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But Harmon-Smith had seen Patrick have an erection. Actually, several. "You're not cutting off anything that's working," she protested. The authorities checked the infant's internal organs and still insisted this baby would be better off as a girl. His mother refused. More tests. After 11 days, 20 doctors filed into a hospital conference room and solemnly announced that they would allow the family to raise Patrick as a boy. "We put him in a little tux and took him home," Harmon-Smith says.

Two and a half months later, Patrick's doctor warned his mother that the boy's testicle, really an ovotestis that also contained some ovarian tissue, was probably malignant. It should be removed -- like the one already taken from his abdomen. His mother finally agreed to a biopsy, just in case. When the surgeon returned from the operating room, he said the gonad was diseased. He had cut it off.

Harmon-Smith pestered the doctor for the pathology report for more than a month. Once she got it, "the first thing I read was 'normal, healthy testicle.' My heart stopped. I just cried," she says. Five years old March 24 and in the first grade, Patrick will never be able to produce semen.

"My son is now a non-functioning eunuch. Before, he was a functioning male," Harmon-Smith says. "I don't think the doctor cared. His reasoning was that this was a hermaphrodite, so everything should be removed."

Quietly and in near secrecy, pediatric urologists and other specialists decide what are the minimum qualifications for manhood, correcting any babies with ambiguous genitalia -- known as "intersexed" -- before their births are announced to the world. Under the urgent conditions of a medical emergency, they decide whether a smallish appendage is a proto-penis or a maxi-clitoris, and perform the surgery to make it so -- sometimes without even telling the parents the truth about their child, and rarely revealing anything to the patient as he or she grows up. Guiding the doctors' work is a commonly accepted theory, pioneered in 1955 by Johns Hopkins University sexologist John Money, that infants are psychosexually neutral at birth. If a surgeon sculpts a baby's undersized, oversized or otherwise confusing genitals to match a sex label within a few months of birth, normal psychosexual development will follow.

But evidence is building that sexual identity is not so easy to manage or mold. New studies in human development are demonstrating that the biological division between male and female isn't clear-cut or even stable. The simple presence of a Y chromosome -- considered by many people to be as male-identifying as a six-pack of Bud and a 4-by-4 Dodge Ram -- isn't necessarily enough to make a man. And frilly dresses adorning a body shaped to be female can't always contain the guy hidden inside.

The questions aren't limited to hospital birthing rooms. From sports arenas to geneticists' labs, experts are struggling to find new ways to define and describe the biology of sex. And some members of the medical establishment are beginning to question whether intersex surgeries make sense in infancy, before the child has a chance to reach puberty, develop his or her own sense of identity and give consent. Later this month, academic surgeons and pediatric urologists meet in Dallas to thrash out the psychological, hormonal, surgical and practical issues of intersex treatment. Their debates are likely to get hot.

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