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Dr. Stoller's admonishment that analysts must do more than pay lip service to biology is well taken. In attempting to heed his own admonition, he has studied some extraordinary people and concludes that his material appears to support the hypothesis which he and others have elaborated.
Methodologically, such patients must be studied from both a biological and psychological vantage point if meaningful scientific gain is to be accrued. At the present time, biological research techniques are not really refined enough to validate or effectively support Dr. Stoller's thesis.
The testes produce little or no hormones during the infantile sexual phase of childhood. It is the adrenals which probably serve the hormonal function which the gonads later assume to a major degree. Thus, the normality or abnormality of his patients' testes in early childhood would not be biologically very pertinent in terms of infantile sexual development. Also, although their abnormality may be reflective of other physiological difficulties which might exert a mysterious effect in childhood such as the author postulates, such difficulties have not as yet been biologically identified.
In this respect, Dr. Stoller's emphasis on some patients' postpubertal breast development, etc., is a mis-emphasis: it only confirms the hypogonadism whose effects are manifested in puberty and need not reflect in any way biological events influencing childhood development. The biology of adolescence most certainly molds the continuing development of sexual identity, but the childhood experience still remains the most potent determinant.
Dr. Stoller notes that hypogonadal patients described in the medical literature are similar to his own. However, he also notes that such descriptions are rare. Even were they less rare, they would not be very helpful in terms of the total psychoanalytic problem involved.
The above considerations influence me to believe that Dr. Stoller's biological evidence does not in any way support his