joella is clearly different, but that differencedoesn't seem to be recognized.

    • 20:26

      DIANNE MILLER: I don't think the registrar-general understandsthe concept of intersex babies whatsoever.Hopefully, when he reads all of the papers that I have sentto him it will be understood and appreciated how differentJoella's case is from anyone else's.

    • 20:44

      PROFESSOR CHARLES BROOK: It's a travestyof the truth to say that's she is transsexual in any shapeor form.I mean, it chairs a complete want of understandingof her problem.

    • 20:57

      JULIA FARMER: I think it's very unfair to labelJoella as a transsexual.I don't wish Joella to have any label on her.She was a little girl born with severe deformities.

    • 21:10

      JEAN IVES: It's not like she's had a sex change as a grown up.They have a choice, but a child doesn't.It's four and a half months since Joella lastsaw Professor Brook.Today, she's having a hand x-ray at Great Ormond Street

    • 21:30

      JEAN IVES [continued]: to measure her bone development.And she will find out just how much the estrogen tabletshave helped her grow.

    • 21:37

      MEDICAL TECHNICIAN: OK, nice and still there.Well done.OK.That's all finished.Good girl.

    • 21:47

      PROFESSOR CHARLES BROOK: 1 3 1 8.OK.Let's see.I have 1-3-1-8.OK.Can you stand on the weighing scale.It's 4 and 1/2 months since I saw you, and during that timeyou have grown in 3.2 centimeters.Which is terrific.

    • 22:11

      PROFESSOR CHARLES BROOK [continued]: That's really good.Excellent.And there's been a little tiny bit of change,hasn't there, on your chest too?

    • 22:23

      JOELLA: How is x-raying my hands going to help my growth.

    • 22:27

      PROFESSOR CHARLES BROOK: It'll helpme to tell you how tall you're going to getand how much time we've got to get you thereif you see what I mean.Probably, we're going to find that you have the bonedevelopment of a girl between one and twoyears younger than you, which will give ustime to get lots of growth in.And one of--

    • 22:47

      NARRATOR: Professor Brook sees children like Joella rightthrough to adult life, and he'll be seeing many moreif the findings of Professor Hughes Cambridge's teamare correct.

    • 22:57

      PROFESSOR IEUAN HUGHES: We are concerned,as are many people, that the more minor formsof the intersex problem, in other words, the genitaliaand [INAUDIBLE] haven't completely developed properly,and is actually increasing.It has been so for the last 30 or 40 years.Now, that suggests that there's something otherthan just genetic factors.Some of it may be explained by the fact

    • 23:18

      PROFESSOR IEUAN HUGHES [continued]: that the environment has changed.And one of the big areas that it has changedis that there's far more estrogen particularlyin the last 40 years with the adventof the contraceptive pill, there ismore estrogen in the effluent in the sewage thathad been previously.We do know what is in the water supply.

    • 23:38

      PROFESSOR IEUAN HUGHES [continued]: We can analyze that chemically, and then see perhapsis there a link between cause and effect.

    • 23:45

      NARRATOR: The increase in intersexis now being linked to other disturbing trends,like falling sperm counts and increasing testicular cancer.These changes are all being blamed on our increasingexposure to chemicals that mimic estrogen. In Cambridge, they'retesting products like clingfilm and fungicidesthat contain estrogen mimicking chemicals.

    • 24:05

      NARRATOR [continued]: They want to see if chemicals from these productscan trigger intersex.

    • 24:09

      PROFESSOR IEUAN HUGHES: You can imaginethat this early, very early fetus,this very early baby developing, very sensitive tissues,if those tissues are exposed perhaps just a little bit toomuch estrogen at a time when it should be developingon the male line and perhaps that could contributeto this increase in frequency.

    • 24:33

      NARRATOR: To deal with growing numbers of these bafflingcases, a unique intersex clinic has recently been set up.Professors Hughes, Brook and Ransley have joined forcesand are hoping that by pooling their expertise and researchthey'll be able to come up with answers.

    • 24:50

      DR. PHILIP RANSLEY: My view todaythat children assigned female whodon't have any form of vagina at allshould have that constructed in early infancy,even if it needs modification in adolescence or adult life.In Joella's case, we didn't do thatand it leaves us with the task of constructing a vagina now

    • 25:14

      DR. PHILIP RANSLEY [continued]: or after puberty.My view is that it's better earlier than later.

    • 25:21

      HANNAH: Oh, wow. [INAUDIBLE]

    • 25:23

      JULIA FARMER: From Joella being very early,I've had to make decisions that Idon't think any other mother has made, you know,choosing a sex and absolutely everything.And I just think that now she's old enoughto tell me what she wants.

    • 25:37

      JOELLA: Mr. Ramsey wants me to have an operation calledMitrofanoff but I'm not too keen on having that operationbecause I have to stop every three hours elseI'll get over full and it will just be horrible and makemy kidneys go all funny.I don't care about being different.

    • 25:59

      JOELLA [continued]: If they don't like me, then they don't like me.I don't care.It's been 10 years, and I've been OK with how I am.

    • 26:09

      JULIA FARMER: She doesn't want the responsibility of itI think of a Mitrofanoff yet.She just wants to be a child.She's so happy and content in being who she is,and until the day comes where she's notcontent with the way she is and the nappies and everything,than I've got to respect everything that she wants.

    • 26:32

      PROFESSOR CHARLES BROOK: I don't think the Joella's future willbe easy for her.To some extent of course it depends on how muchshe understands and how much she wants to make it is a success.But I think that one has to face the factthat the construction of an artificial vaginaputs all sorts of problems in the way of intercourse

    • 26:52

      PROFESSOR CHARLES BROOK [continued]: and so on.And the anxieties that any teenagerhas about their sexuality and their sexual functionare bound to be more for her.

    • 27:03

      DR. PHILIP RANSLEY: It is a very profound decisionthat you help the parents to make, but in a wayI don't think we're playing God.I mean, God and the Home Secretaryhave decided that there are only two sexes.And if you apply for a passport or fillin an American immigration form, there are only two boxesto tick.

    • 27:24

      DR. PHILIP RANSLEY [continued]: And therefore, we have to help them decide whichbox their child should go into.And I think we feel very humble in making that decisionto give these children the best chance of the best lifethat we can make for them.

    • 27:39

      DIANNE MILLER: I think there's a resistance to changing the law,because it would be a foot in the door to a lotof other cases being allowed.And therefore, I think that there'svery little hope of the law being changedalthough obviously I hope that they would acceptmy argument that this is a one off so far

    • 27:59

      DIANNE MILLER [continued]: as Joella is concerned.And there is no problem in changing her birth certificate.

    • 28:09

      HANNAH: Dear Hannah, I'm writing to say thank youfor coming Great Ormand Street to show me your catheter.It made me understand what they were talking about,and now I'm not so worried.I've decided not to have the operation for lots of reasons,but most important is that I'm happy as I am.My mom says that nobody is perfect,

    • 28:30

      HANNAH [continued]: and nobody is the same.I just want people to like me even if I wear nappies.I don't want to change myself to make other's happy,because I like being me.Thank you, Hannah.Love, from Joella.

    • 28:49

      NARRATOR: On the 19th of November,the family got a totally unexpected letterfrom the registrar-general telling themthat Joella's birth certificate had been changed.She's now legally a girl.

    • 29:06

      JULIA FARMER: Make a wish.

    • 29:07

      JOELLA: Oh, hang on.I wish to meet Manchester United.

    • 29:11

      JULIA FARMER: I knew she'd wish for that.Opening that letter was-- Well, I just kept reading it.I didn't know what to-- I didn't understandwhat it said, to be honest.And I was expecting a catch and there wasn't.And it was just everything, everything we wanted.And it just means that she's got a future now.

    • 29:32

      JULIA FARMER [continued]: She's got her own identity, and she's just the sameas everybody else.This said male.Now, it says female.And before it was like that.Now, it's like that.And then there was David there.But now we've gotten rid of that and put Holiday.I wanted my birth certificate more

    • 29:53

      JULIA FARMER [continued]: than anything for Christmas.I can get married.[MUSIC PLAYING]

Joella's Journey

View Segments Segment :


Joella’s Journey follows a child born intersex and discusses the growing number of these cases. The documentary follows the process she underwent to develop an identity, as well as decisions her parents and doctors made to complete Joella's development into a female or male.

Joella's Journey

Joella’s Journey follows a child born intersex and discusses the growing number of these cases. The documentary follows the process she underwent to develop an identity, as well as decisions her parents and doctors made to complete Joella's development into a female or male.

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