McHugh's position flies in the face of research spanning close to twenty years before his decision to close the clinic at Johns Hopkins. It relies upon a single paper, which is deeply flawed:
Because this publication is cited frequently by the professional and lay literature it seems important to us to demonstrate extensively why the results of this work are not very enlightening and cannot support the conclusions derived from them.
The scoring system used by the authors is undifferentiated because it is, for example, not evident if an arrest happened because of cross-dressing or for real crimes; if the partnerships classified as gender-appropriate, resp., as nongender-appropriate were partnerships of operated that existed over the time period of the operation or they were entered into post-surgically; if they are living partnerships or sexual partnerships; if the surgical results permitted to have sexual intercourse or not and if the psychiatric contacts, resp., inpatient treatments, came about exclusively because of the persistent pursuit of the goal sex reassignment or happened because of other psychiatric illnesses. One does not learn, for example, if also the routine contacts to the care-providing psychiatrist are counted or not.
The valuing done by the authors is absurd because, for example, the gender of the partner with whom a patient lived was evaluated pre-, resp., post-surgically as opposite. A single who possibly was not capable of having a long-term relationship and not maintain it received a better score (0) than an MFT who had lived for years with a female friend (and had an intimate relationship?) and did this past the time period of the operation, but whose relation after the operation was evaluated as nongender-appropriate (-1). An inpatient psychiatric treatment was evaluated more negatively (-3) than a jail term (-2). The professional of plumber (Hollingshead job level 4) counted exactly as much as post-surgical "gender-appropriate marriage" (+2).
The tables and figures shared by the authors do not seem serious because after the scoring table a maximum of only eight minus and five plus points can be achieved, but in the results table (p. 1014) a range from -18 to +19 points is given. How these figures came about remains totally in the dark. The presumption made by Fleming et al. (1980) that every category could be scored multiple times, is negated by the following thought: It is imaginable that with a multiple evaluation a number of 18 minus points can come about - by three stationary psychiatric admittances (3 times -3) plus three jail terms (3 times -2) plus three "nongender-appropriate partnerships" (3 times -1). It is unfathomable, however, how 19 plus points can be achieved with the scoring system,unless by, for example, five gender appropriate marriages (5 times +2) plus three different academic professions (3 times +3) within a follow-up study period.
One asks the question how it came about that a renowned professional publication published such opaque figure material. Meyer & Reter considered the shared data for the, in a sense, most objective data of their sampling and left out as good as all subjective statements of the follow-up study. It is possible that there was more to be learned from them.
Not without a problem is also the use of the not-operated as a control group, especially because 40% (14 of 35) of the not-operated had surgery in the course of the follow-up study and the other 21, even if not very decided, further pursued the goal to be operated. If the operated, in the course of the follow-up study, were counted in the partial sample right away of the operated, the average follow-up study period would have been shortened. How the other results could have been changed by this cannot be fathomed; the authors do not have any comments or calculations for this (comp. the remarks to the publication by Edgertom & Meyer [1973] and the critiques by Fleming et al. [1980], Lothstein [1982] and Abramowitz [1986]).
In short, McHugh's conclusions are based on even more limited data about transsexuals than normal, and it is based on what are clearly very flawed methods for gathering and quantifying the raw data.
