In the 1950s psychologist John Money and his colleagues at Johns Hopkins University pioneered the study of sexually ambiguous patients. As he worked with children and some adults born into the world with unusual combinations of sex markers. Money developed a layered model of sex and gender. The social response to the genital sex of the new born is intense. The anatomy of the external genitalia affects infants developing body image, and this is yet another level of sexual formation-the sex of the body image. All of adult different sexes and identities in turn converge to produce adult gender identity, the sense of self as an adult male or an adult female. At birth, John Money and his colleagues pointed out, the adults surrounding the new born identified sex based on their perception of external genital anatomy; this identification initiated a social response that began the gender socialization of the newborn.