Once Tina was conceptualized by the treatment team as an example of a "stable" female transsexual, her assessment and treatment were predetermined. In a personal communication Jon Meyer has described a woman like Tina whom the Johns Hopkins gender clinic deemed to be their most stable and reliable patient. After SRS she became impulsively disorganized, promiscuous, and generally out of control. How are we able to account for such discrepancies between what was observed during the evaluation of a female transsexual and her subsequent behavior? I hope to be able to answer this question in the course of my inquiry .

In order to review the assessment process I will present a reconstruction of the patient's diagnostic evaluation (which I observed and recorded but with which I was not directly involved). This analysis will help us to better understand the process of how decisions regarding diagnosis and treatment of female transsexuals are made by a multi disciplinary gender identity clinic. The clinic at Case Western Reserve University Medical School, in the Department of Psychiatry consists of approximately ten interdisciplinary clinicians who have met weekly for more than eight years to evaluate, diagnose, and treat patients with gender identity disorders.

Tina was initially evaluated at the Cleveland Metropolitan General Hospital gender identity clinic. (She was evaluated there prior to the organization of the CWRU gender identity clinic, which combined the staff and facilities of University Hospitals of Cleveland and Cleveland's Metropolitan General Hospital.) After an initial intake Tina was referred to the surgeon for a physical exam. The patient, who was 22 years old, was then seen by a male social worker for evaluation. The social worker also interviewed Tina's parents and her lover. It was noted that her family situation was quite chaotic and that she had recently physically attacked her father. Tina's behavior was interpreted in terms of her gender dysphoria (as if the disorder provided its own rationale and source of explanation for her behavior), In conclusion, the social worker noted that "whether or not Tina has more of a homosexual, or a trans sexual orientation, remains somewhat unclear. She does not demonstrate any pathology in other areas of her life. In fact, she appears to be coping with life rather effectively and possesses a good measure of personal maturity it is unclear whether or not she desires the operation to function as a male or to justify her 'homosexual' behavior or to reverse a rejection of her femininity by her parents." (see PROPOSITION 1: THE SO CALLED "STABLE" COURSE OF FEMALE TRANSSEXUALISM PART IV)