When I’m writing a book, I like to know the title beforehand. It’s reassuring in the way a life ring is to a person who’s fallen overboard.

A good title tells you what the book’s about. It reminds you, when you lose heart, why you started writing it in the first place. I saw an interview with Francis Ford Coppola once where he said that he likes to boil down his films into one word. For The Godfather, the word was “succession.” Whenever Coppola decided something, even a small thing like a costume detail, he reminded himself of his theme in order to make everything cohere, from the storyline right down to the gangsters’ hats.

With two of my novels, The Virgin Suicides and The Marriage Plot, I knew the titles before I even started writing. I wasn’t so lucky with Middlesex. For years I had a terrible working title for that book, so bad I won’t even mention it here.

It took me something like eight years to write Middlesex, and by year five, I still didn’t have a good title. The novel begins in 1960 with the birth of the narrator; then it goes back to 1922 and slowly works its way back to 1960 before telling the story of the narrator’s life. The narrator of the book, Cal Stephanides (formerly Calliope) is intersex. As a result of an inherited genetic mutation, he has a condition called 5-alpha-reductase deficiency syndrome. Cal is raised as a girl; later on, after puberty, he assumes a male gender identity.

One day as I was writing about Cal’s early years and recalling my own childhood, it occurred to me that the street I’d grown up on, in Grosse Pointe, was called Middlesex Blvd.

Americans name a lot of things “Middlesex.” When I lived in New Jersey, the next county over was Middlesex County. I stayed at a hotel once that had a conference room called “The Middlesex Ballroom.” “Middlesex” sounds classy to us.

And so for both these reasons, my intersex narrator and his suburban upbringing, I realized that I had found the perfect title at last. It had been there ever since I started third grade: on the street sign at the end of my block.

Order a copy of Middlesex here.