It was a quick procedure. Quick enough for the men to fit it into a lunch break or the gap between a ten o’clock meeting and a gym session. Nazneen would usher the men, one at a time, into her office from the waiting room with its television screen stuck on ESPN. Some wore suits, some wore jeans. All chewed on the gummies from the glass jars next to the Keurig.
Each man’s legs dangled off Nazneen’s padded examination table, the paper cover still wearing a dent from the last patient. They watched the medical illustrations on the wall while they peeled off their shirts. Epididymides, vas deferens, and a cross section of the testes hung next to the medical waste bins.
She injected half a vial of clear fluid into the skin on the inside of the upper arm, a few inches from the armpit. A minute would pass and then she would stick a scalpel into the skin, deftly slicing through epidermis.
The men swallowed the pain, their heads lolling gently, neck muscles loose from the gummies they had sucked in the waiting room. Nazneen would part the flesh, bloodless and numb from the shot of lidocaine and adrenaline. She’d press the pale blue jelly implant into the flesh and suture the skin with a single dissolvable stitch.
For the first time in years she was using her more rudimentary medical training. The puncturing of a sterile vial, the injecting of local anesthetic and adrenaline, the sterilizing of the blade, the feel of flesh beneath her gloved fingers. She enjoyed the chance to refresh her sewing skills.
The implant was fatter than the contraceptive implant for women which was injected beneath the skin using a no-cut method and a hollow needle that slid the implant into place. Nazneen was working on reducing the thickness of her implant, but there was no rush. The men said it was fine; they could handle the thickness. They came from all over the world, in awe of the technology dreamed up in Nazneen’s mind and synthesized in her fancy laboratory. Why shouldn’t men be in control of their reproductive cycles the way women had been for decades? they wrote on internet forums after men’s health magazines published profiles of Nazneen. Why shouldn’t men get to choose when they started a family?
The trial was ongoing but preliminary results were pleasing. Over the course of three months, Nazneen’s chemical cocktail would trickle out of the implant, into the bloodstream, up to the anterior pituitary gland and down to the testes, where it shut down spermatogenesis. Sperm production resumed in twelve weeks when the jelly implant dissolved into muscle.
Years earlier, when Nazneen was a fellow in endocrinology in Tehran, she marveled at the ways that mood and medicine manipulated hormones. A baby born into a family with feuding parents would release enough stress hormones in her first few years to cement her stress pathways for life. The highway from adrenal glands to brain would be fixed to anticipate high stress situations, and the glands would squeeze out catastrophe-appropriate amounts of cortisol and adrenaline in response to a missed train or spilled tea.
Endocrine disruptors were her favorite. Chemicals exploited in modern medicine to help a nursing mother release enough milk to feed her baby, or to treat breast and prostate cancers. But then there were those everyday chemicals that disrupted the endocrine system—dry-cleaning solvents that caused Alzheimer’s disease, the rubber lining in tin cans that caused tumors to swell in babies’ brains.
One day during her fellowship, Nazneen was sitting in the front row during grand rounds, fanning the steam from a cup of green tea when a researcher from California stepped up to the podium. He was a short Black man wearing a grey sweater with Berkeley written in canary yellow, khakis, and one feather earring. He clicked through slides of dissected amphibians. Girl frog, girl frog, boy frog, boy frog. Hermaphrodite frog? Nazneen squinted at the specimen projected on the screen. Its shrunken testes strangled by twisted oviducts.
On the next slide, pearly eggs spilled out of a gutted frog. Its streaky ovaries glistened pink and yellow. This frog was born male, the American professor said, but a post-doc accidentally spilled a chemical—the world’s most ubiquitous herbicide—into the tank of male frogs, and the next week, the frogs were female. Nazneen’s tea grew cold.
Pink pearls had lined the hijab of the childless aunt who took Nazneen’s right hand between her meaty palms when Nazneen was seven. She was at a cousin’s wedding, high off rosewater gaz and Jolly Ranchers, giddy from being chased around the table. The aunt extricated a melted candy from Nazneen’s hand and wiped her sticky palm with a serviette. “The left hand shows what could be, but this hand,” she said, pressing her thumb into the center of Nazneen’s right hand till Nazneen’s tendons flexed and her fingers closed like petals around a bud. “This hand shows what will be.” Nazneen held her tongue against a glob of sweet stuck to the roof of her mouth. The pearly aunt’s grip was firm, her expression grim. “You will do deeds of great importance,” she said to Nazneen’s palm. “Or great loss.” She turned her head sideways to look at Nazneen. “Or both.” She pushed Nazneen’s palm away and told her to chase after her cousins. Nazneen ran. Her right palm, robbed of its candy, still throbbing.
She massaged her palm with her thumb as the American professor fidgeted with his feather earring and asked if anyone had questions. Nazneen stuck her right hand in the air.
At Berkeley, Nazneen switched from studying frog testes to human ones and developed the implant technology for male birth control—the first of its kind.
With the Food and Drug Administration dismantled, testing new therapies was much simpler. Scientists no longer prepared terabytes of e-documents for submission to the agency. There were no safety checks or patient recruitment protocols, only an online portal where Nazneen uploaded an outline of her research and her initial pool of patients.
That list grew when Esquire and GQ ran features on her technology. Esquire touted her as “the beauty and brains behind a revolutionary new way for men to take control of their bodies—and their lives.” The article ran with a photo of Nazneen, her shiny, flat-ironed black bob tucked behind her ears, her lab coat stopping inches above a black Elie Tahari pencil skirt. Her lips were painted a nude pink, her eyes a smoky grey. She was half smiling against a backdrop of test tubes and bunsen burners, miles away from her actual office. But the photographer said he wanted it to look, “you know, sciencey,” so she fiddled with a Bunsen burner and later sent the photos to her mother and aunts.
Nazneen collected data about testosterone levels, sexual appetite and genetic sequences, and saved it all on her MacBook Air and a back-up hard drive. Her protocols weren’t subject to review by the data monitoring board or the ethics committee. No one talked about Tuskegee or Guatemala. No one mentioned Nuremberg or the Puerto Rico pill trials—experiments that her textbooks covered in a sentence or two. Now, scientists could get on with the real work of developing new treatments, and the federal government no longer slowed down the pathway from bench to bedside.
Years later, when Nazneen worked out of a bungalow on Vancouver Island, she wondered if her work helped re-establish the FDA as the FDDS, a new iteration of the agency, triple the size of its predecessor.
The Y chromosome is a broken X chromosome, the fourth appendage of the X shrunken into a defunct stub. Nazneen first learned this when her toes were buried in the sand on Kish Island.
“You know, ma cherie, that is the only difference between you and your brother,” her mother had said. “This little chromosome.” Nazneen slapped her feet into the wet sand. Her brother sat on a dry towel, far away from the water.
Nazneen thought the paltry Y chromosome explained why her baby brother was born yellow and sickly, why she could stick her finger between his ribs and feel his heart tense and push against her.
She thought it explained why they buried him when he was forty months old. They filled a three-foot casket with Tintin in America comic books and stuffed his pockets with seashells.
In the three months that the pale blue implant sat snugly in the flesh and arrested the sperm cycle, it eluted drugs that fixed the damaged chromosome. After the implant dissolved, men were capable of producing sperm—but only sperm with X chromosomes.
The uptick in the number of girls was first documented in California. Demographers considered it an anomaly. In the second year, when twice as many girls were born and the phenomenon was seen in thirty-eight states, the census data was questioned. A Senate review committee grilled a panel of demographers. A six-billion-dollar repeat of the census was ordered.
In Israel, Australia, the United Kingdom, and Germany, countries in which the pale blue implant had lived in the arms of men, the birthrate of girls outpaced boys threefold.
On the ferry to Vancouver Island, Nazneen pulled back the hood of her car and folded the stiff canvas into a pile that rested on her trunk. She sucked on a red gummy bear and watched jellyfish float south towards America.