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Dr. Robert Stoller has done his usual effective job of presenting material that simultaneously is confusing and challenging to most of us. In the past, as with all other investigators in this specific area of human sexual response, he has been grossly handicapped with laboratory facilities inadequate to the demands of such sophisticated research.
Now we may make a plea for use of the basic science laboratory as an adjunct to analytic concept and procedure. With the instrumentation available today, the patterns of steroid influence so vital to gender identity now can be established on an unequivocal basis. Due to lack of adequate laborative techniques, none of the patients Dr. Stoller describes was evaluated satisfactorily from an endocrine point of view. In the last 18 months to two years the development of biochemic and neurophysiologic research techniques potentially applicable to this specific area of sexual response has been so rapid that what hadn't even been considered possible in ’65-’66 will be routine laboratory procedure in ’68.
In making this plea for adequate laboratory investigation of controversial clinical problems, an alignment opposed to acceptable analytic procedure must not be presumed. Far from it! The laboratory should be used only as an adjunct to clinical evaluation, never as a replacement.
We do venture to suggest, however, that there are many different ways, in addition to clinical judgment, of defining or establishing core gender identity, i.e., genetic, endocrine, external anatomic, infant-parent relationships, etc. Every possible clinical diagnostic approach should be exhausted in these cases involving, as usually they do, whole family structures rather than restrictive individual identities.
While not quarreling with Dr. Stoller's 1964 concept of “biologic force,” we currently feel that transsexual enigmas well may be resolved insofar as gender identity is concerned by exposing them to the definition of the basic science laboratory. Only in