The formulation of Barbara's diagnosis of transsexualism was gleaned from several sources: transcripts from her long term individual, group, and family therapy; intensive psychological testing; interviews with family members, children, lovers, and friends; and post operative follow up data up to four years post surgery.

Eventually, Barbara found a man willing to impregnate her (but refused to reveal his identity, thereby recreating for her daughter the same mystery that surrounded Barbara's own birth). At the time of the delivery, Barbara told the nurses about her situation and they arranged for Arlene to take her place in bed and be wheeled out of the hospital with little Arlene (the child was named after her).