A Pilot Research Project

Mr. Stephen Whittle, PhD, present day president of HBIGDA posted at HBIGDA Forum that message:

16th August, 2006

Dear Ms Torres

I would be very interested in taking a Pilot research project, inclunding a control group of non-trans patients and a comparator group of trans patients and running these volunteers through your various analytical tests. It would not be a study I could obtain monry for in the early stages - I would need to do a pilot study with 12 to 20 indiiduals completing your early daignostic forms. I would like to test patients on your 'First Anamnesis test', the Female Identity (2011), Male Identity (2012), PdQ4 Questions (3013), PTSD evaluation (3015), MMPI Questions (3011), and PdQ4 Conclusion (3014).

I would suggest that if your practices wish to obtain recognition, the project must involve using 2 blind control groups; a control group and a group of people starting the process of assessment and treatment. The control group would be reached through the non-crossdressing trans populaton, and the others through a clinical team either here in the UK, or based in Europe and attending European clinics.

Throughout the various stages the results of the tests, comparisons would be made with the groups to see to what extent the test results represent their life choices.
This could only be an unfunded pilot project, but it might enable a larger funded project to be developed.
It would require complete co-operation from your team in either analysing and reporting back from the tests, or by teaching us how to do that analysis.
It may take 3 to 4 years to complete such a project, and of course we would not be in a position to pay for the tests or their analysis.

Would you be willing to put your theory and practice through such outside scrutiny?

Stephen

 

Gendercare answer to Dr.Whittle

 

16th August 2006

 

 

I would like to thank you Dr.Whittle for your interest on our methods.

Surely our answer is YES.

We will need your help to send to us let's say for that "pilot" project, some 20 people. We will not know if they were evaluated or not by face-to-face therapy. You will put them in contact with us, and we will evaluate them following our standard method, as if they were our normal patients. Among them there may be "normals", TS,TG,CD... and we will be "blind" about who is who. Our reports we will send to you, and you will compare their realities with our results, and later we may discuss the results. These let's say 20 subjects, they will be evaluated with no charge for them, limited to 20 subjects.

I am not sure if all our tests will be evaluated, because PTSD, PDQ4, we use really very rarely.
What surely we will be able to evaluate will be our anamnesis and Identity tests (MFX and FMX) and also MMPI. The other tests we use very rarely, so I think we may not consider them now.

We are prepared to start it soon, let's say in the beginning of September... is that schedule good for you?
Send me subjects and they say me only, thru our contact page... I am a patient from.... and I am in the program of Dr.Wittle... than we will consider that subject in our pilot project... until 20 subjects please, including "normals" please!

Thank you!

Dr.Torres

Gendercare

Continuing that subject, a new Gendercare post at HBIGDA Forum (Aug, 16th,2006):

Dear Dr.Whittle,

We would like to ask you some questions about our Pilot Study:

1. We would like to know who will define the 20 subjects. We would like to know what is the European Institution where they were evaluated, or are they related to. We would like to work with one institution only, with a designed representative of that institution;

2. We would like to consider, that we agree that after the Pilot Study, we may complete in some few months, we will discuss openly in that Forum the conclusions: you, we and one representative from the European Institution that will participate on it;

3. We will never open, due to ethical points of principle from Gendercare, the identities of all 20 subjects. Our anamnesis email consultations we will send to the patients only, and they will show it to you and the European Institution representative, at their own decision. The MFX test reports we will send them to the patients and directly to you, in PDF format, and you may send it to the European Institution for analysis.For us we prefer the 20 subjects will receive code numbers... not names.

4. All will be man or MtF gender dysphorics... for these 20 pilot project subjects, do you agree? Or the 20 women or FtM's. You decide what will be better for you, but when we start, we will not nomore change, please.

5. We would like, at the final of the Pilot project, we prepare: you, the Institution and Gendercare, a paper to publish at IJT from HBIGDA, in co-authorship.

6. That paper will be prepared by the 3 involved persons, and the European Institution will prepare a first version of it, and later we will revise and comment it, and only after we all agree, we will publish it.

7. Outside that Forum and Gendercare and the European Institution, during the pilot project no comments please... about Gendercare methods... before we have a final report. The final report will be the conclusion, and only from then on we may open that result for outsiders, do you agree?

Thank you,
Dr.Torres
Gendercare

The Pilot project may be based on already evaluated people at the European Institution... so fastly we may evaluate the already evaluated subjects (or "normal" ones...)... that way we will need not an Ethical Committee liberation for the Pilot Project subjects, and in some 3 to 4 months or at least 5 to 6 months we may have all data to start discussing a conclusion for that pilot project, and preparing the paper for publishing.

Obviously later, we are very interested in a big project, with the support of an European sponsor, to develop more knowledge of our methods and also to develop these methods... and we will be very satisfied if we could start teaching about Gender Variance through the Web, as we started in Brazil, with the help of HBIGDA or a sponsor.

You may see more on that subject at
http://www.gendercare.com/index2.html
All that will be published at that Forum, we will feel free to publish or not at Gendercare. Not test results or about patients, but our discussions, that we will have through the HBIGDA Forum, openly.

More... (Aug 16th, 2006):

Dear Dr.Whittle, some more comments please, about our Pilot Study.

1. Who will be administering the study to analyze the results in an objective way? As we will send you our results, we would like also, for each patient, to receive a resume about that patient overall situation, after our final evaluation of the same patient, so we may discuss objectivelly our conclusions about each patient;

2. Are the trans people in the study going to be ones who are currently undergoing conventional face-to-face therapy? or that had face-to-face therapy recently? That situation we believe would be the better way to analyse our methods, and not considering people who perhaps did this face-to-face therapy years ago and also made a decision about what to do, years ago--transition, SRS, or remain in the original gender. That would be a not so real situation, we believe; but we are open to discuss it;

3. If we evaluate a patient as TS, but then the European Institution says, "that person decided not to transition", we will need to consider each result objectively because some patients could still really be a TS, but for some reason couldn't face making a transition. That is, what a person decides to do in his/her life may not be the whole story... so we would like to discuss all 20 cases AFTER we evaluate them in a blind way;

4. So if we come to a different conclusion about a patient than a conventional therapist, who is to say which one of us has the correct diagnosis? So after our evaluation we intend to discuss each one to have a fair conclusion;

5. I could not understand perfectly your statement "the control group will be reached through the non-crossdressing trans population." Does that mean that transpeople will recruit their non-crossdressing friends to participate in the study? Why not find a way to have the participation of people who know less about gender issues than friends of transpeople do? Or what you said is not what I understood?

6. Will part of this pilot study involve some patients trying to deliberately mislead us? that surely would not be a real situation, because when people spend money doing an evaluation, they intend to do it seriously... but we would like only to know first if you are considering deliberately that possibility or not;

7. Obviously we consider the 20 subjects will answer us in an honest way... our tests and telling us the real life story they lived and are living... answering us all our questions, when possible.

Thank you Dr.Whittle,

Dr.Torres
Gendercare


More... (Sept 21st, 2006):

Subject: RE: Gender Identity formation dynamics
Date: Sep 21 2006
Reply From: Kim Hurn

Message:
Dear Dr Whittle & Ms Torres

I would like to volunteer for your pilot study if this would be helpful in advancing knowledge in this field. As background, I have not taken any test, either internet or face-to-face, to determine my gender identity. I have known since age three that my birth sex was not my gender (or the gender I desired). I have used and continue to use internet resources on transgenderism and I procure my hormones via the internet. The reason I am volunteering myself is that I strongly believe in the relevance of HBIGDA for advancing our knowledge, understanding and care for transsexuals and I would like to support its aims to the fullest extent that I can. Regards

Kim Hurn

More... (Sept 22nd, 2006):

Message:

I received that message in my email, from that Forum:

Hi Wal Torres,
The following message has been posted to the HBIGDA Forum, discussion thread - Gender Identity formation dynamics.
Subject: RE: Gender Identity formation dynamics
Date: Sep 21 2006
Reply From: Kim Hurn torrwad@gendercare.com

Message:

Dear Dr Whittle & Ms Torres

I would like to volunteer for your pilot study if this would be helpful in advancing knowledge in this field. As background, I have not taken any test, either internet or face-to-face, to determine my gender identity. I have known since age three that my birth sex was not my gender (or the gender I desired). I have used and continue to use internet resources on transgenderism and I procure my hormones via the internet.
The reason I am volunteering myself is that I strongly believe in the relevance of HBIGDA for advancing our knowledge, understanding and care for transsexuals and I would like to support its aims to the fullest extent that I can.

Regards

Kim Hurn

Now when I came to the Forum I am not seeing the message from Kim Hurn here, I do not know why.

I would like to say Kim:

I believe it will not be possible to include Kim in the Pilot-Study proposed by Dr.Whittle and accepted by Gendercare Gender Clinic, because:

1. All 12-20 subjects could not be identified by Gendercare;
2. They need to be first evaluated by an European Institution through face-toface standard conservative procedures, and up until now no European Institution contacted us , so we do not know from what country will be that institution;
3. We would like to know nothing about the subjects we will evaluate.

So we would like to ask Kim, to contact Mr. Whittle and ask him first of all:

1. What will be the European Institution, and see if that institution could evaluate him/her as soon as possible;
2. We would like also Dr.Whittle informed us what will be that institution from Europe.
3. If Kim will be one of the subjects, we would like to ask we know nothing about any of the tested subjects, nor from Kim or any other.

Thank you, we are still waiting to start the propeser - and accepted - pilot program.

Thank you.

We would like to specialy thank Kim for his/her intention to cooperate.

Dr.Torres

Gendercare Gender Clinic

More... (Sept 23rd, 2006):

Message:

Dear Dr.Torres & Dr. Whittle

I apologize that you were unable to see my message - after I posted it I had second thoughts and so deleted it. On further reflection though, if there is genuine interest in proceeding with a pilot study and I can contribute, I would be happy to participate.

On the question of the European Institution, the only issue would be timing as I live in Singapore. I do travel to Europe maybe 3 or 4 times a year and if the evaluation did not take up more than a day, then I could do that during one of my trips. Dr. Whittle would need to let me know which Institution would involved for the evaluation and its location.

Kim Hurn

More... (Sept 23rd, 2006):

Message:

Thank you Kim for your message.

From Gendercare Gender Clinic side, be sure our intention to develop that pilot study is absolutely serious. We believe Mr.Whittle's intentions are also serious.

So we believe really we would like to know what will be the European Institution Mr.Whittle suggests for the pilot study.

I think Kim, it will be better for that study, we consider subjects already evaluated by that institution, so I believe you living in Singapore, and having not being evaluated by the institution would delay the pilot study a way we will not need to delay.

But surely we thank you your intention to cooperate with us.

What we may suggest is you take your evaluation, through the Web with Gendercare at www.gendercare.com

It is not expensive, and surely will be a very interesting experience for you. We suggest you try it.

Thank you,

Dr.Torres

Gendercare

Subject: RE: Gender Identity formation dynamics Date: Sep 23 2006 Author: Kim Hurn Reply

Dear Dr.Torres & Dr. Whittle

I apologize that you were unable to see my message - after I posted it I had second thoughts and so deleted it. On further reflection though, if there is genuine interest in proceeding with a pilot study and I can contribute, I would be happy to participate.

On the question of the European Institution, the only issue would be timing as I live in Singapore. I do travel to Europe maybe 3 or 4 times a year and if the evaluation did not take up more than a day, then I could do that during one of my trips. Dr. Whittle would need to let me know which Institution would involved for the evaluation and its location.

Kim Hurn

Subject: RE: Gender Identity formation dynamics Date: Sep 23 2006 Author: Wal Torres Reply

Thank you Kim for your message.

From Gendercare Gender Clinic side, be sure our intention to develop that pilot study is absolutely serious. We believe Mr.Whittle's intentions are also serious.

So we believe really we would like to know what will be the European Institution Mr.Whittle suggests for the pilot study.

I think Kim, it will be better for that study, we consider subjects already evaluated by that institution, so I believe you living in Singapore, and having not being evaluated by the institution would delay the pilot study a way we will not need to delay.

But surely we thank you your intention to cooperate with us.

What we may suggest is you take your evaluation, through the Web with Gendercare at www.gendercare.com

It is not expensive, and surely will be a very interesting experience for you. We suggest you try it.

Thank you,

Dr.Torres

Gendercare

Subject: RE: June WPATH Update Date: Sep 23 2006 Author: Kim Hurn Reply

Hi Dr. Torres

I am pleased that the name change has started to generate some debate and I'm glad that this forum can accommodate many different views, as that ideally should be what a civilized society does. In this context then, I would like to offer a different view to yours. As you are aware from my previous posting, I am uncomfortable with the idea of transgenderism being classified as a disorder. Unfortunately I would include "dysphoria" within the definition of disorder and disagree entirely with your view that "all transgender triggers a gender disphoria". I am OK with the term "gender variance" as I agree with Kate Bornstein's hypothesis put forward in My Gender Workbook that there exists the potential for several different genders.

Personally I prefer the term "transsexual" as a description of my gender as it defines me as a person who lives as a different gender to her biological one and that is how I view myself.

It does seem to me that a large portion of the trangender health care professional community seem to start with the premise that transsexuality is a disorder, dysphoria, mental illness, whatever and that treatment OF that disorder is required, rather than treatment of resulting disorders (guilt, fear, depression etc.) that are often present. Incidently, this is why I also disagree with "evaluations" because they are evaluations of what exactly? (sorry). I do agree with Reverend Linda that the test of really living in our society today as a transsexual is by far the most important (self) evaluation a transsexual can take in understanding whether this is truly her gender. Allied to this, I believe self evaluation is crtitical and in a way this is akin to the idea of "acceptance" often discussed in counselling sessions, although obviously I dispute the concept of "acceptance" because it implies settlement for something less than one is worth - that is coming back to the idea that the transsexual has a disorder and needs to "accept" this to be able to move on.

Sorry I rambled on a bit there but you've probably guessed that the whole prejudice against transsexuals thing is a big deal for me. The main point I actually wanted to make here was that transsexuals do rely heavily on professional help in the form of HRT and surgery to be able to live their lives naturally. Because HBIGDA/WPATH is for such transgender healthcare professionals, I prefer the new name to the old one as it promotes this idea of healthcare rather than focusing on classification. On the other hand, I also agree with your earlier view that it would have been nice to have kept the name Harry Benjamin because of the historic debt we owe him.

Kim Hurn

Subject: RE: Gender Identity formation dynamics Date: Sep 23 2006 Author: Kim Hurn Reply

Hi Dr. Torres

I will do your web-based test as I fully support the work of anyone who is striving to improve the life of transsexuals even if I have reservations about the underlying premise evaluations are based on (as I discussed under June WPATH Update). Perhaps you would also allow me to make any comments I may have on the test?

Please let me know which test(s) you would like me to take.

Kim Hurn

Subject: RE: June WPATH Update Date: Sep 24 2006 Author: Wal Torres Reply

Message:

Hi Dr. Torres

I am pleased that the name change has started to generate some debate and I'm glad that this forum can accommodate many different views, as that ideally should be what a civilized society does.

Wal Torres: Hi Kim! I completely agree with you. The diversity of opinions - with the respective respect for other opinions - is the way for the improvement of knowledge, in a civilized society.

In this context then, I would like to offer a different view to yours. As you are aware from my previous posting, I am uncomfortable with the idea of transgenderism being classified as a disorder. Unfortunately I would include "dysphoria" within the definition of disorder and disagree entirely with your view that "all transgender triggers a gender disphoria".

Wal Torres: Dear Kim, when I say Dysphoria - for me that word signifies to be not happy, to have an uneasiness with the own condition - so it is not necessarily a "disorder" - it is a condition when you love not your situation and intend to change that situation. So when I say I like the term gender dysphoria is in that sense - someone that have a gender problem, or a gender variance - and intend to change it! So, considering that way, transsex, crossdressing, transgender are always develop a gender dysphoria in the sense the person is not happy with the present day situation and would like to move.

I am OK with the term "gender variance" as I agree with Kate Bornstein's hypothesis put forward in My Gender Workbook that there exists the potential for several different genders.

Wal Torres: Dear Kim, I go ahead from Bornsteins's very good perceptions. I am defining a Gender Space. We consider gender a near-continuum. When gender and genitals/secondary signs are in discord, we trigger the dysphorias. But sometimes, as in some intersex with intergender feelings and self-perception, there are intergender realities, but no dysphorias. I am a board member of OII- Organisation Intersex International - and among intersexuals it is very common to live a intergender condition, with no dysphorias. So I agree, the best Umbrella is Gender Variance - and inside it all possible gender discords and intergender - with or whitout gender dysphorias.Gender IS NOT A BIPOLARITY ONLY. The bipolar gender was a necessity, mainly for reproduction, to increase human population, to preserve our species. Nowadays, in an human overpopulated world, each day is more clear, IN NATURE AS A SYSTEM , gender is not bipolar, but a continuum of possible diversities. So mainly when we live in an overpopulated world the perception of that continuum system is very important.

Personally I prefer the term "transsexual" as a description of my gender as it defines me as a person who lives as a different gender to her biological one and that is how I view myself.

Wal Torres: Probably dear Kim you are a transsexual - someone that has genitals and brain/mind/self-perception in discord of gender - and that discord may be in your brain - in your body - brain is body - or not.

It does seem to me that a large portion of the trangender health care professional community seem to start with the premise that transsexuality is a disorder, dysphoria, mental illness, whatever and that treatment OF that disorder is required,

Wal Torres: You are right Kim, really medical/therapist community learned that way. Transsexualism is considered up until today "officially" a disorder and a mental problem. That is not my opinion - nor Gendercare opinion, dear. Exactly because gender variance is not necessarily due to a disorder, it is feasible its evaluation through the web. We may see if it is due to a disorder or not - through the Web. If yes, we suggest a local treatment and face-to-face therapy. But as most part are not due to mental disorders, we may develop through the Web an evaluation method to help people WITH NO MENTAL DISORDERS but with some dysphoria - some unhappiness with the original situation - to improve the harmony between body and mind.

rather than treatment of resulting disorders (guilt, fear, depression etc.) that are often present.

Wal Torres: Most of these recurrent signs are easily eliminated when the person understands what happened and how harmony may be improved. But if the recurrent distubs are at a pathological level, the person will need a local face-to-face help.

Incidently, this is why I also disagree with "evaluations" because they are evaluations of what exactly? (sorry).

Wal Torres: What a good question dear Kim! I am waiting for that question at that Forum for some 6 months now! First of all, as gender variance is a condition and not necessarily a mental disorder, we need to know only the life story of the person. To know with whom we are talking about these matters. That means what we call "anamnesis" = your story. We may easily do it by emails. The next step is our Unexpected Gender Test, online. With that simple 100 questions test, we will develop your PORTRAIT IN GENDER SPACE - in mathematics we call it phase space portrait. All humans may answer that test, it is not a test for "people with disorders" but a test for "all humans to discover its own position in a Gender Space". That test will show where you are, and how you are where you are inside a gender space. Not why you are, but only where and how. But that answer is very important, for you and for all "humans that have any �possible gender variance - with or without any dysphoria". So, up until now WE DO NO EVALUATION, but only as any kind of tomography, or radiography, we intend to see where you are and how you reached that place in gender space. SURELY YOU ALREADY KNOW THAT POSITION IN AN INTUITIVE WAY. When someone asks for a radiography, that someone knows it is suffering from something or not - but the test will show more precisely where you are and how you reached your position in gender space - and that way we may compare your result with others results - to be able to help you, if necessary. Then the last step is a MMPI screening to know if you have a possible mental problem - or not. If yes we send you for local help. If not - and most people show no need for psychotherapy - we are prepared to help you to improve your harmony between body and mind - if you desire it. Intergenders with no dysphorias sometimes intend only to know where they are in gender space - and need nothing more. So, we would like to say not MY or OUR EVALUATION OF YOU, because we are only showing you YOUR EVALUATION COMPARED WITH OTHERS typical ones. And we conclude together what to do - if you will need some help.

I do agree with Reverend Linda that the test of really living in our society today as a transsexual is by far the most important (self) evaluation a transsexual can take in understanding whether this is truly her gender.

Wal Torres: Kim, I fear the really-living-one-year mainly for youths. Boys are almost always a little violent. Sometimes we suggest for our clients to live in stealth to loose not jobs, to be not disrespect and in danger in school, to loose not opportunities and in some places - as in the poorest countries - sometimes that experience could be life threatening - so I think that may not be a global criteria. But surely when it is feasible, it is a good experience. I suggest also - as I suggested in a Brazilian Meeting about gender variation two years ago - that therapists - gender therapists - could try to live, at least one week per month, or at least per each 6 months, that way, as a crossdresser... to learn a little the danger of obligging others to endure that reality, mainly in not so civilized countries.

Allied to this, I believe self evaluation is crtitical and in a way this is akin to the idea of "acceptance" often discussed in counselling sessions, although obviously I dispute the concept of "acceptance" because it implies settlement for something less than one is worth - that is coming back to the idea that the transsexual has a disorder and needs to "accept" this to be able to move on.

Wal Torres: Kim, the best "evaluation" is the self-evaluation. We believe always the best way for gender variance understanding, is the patient centered way. But to be sure we need to know the client, to see where it is in gender space and how the client went there, and if the client has no real mental problem. It is not "invasive - of - the - autonomy", it is respectifull and patient centered, it is fast and easy.

Sorry I rambled on a bit there but you've probably guessed that the whole prejudice against transsexuals thing is a big deal for me. The main point I actually wanted to make here was that transsexuals do rely heavily on professional help in the form of HRT and surgery to be able to live their lives naturally.

Wal Torres: See Kim, to prescribe hormones and surgeries for someone WITH NO DISEASE, and understanding these necessities are not "cosmetic", means we need some knowledge of the person we intend to help - that knowledge we name "evaluation".

Because HBIGDA/WPATH is for such transgender healthcare professionals, I prefer the new name to the old one as it promotes this idea of healthcare rather than focusing on classification. On the other hand, I also agree with your earlier view that it would have been nice to have kept the name Harry Benjamin because of the historic debt we owe him.

Wal Torres: Kim, as I consider gender dysphoria NOT A DISEASE OR A DISORDER - but unhappiness - and as I think Harry Benjamin was considered for more than 30 years - I prefer the old name dear. Another point... in my country, transgender means what you call "she-males". That is a bad name in Latin America, for a serious society.

Kim Hurn

Thank you Kim!

Dr.Torres

Gendercare

Subject: RE: Gender Identity formation dynamics Date: Sep 24 2006 Author: Wal Torres Reply

Hi Kim,

As I showed in the other Forum, our evaluation is the only way we have to know something about our clients - to try to help them to achieve any desired inner harmony.

The evaluation needs 3 steps. Take the first step as soon as you can dear, and we will start. You may take it at

www.gendercare.com

Then we will develop the second step - the Unexpected Gender Test - and finally the MMPI as the last step.

AFTER ALL 3 STEPS - when we end what we call your "evaluation", when we send you your evaluation report - surely we would like you comment it here, at the HBIGDA Forum, and here will be a good place we may exchange ideas about it.

NO COMMENTS AT THE FORUM BEFORE WE END THE EVALUATION PLEASE. Public comments only after the third step, after our final report, please!

Thank you dear Kim.

Dr.Torres

Gendercare

Subject: RE: June WPATH Update Date: Sep 24 2006 Author: Kim Hurn Reply

Dear Dr. Torres

Thank-you for your very detailed response to my last post. I was very happy to read it and have to say that I absolutely love your ideas, definitions and philosophy. It seems to me that you are engaged in some very meaningful work in the gender sphere. I was also pleased to hear how you view "evaluations" and what you are trying to achieve through the internet. As we are also discussing on the "Gender Identity formation dynamics" thread, I will take your series of internet evaluations.

You make a valid point at the end of your post concerning the translation of certain terms into other (non-English) languages that I had not considered. As we are an international association we must make sure that whatever name we use does not contain any upsetting or insulting terms when translated. I'm not sure where that leaves us on the name change debate, but after your description of how you interpret the term "dysphoria", then I would be comfortable with either the old or the new name (although as I said before I like the idea of retaining Harry Benjamin in the name).

Kim Hurn

Subject: RE: Gender Identity formation dynamics Date: Sep 24 2006 Author: Kim Hurn Reply

Thank-you Dr. Torres,

I will try to start your series of evaluations this week, but it may be delayed until the weekend depending on my workload.

Kim Hurn


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