Fairfax, VA, USA. Case study research represents an important opportunity for transsexual inquiry, with benefits that extend to the entire population.

For many years, there was little meaningful investigation into transsexualism, with efforts largely confined to particularly undisciplined versions of social science research. The full array of scientific tools lay unappreciated and unused, with scant attention and funding for biology, hard data collection, analysis, experiments, surveys, multiple histories, and in-depth mining of archival information.


While we have made significant progress, clinicians and patients with a transsexual history still seldom benefit from systematic research specific to their birth condition. In fact, data from counseling and related intake activities most often go unreported or screened from candidate datasets as puzzling exceptions.

A case study (or report) can be thought of as an empirical inquiry and investigation into a subject within its real life context. It consists of an in-depth examination of a single instance or event: a case. Rather than using large samples and following a rigid protocol to examine a limited number of variables, case study methods provide a systematic way of looking at events, collecting data, analyzing information, and reporting the results.

From this, a researcher may gain a sharpened understanding of why the instance happened as it did, and what might become important to look at more extensively in future research. Theoretical propositions that can be tested and confirmed, or found to be wrong based on the actual data instead of supposition.

Case study research, using a combination of single and multiple case studies, focuses on quantitative evidence drawn from multiple sources analyzing and evaluating both the isolated data points and the relationship of multiple case study data groups to each other. Broad roll-ups of the aggregated case data (e.g., meta-studies) lend themselves to both generating and testing hypotheses.

Properly done, a series of case studies, or even a meta-analysis of their results, are no substitute for rigorous longitudinal research with large datasets and extensive follow-up. However, case studies are essential to both formation of the going-in premises for longitudinal studies, and a useful way refresh approaches and calibrate data collection procedures over time.

So far, many of the case studies related to transsexuality are based — if at all — on statistically small and self-selecting data bases and, as such, are limited in scope. Theories are presented in a vacuum and their acceptance is based more on the personality of the researcher than the validity of the case study data.

Moreover, distribution of the case studies (and the various medical theories they embody) are confined within small circles of researchers. Findings in other research areas that might provide innovative insights into people of transsexual history are not readily available to the broader medical community. Targeted distributions fall into more informal channels maintained by lay volunteers and interested scientists from other disciplines.

Journal of Medical Case Reports

We are pleased to recommend the Journal of Medical Case Reports, for its vital role in promoting the collection of practice-based evidence to support both clinical research and daily clinical care.

Submissions to the Journal of Medical Case Reports, although not focused directly on transsexuals, can help to correct that situation. Every new condition — a birth condition, medical drug, reactions to medications, or the next new disease — begins with a single case study. The Journal of Medical Case Reports will publish any case report that is authentic, understandable, and ethical, including those that deal with transsexualism.

The journal's editors contend that every case is important. Contributors are challenged to apply formal methods and procedures that draw out the lessons and point to further research opportunities. Once published, readers may see what the contributors see — or even can not or will not see. In the long run, there will be accumulative value in the mass of cases that may not be so immediately apparent in the single instance.

Researchers need access to a reliable, multi-disciplinary data base that is accessible to all researchers and therapists, not just a handful of independent psychological theorists or clinicians. The Journal of Medical Case Reports, and open-access journal, presents that opportunity.

TS-Si encourages scientists, medical researchers, clinicians, counselors and all other care-givers to access the Journal of Medical Case Reports and contribute to this important effort.

People with an transsexual history have a special opportunity. You can contact your care-givers and other authorities to inform them about the Journal of Medical Case Reports and help them build a comprehensive database of evidence that will support future research and policy making.

Some Additional Background

We first published our call for submissions to case-style journals in 2005; since then, a great deal has happened — including a strong emphasis on physical neurobiology and the founding of specialized journals to distribute the results.

We first commented on the topic transsexualism and case reports as a contribution toward bringing some order to a chaotic situation in medical publishing.

Studies of people with a transsexual history were scattered and prone to one-off observations of self-identified individuals with little notice of their underlying neurobiology. To put it kindly, they were observational studies for a newer generation of researchers, mainly from psychology. We discovered rather quickly that they had next to no communication with medical clinicians, the sources of medical case reports.

In any case, the clinicians depended on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for guidance, developed by the very same people who were ignorant of the neurobiological implications.

In the meantime, some of the universities and research institutions have increasingly demanded more scientific knowledge of its researchers, and the focused and difficult examination of underlying developmental processes reached a critical stage.

This means clinicians know better what questions to ask and can rely less on the DSM for answers. Their issue now is primarily that of challenging their medical organizations (e.g. the HMOs and NHS authorities) to take clinical experience into account when setting institutional policies.

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