[RADIOLAB INTRO]

LULU MILLER: They got it. Okay, they got it.

JAD ABUMRAD: What up, ladies?

LULU: Hey!

JAD: How's it going?

ALIX: Is that Jad?

JAD: It is.

ROBERT KRULWICH: Yeah.

JAD: It is indeed.

ROBERT: Hey, Alix.

ALIX: Hi.

JAD: Hey, this is Jad Abumrad. This is Radiolab. Today, Robert and I invited two folks into the studio. Our former producer, Lulu Miller, who basically started the show with us. She's even in the Sonic ID.

[RADIOLAB INTRO]

LULU: Okay.

JAD: You can hear her right there say "Okay."

LULU: Okay.

JAD: And we invited her in. And also Alix Spiegel, reporter at NPR. Because Lulu and Alix together are starting a new radio show.

ALIX: We are.

JAD: And podcast, and everyone's very excited about it. It's called Invisibilia.

JAD: Is that like a Latin word? What is that?

ALIX: It is a Latin word. It's a name that my mother came up with. This is Alix talking. Because she's a French medieval historian, so they just, like, know stuff like that.

JAD: [laughs]

ROBERT: Under what circumstances did this come up?

ALIX: We were just, you know, hanging the way that the Spiegels hang in, like, her bedroom. And I was like, "But this is what the show is about. It's about all these invisible things. They're invisible, but they're affecting you. And what's the name?" And she was just like, "Why don't you just call it Invisibilia?"

ROBERT: Did a little [angelic singing]?

ALIX: I was like, ba bing!

JAD: And it's Latin for what?

LULU: Invisible things.

JAD: So the show promises to be sort of an investigation of all the invisible things that guide our behavior that we generally don't see. Now they've been sharing some stories that they've been working on as they're going, and a lot of it is kind of amazing. So we asked them if we could preview one of their stories for you guys. This one you're gonna hear comes from an hour that they're producing on the topic of categories, like the different boxes that we put things in our world into.

LULU: And the first piece in the show looks at one of the most basic categories that there is. The first question that anybody asks a parent who has a new baby: is it a boy or a girl?

ROBERT: Hmm.

LULU: I have to say, in my career, I have done a number of stories about a blurring between boy and girl, but the story I'm about to tell you is about a kind of blurring that I had never heard of before.

JAD: Hmm.

ALIX: Hi.

PAIGE ABENDROTH: Oh, hey. How's it going? Come on in.

ALIX: This is a person I met who calls herself Paige Abendroth.

PAIGE ABENDROTH: Abendroth means the color of the sky when it's that deep red right before the sun sets.

ALIX: Paige had bright blue eyes, long, black hair in a ponytail.

PAIGE ABENDROTH: Come in. Make yourself comfortable.

ALIX: Thanks.

ALIX: We were in San Diego, by the way, setting ourselves up to talk.

ALIX: I'm gonna make you scoot. Scoot, scoot, scoot, scoot, scoot, scoot, scoot, scoot.

ALIX: So after we sat down, I asked Paige to show me some pictures of herself from about a decade before.

PAIGE ABENDROTH: So there aren't many.

ALIX: In the pictures was a man, a man in a Naval uniform. He was very buff, strapping.

PAIGE ABENDROTH: Yeah, very military. I had a high and tight haircut.

ALIX: And there they were, those bright blue eyes.

ALIX: You look pretty conservative here, too.

PAIGE ABENDROTH: Yes, I do.

ALIX: Paige spent the first three decades of her life as a man. But let me be clear from the top. Paige's story is not the transgender story that you typically hear. Typically, people who are transgender feel like they are one gender trapped in the body of the other gender. Their internal gender identity is misaligned with their biological sex, but it's static. It stays the same. But when I was talking to Paige, that didn't capture her experience at all. Because when I met her, Paige was flipping, flipping between the category 'male' and the category 'female.'

PAIGE ABENDROTH: I flip back and forth multiple times a day. I'll say I maybe spend 20 percent of my time in guy mode and the rest of it in female mode.

ALIX: One morning, Paige would wake up feeling strongly that the gender at the core of her being was female. But then suddenly ...

PAIGE ABENDROTH: It's just kind of like [snaps].

ALIX: ... there was a change, and Paige was in guy mode. When that happened, all kinds of things about Paige changed. Her posture changed.

PAIGE ABENDROTH: And my weight kind of moves up to my shoulders. Like, my center of gravity is kind of up here.

ALIX: More significantly, she told me, there was a real psychological shift.

PAIGE ABENDROTH: The way I see the world and the way I interpret the world is different.

ALIX: When Paige was in male mode, Paige was less interested in people—in talking to them, in making eye contact with them.

PAIGE ABENDROTH: I'm a lot more introverted. I'm a lot more—I'm quieter.

ALIX: But in female mode, she was much more expansive. And sights, sounds, smells, likes, dislikes, they were all different.

PAIGE ABENDROTH: When I'm female, all my emotions are like just really vivid, like, colors.

ALIX: Basically, Paige was constantly—and very abruptly—bounced between two starkly different ways of being in and filtering the world. Paige wasn't able to dictate when or where this happened.

PAIGE ABENDROTH: I really have no control over it.

ALIX: She'd be sitting in her office, talking to her boss and bam! She'd be walking down the street. Bam! Now when this happened, it wasn't like Paige was an entirely different person.

PAIGE ABENDROTH: I'm always the same person. I experience the world differently, but I'm still me. I still am in control of myself. I still have my same wants and desires.

ALIX: There was just this profound difference beneath everything.

PAIGE ABENDROTH: It's just a sense of knowing. Like the way that you know you're a female right now without having to be told, it's the same way that I know that I'm a female. And when I'm a guy, it's the same way I know I'm a guy. It's just this instinctual knowing of what I am.

ALIX: By the way, right now are you male or female?

PAIGE ABENDROTH: Definitely in girl mode, yeah.

ALIX: And how long have you been in girl mode right now?

PAIGE ABENDROTH: About an hour, I'd say.

ALIX: So maybe you're thinking that Paige seems nuts.

PAIGE ABENDROTH: Mm-hmm.

ALIX: Paige herself has had that thought.

PAIGE ABENDROTH: I thought that I was going crazy.

LAURA CASE: Yeah. I mean, some people first hear about this, you know, they may wonder if it's dissociative identity disorder, which is formerly known as multiple personality disorder, or a form of psychosis.

ALIX: This is Laura Case, a researcher who has worked in the lab of a very famous neurologist—a man named V.S. Ramachandran.

LAURA CASE: At UC-SD.

ALIX: And a couple years ago, they got an email from a woman describing exactly the same kind of experience that Paige describes.

LAURA CASE: Someone who experiences this switching back and forth.

ALIX: And while on the one hand, they were dubious ...

LAURA CASE: We get a lot of interesting emails in our lab, emails from people claiming all kinds of wild sounding experiences.

ALIX: On the other hand, they study the brain. And they have seen brains do all kinds of things. They've seen brains that suddenly stop recognizing faces, brains that think their owner has a mysterious limb. So they were curious.

LAURA CASE: Here's a person who goes back and forth in terms of what their brain seems to be telling them about whether they're male or female. How fascinating would that be to look and see what could be changing in the brain or in their environment to be causing that shift and identity?

ALIX: So they decided to look into it. Over the past couple years, Case has found dozens of people with this experience. And Case has started testing them in different ways, including giving them psychological screenings. And what she found was that as a group, these people are not mentally unstable.

LAURA CASE: They simply don't have dissociative identity disorder. None of them had any form of psychosis or anything like that.

ALIX: They ruled out bipolar, schizophrenia, and saw some other interesting things.

LAURA CASE: They were actually a little bit more ambidextrous than the general population.

ALIX: Basically, they found enough to suggest that there might be something neurological going on, so they published a very, very small study.

LAURA CASE: A preliminary sort of report in a journal called Medical Hypotheses.

ALIX: And then started on another study.

LAURA CASE: But we're not ready to talk about the data from that study.

ALIX: I did, though, get one tidbit about this from Case. And again, this is very, very, very, very preliminary. But she found that the same person will perform differently on certain tests depending on whether they are in male or female mode. For example, she gave the same person these mental puzzles.

LAURA CASE: That test spatial and language abilities.

ALIX: And Lulu?

LULU: Mm-hmm?

ALIX: You know how men are really good at—supposedly, men are really good at kind of spatial ...

LULU: Directions?

ALIX: No, like, spatial manipulation.

LULU: What does that mean?

ALIX: I don't know how to explain it exactly, but like ...

LULU: You're a woman, so you wouldn't understand it very well.

ALIX: I'm a woman, so I wouldn't understand it very well. Right. Like, take a geometric shape, rotate it in your mind. Stuff like that.

LULU: Okay.

ALIX: They found when they gave these tests to these people when they were in their different states, they had different abilities.

LULU: Oh, wow!

ALIX: So, like, when they were men, they performed more as men, and when they were women, they performed more as women.

LULU: Whoa!

LAURA CASE: Yeah. We did see some differences between gender states that were intriguing but not conclusive.

ALIX: Anyway, here's the point. There's some evidence that the shifts these people say that they are experiencing could be real. Which brings us back to Paige.

PAIGE ABENDROTH: You know, I wake up in the morning, I'm like, am I male? Am I female?

ALIX: I wanted to talk to her about what it was like to move in this way between categories.

ALIX: So let's just start with, like, your childhood.

ALIX: Now Paige didn't start off this way. She started off as a he, who really didn't even have that experience that you sometimes hear about where people describe feeling from a very early age like they're trapped in the wrong body.

PAIGE ABENDROTH: I mean, loved playing with GI Joes.

ALIX: And as teen, too, he was a boy obsessed with the things that most boys are obsessed with.

PAIGE ABENDROTH: I always thought about women.

ALIX: You never thought you were gay?

PAIGE ABENDROTH: Uh-uh.

ALIX: Still, Paige says there were these strange momentary flashes that were disturbing.

PAIGE ABENDROTH: I remember looking at girls, and not just being attracted to them, but thinking that I was supposed to be them, and wishing that I could kind of go over to the girl group and be accepted because that's where I felt I should be. But these thoughts were really inconsistent. It's not—I didn't always feel that way.

ALIX: So Paige grows up, graduates from high school, goes to college and then really starts to struggle. The flashes are still there. College is hard. Paige drops out and begins to feel really, really lost. And then, in a somewhat odd place, Paige finds relief in the Navy.

PAIGE ABENDROTH: I love the discipline of it, the structure of it.

ALIX: First of all, for some reason, those flashes go way down.

ALIX: Why?

PAIGE ABENDROTH: I don't know. I saw myself as being more of a guy than I ever did before.

ALIX: But really, it was while stationed at a naval base in Japan that Paige found relief in a way that will be familiar to many of you.

PAIGE ABENDROTH: I walked around the corner and I saw her. And she was just kind of bouncing around, and she was very energetic. And ...

ALIX: It was love at first sight.

PAIGE ABENDROTH: Immediately, I knew that there was something, like, special about her.

ALIX: And even though Paige had never been a very aggressive person, Paige completely went after this girl.

PAIGE ABENDROTH: I was smitten. I was immediately smitten.

ALIX: And it worked.

PAIGE ABENDROTH: We were just like this. We were so in tune with one another. I mean, we knew each other so good we could communicate, like, with a series of clicks.

ALIX: Like, what do you mean?

PAIGE ABENDROTH: I mean, [clicking] and, like, the other person would answer back, and we'd know what we were, like [clicking] getting at.

ALIX: And sometimes, it would mean, like ...

PAIGE ABENDROTH: It could mean, like, how are you? Or it could just be acknowledging that, you know, you're there. [clicking].

ALIX: So began the best chapter in Paige's life.

PAIGE ABENDROTH: [laughs] I can't believe you're recording this.

ALIX: They get married. They move to California.

PAIGE ABENDROTH: Got a home, had a car, had a steady job. I had everything that I ever wanted [clicking]

ALIX: Okay, what does that mean?

PAIGE ABENDROTH: It depends on the context. [laughs]

ALIX: And then Paige turns 30, and all of a sudden starts feeling really, really tired.

PAIGE ABENDROTH: I'd—I mean, just coming up the steps, I would run out of breath.

ALIX: So Paige goes to see the doctor.

PAIGE ABENDROTH: And eventually, what they finally figured out was that my body thought it'd be a really fun joke on me to stop producing testosterone. Basically, at 30 years old, I had the testosterone level of an 80-plus-year-old man.

ALIX: So the doctors put Paige on testosterone replacement therapy, and very quickly the exhaustion went away.

PAIGE ABENDROTH: Physically, I felt like I had before.

ALIX: But the flashes? They're back with a vengeance.

PAIGE ABENDROTH: I would have those feelings again where I thought I was supposed to be female, except there wasn't anything subtle about it. It was a very strong feeling that something had gone terribly wrong and that I was not supposed to be male.

ALIX: In these moments, Paige would look down at her body, this hard torso, covered in hair, and feel utter disgust.

PAIGE ABENDROTH: Imagine you woke up and your body was a cockroach. It was really unsettling.

ALIX: Did you—so did you start talking to your wife about it?

PAIGE ABENDROTH: No, I was terrified. I thought I was going crazy. I didn't want her to think less of me, and it was something that I kept inside.

ALIX: Paige started telling me that occasionally during this period, to ease this feeling of disgust that came over her when she flipped into female mode but had a male body, she would secretly put on women's clothing. She felt a need to cover this body that felt so wrong with clothes from the right sex.

PAIGE ABENDROTH: I was just trying to do anything I could to make myself feel more female.

ALIX: So I started asking questions about this.

ALIX: Do you remember the first time you decided to do that?

PAIGE ABENDROTH: Mm-hmm.

ALIX: But suddenly, the whole tone of the conversation changed.

PAIGE ABENDROTH: I don't want to talk about it.

ALIX: Okay, all right. So when was—so after that, what happened? So, like, you—do need to take a break?

PAIGE ABENDROTH: Yeah, I'm cool.

ALIX: Yes, you're cool, you want to take a break? [laughs] Or yes, you're not cool?

PAIGE ABENDROTH: Yeah, I ...

ALIX: Okay, sure.

ALIX: Paige got up and disappeared around the corner. I could hear the faucet running in the bathroom. And when she came back, she wanted me to know something.

PAIGE ABENDROTH: If it matters, I flipped back into guy mode.

ALIX: Okay, so is that why you don't want to talk?

PAIGE ABENDROTH: It's just kind of like [snaps]. It's just different now.

ALIX: You flipped into guy mode. Was it when your eyes closed that you flipped into guy mode?

PAIGE ABENDROTH: I don't know.

ALIX: So are you in guy mode right this second?

PAIGE ABENDROTH: Mm-hmm.

ALIX: So is it hard to answer questions?

PAIGE ABENDROTH: Mm-hmm.

ALIX: Okay.

PAIGE ABENDROTH: I can—I'll be okay. I just need, like, a little bit.

ALIX: We sat awkwardly for a while, neither of us quite sure what to do. It did feel like there was a difference in Paige, even in the way that she talked.

ALIX: So how are you doing?

PAIGE ABENDROTH: I'm good.

ALIX: Are you male or female?

PAIGE ABENDROTH: Male.

ALIX: Okay. Is that okay?

PAIGE ABENDROTH: Yeah, let's do this.

JAD: Actually, we're gonna do it in just one minute after we take a quick break.

[LISTENER: Hi, this is Candice, currently calling from her bicycle. Radiolab is supported in part by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org. Thank you!]

JAD: We're back. This is Radiolab, bringing you a preview of the NPR show Invisibilia. And we'll continue with our story about Paige Abendroth. Here's Alix Spiegel to pick up the tale.

ALIX: Paige explained that the next chapter of her life involved finding a name for what was going on with her—bi-gender, people who consider themselves both female and male at the same time. She found it on a bi-gender website, and though only a small portion of the people on the website described flipping like Paige, it felt like this could be an explanation.

PAIGE ABENDROTH: The way I felt was other people felt that way, and it was real. It wasn't, you know, just some weird psychological construct.

ALIX: But with this validation came a horrible realization: Paige had to tell her wife.

PAIGE ABENDROTH: I told her that we needed to talk. And so we sat down in separate chairs. I think I was on the couch and she was on her recliner.

ALIX: Paige was terrified. She was certain that her marriage would be over.

PAIGE ABENDROTH: And she was very visibly upset. I'm sorry. I was just—God, I was just begging her to not leave and to accept me for who I was. I couldn't—I had lived for her for so long, and I didn't know how I could live without her.

ALIX: But to Paige's surprise, her wife said it's okay.

PAIGE ABENDROTH: She told me that everything was gonna be okay and that, you know, we're gonna make this work and she wasn't gonna give up on me. [clicking]

ALIX: Paige couldn't believe how lucky she was.

PAIGE ABENDROTH: [clicking]

ALIX: Together, they walked into the space between categories.

PAIGE ABENDROTH: [clicking]

ALIX: Some mornings, Paige would wake up male, the husband her wife had married. That man would put on male clothes, go to work. Other mornings, Paige would wake up female, a woman trapped in this strange body. And they were doing it, helping each other through life in this odd space.

PAIGE ABENDROTH: [clicking]

ALIX: But one problem remained. As much as the two of them could get used to the idea of flipping, Paige couldn't get used to the physical experience of it.

PAIGE ABENDROTH: I came out of the shower one day, and I'd gone in in guy mode and I came out in female mode.

ALIX: She was standing there, beginning to dry off.

PAIGE ABENDROTH: And I saw myself in the mirror, and I was so disgusted that I threw up.

ALIX: These kinds of feelings happened all the time. Now Paige had come across a potential cure for this, a sort of homespun remedy that some of the bi-gender folks had written about online. It involved hormones. Paige would go on estrogen to make her body more androgynous.

PAIGE ABENDROTH: Bring my body to an androgynous point where I could present both as either male or female.

ALIX: Apparently, it would reduce the shock of being thrown between categories so violently if her body was in a permanent state of in-between. So Paige decided to try it. She began estrogen treatments—and it worked!

PAIGE ABENDROTH: The first time I got my first injection, I just felt this immense relief like I was finally on the right track.

ALIX: There was no longer the same physical discomfort. But as Paige finally was becoming comfortable in her own body, Paige's wife started to turn away. They began sleeping in different bedrooms.

PAIGE ABENDROTH: It was almost like we were becoming strangers. And one—there just came a point where I realized that, you know, she wasn't suddenly gonna—I don't know.

ALIX: Accept you?

PAIGE ABENDROTH: She tried really hard.

ALIX: But it's really difficult. When things don't have a clear category, that's scary for us all. They're a shape we don't recognize.

PAIGE ABENDROTH: I felt like a monster. And I felt like this terrible, like, alien creature that had come down and taken over her husband's life and taken him away from her. One night I heard her crying in the bathroom, and I asked her if everything was okay, and she said no. And she said, "It's over, isn't it?" And I think the next day she told me to move out. I mourn for my marriage the same way I would mourn for, like, you know, the death of, you know, my mother or someone who I was really, really close with. You can kind of see right now, it's really hard to talk about still.

ALIX: Sitting there in Paige's apartment, the afternoon light fading in the window behind her, I was just struck by how hard her situation was. It's not just the fact that Paige wasn't in one clear gender category. She was stuck between categories in other ways as well.

ALIX: In the weeks before and after our visit, I had called around, trying to get a handle on how to make sense of this experience that people like Paige describe. I had spoken to all kinds of people—therapists, historians, gender researchers. But it seemed like a lot of the people that I spoke to were convinced that the experience I was describing didn't really exist. There's no way they're actually flipping between genders, I was told by two different gender researchers in two different European countries. These people are just psychotic. Both of the men who told me this had worked in gender research for their entire professional careers, and they sounded extremely confident.

ALIX: A gender therapist in San Francisco was also skeptical, but she had a different reason. These people are actually just normal transgendered people, she explained, in the sense that they are experiencing the same things that any transgender person experiences. They've just developed a different way of describing it. Same experience, different label seemed to be her argument. In other words, it's not just that Paige was existing between genders, the problem was even more profound. Most of the people that I talked to didn't seem to believe that the experience that Paige was saying that she had was real.

ALIX: Like, why do you think this happened to you? Like, where does this come from in you?

PAIGE ABENDROTH: I don't know. I have stopped asking myself that because it doesn't matter anymore where it came from. I just kind of am what I am.

ALIX: When we talked, Paige seemed as mystified by what was happening to her as anyone else. But her experience, she concluded, was her experience. There wasn't that much she could do about it.

PAIGE ABENDROTH: Like my biggest worry is that I'm never gonna really fit in to, like, female spaces or male spaces. I'm afraid that I'm gonna be living the rest of my life in some kind of weird gender twilight zone.

ALIX: And what will you do then?

PAIGE ABENDROTH: I don't know. I'll keep on doing my best.

ALIX: More than a year after we first met, I called Paige up on the phone. I wanted to check in and see how she was doing, and it was clear from the very first moment she answered that something was different. Her voice sounded different—higher.

PAIGE ABENDROTH: Hello?

ALIX: Hi, can you hear me?

PAIGE ABENDROTH: Yeah, I can.

ALIX: Turns out, about six months after I went to San Diego, the flipping started to fade. And eventually, Paige had settled full-time into being a woman. The last time Paige had flipped into being psychologically male was in the fast food restaurant Five Guys, and she said it took her completely by surprise.

PAIGE ABENDROTH: I had gotten so used to constantly staying like I am now as a woman, that I thought it had stopped. And I remember I flipped really hard. It was really bizarre. I felt like I was wearing a really uncomfortable sweater or something like that.

ALIX: Now, Paige couldn't really explain why the flipping had stopped any better than she could explain why it had started. She said she thought the estrogen hormones she'd taken to make her body more androgynous probably had affected her. And Laura Case, the researcher who's been studying people like Paige, agrees that hormones do affect the brain. But still, there was no way to be absolutely certain. But there was one thing that Paige seemed absolutely clear about: living in one category, even if it's a category that's often discriminated against like transgendered women, is way better than having no category.

PAIGE ABENDROTH: Oh, my goodness, yes. [laughs] It's so much easier. It's so much more manageable. The world to me just—it makes so much more sense.

ALIX: Now Paige knew what she was supposed to do, where she could place her foot. She didn't have a wife, but she did have that.

ROBERT: What I really want to know, since I've never heard of anybody like this, I didn't know this was—this was in the human experience. Are there a lot of these people? I mean, is there like a teeny, teeny handful? Or is this a very ...?

ALIX: So I have spoken to maybe six people who have alternating gender incongruity, who flip. Who are—they're bi-gender. And they kind of move between their genders in this way. Because there are lots of different ways of being bigender, right?

ROBERT: It's just this click thing.

JAD: Yeah, this was surprising. I mean, the other people you spoke with, was it also sudden like that?

ALIX: Yes.

JAD: So they had that, too.

ALIX: Yes.

JAD: Any idea what causes those sudden flips?

ALIX: That's exactly what Laura Case is trying to understand. I think she has about 26 of these people that she has been talking to. And so she has been talking to these people, but I don't know that it's clear yet. It could be biological, or it could be a different kind of disorder. It could simply be a way of conceptualizing an experience that a lot of different people have.

LULU: We can't even say this is a condition with a strong in Sharpie marker declaration of now there's a name, and now this exists. Like, there could be hundreds or thousands of people privately sitting with this, and if that name came out, maybe they'd suddenly have a place. But the name right now itself is, like, in gray translucence.

JAD: What is the name again? It's a ...

ALIX: Alternating gender incongruity.

ROBERT: But what you're saying is this is really a mystery. You don't really know what happened in this story, really. Nor do the scientists.

ALIX: I mean, that's the—that's—it is in no category.

JAD: All right.

LULU: All right. Talk to you later.

JAD: If you want to check out Invisibilia, you can tune in on the radio. They'll be airing a bunch of episodes on a couple hundred stations in the next few weeks, but the best way to find them is to go to iTunes or Stitcher or whatever and check out the podcast. They have hours coming up about fear, about trying to control your thoughts. It's all pretty fantastic. Check them out. Invisibilia. Thanks for checking us out, Radiolab. We'll see you in two weeks.

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