‘Transgenderism has become a youth subculture’

Psychiatrist Dr Az Hakeem, a fellow of the Royal College of Psychiatrists and honorary associate clinical professor at the University College London Medical School, cuts quite a dash. As we sit down to discuss his new book, his fingers are weighted with hefty silver skull rings and his tie is adorned with crossbones.

But the reason he stands out isn’t simply his gothic sartorial elegance – it’s because, unlike most therapists who work in the field of gender dysphoria, Hakeem follows the evidence and refuses to go along with so-called affirming care.

DETRANS: When transition is not the solution, Hakeem’s second book, draws on the experience of those who have stopped identifying as transgender, placing their testimonies within his own clinical experience. It can be read as a rebuke to clinicians at the NHS Gender Identity Development Service (GIDS), which he describes as a ‘transing factory where young children were affirmed without their gender assumptions being challenged’.

Gender medicine, Hakeem tells me, has ‘been captured by trans lobby groups like Mermaids and Stonewall’. Consequently, for the past few years, the clinicians who have chosen to work at specialist services have taken an ‘affirmative approach’ to trans identities. Hakeem argues that affirming without question is ‘merely colluding in a form of grooming’. He compares it to a doctor enthusiastically agreeing with an ‘anorexic at critically low weight who believes they need to lose more weight’.

‘Instead, we should explore with them how they came to believe they needed such an intervention and help them with the distress [caused] by not having that intervention. But for some reason we do not do this with gender dysphoria.’

Having worked in the field for 23 years, Hakeem knows more about the ‘trans community’ than most of his peers in the psychiatric profession. For 12 years, from 2000 to 2012, he worked with patients with gender dysphoria at the NHS Tavistock and Portman Trust, where he championed a pioneering approach. He brought together people seeking so-called sex-reassignment surgery and post-operative transsexuals. The two groups were able to talk honestly, dispelling some of the fantasies the ‘pre-op’ people had about life trying to pass as the opposite sex. This cemented his interest in reconciling gender-dysphoric patients with their bodies and managing the expectations of those who want to undergo surgery.

‘I have dedicated a large proportion of my career to understanding and working with people with gender dysphoria’, he tells me. ‘My understanding has been informed by the many hundreds of hours I have spent with each patient, getting to know them often better than anyone else has known them in their lives.’

Just for doing his job, and for daring to follow the evidence, Hakeem has been smeared by trans-activist journalists and even reported to the General Medical Council (the complaint was later dismissed). But now, in light of the planned closure of the scandal-struck gender service at the NHS Tavistock clinic, Hakeem’s considered approach to supporting patients who identify as trans seems eminently sensible.

To him, ‘trans’ is not a useful term. There is a difference, Hakeem says, between those who might once have been termed transsexual and those who are transvestites. ‘The unhelpful lumping together of all these distinct categories as “trans” gives the false impression that transsexualism is on the ascent and that any man wanting to dress in female clothing is en route to a “sex change”’, he says. ‘Whereas, in reality, most are fetishistic crossdressers who are excited by wearing women’s clothes… it’s nothing to do with wanting to change their sex.’

As a former teenage goth himself, Hakeem believes that many of the new cohort of trans-identified youngsters are simply members of a new subculture. With tongue firmly in cheek, he has referred to the phenomenon of Rapid Onset Gender Dysphoria (ROGD) as ‘Goth Mark Five’.

Notably, he has also observed from his clinical experience that ‘males with gender dysphoria tend to be on the autistic spectrum, as opposed to males with transvestitism or who experience autogynephilia [arousal at the thought of being female], who do not’. He tells me that the overrepresentation of autistic people among those who access gender-identity services might have influenced current clinical practice:

‘The autistic mind is very binary. It tends towards absolutes. It has a definite sense of right and wrong. It struggles with intermediate, non-binary ways of seeing the world and struggles with not keeping to frameworks. This is manifest in the very black-and-white, stereotypical relationship frameworks of gender, and in the notion that people are either “with us” or “against us”. The gender clinics would replicate this by believing that any clinician who was offering an exploration or not affirmation was anti-trans, and this is replicated generally in medicine and psychiatry, where those who are not affirming must be against the transsexual.’

It’s now been over a decade since Hakeem worked for the NHS. Today, he heads up a successful and well-respected Harley Street clinic. Much of his work involves reconciling detransitioners to the permanent changes they have made to their bodies and raising awareness about the flaws in NHS gender-identity services.

He isn’t smug about the damning investigations into the Tavistock clinic, nor does he crow about the mounting evidence showing he was right to reject the affirmation approach. Hakeem might have a dramatic, gothic flair, but at heart he is a dedicated clinician – and he remains baffled by his profession’s blind spot on gender identity:

‘Psychological distress should be considered as psychological and treated as such. My experience of working purely therapeutically with gender dysphoria suggests that this approach is entirely successful, and I remain in disbelief as to why this is not routinely offered.’

If only there were more brave doctors like Az Hakeem, willing to put their patients’ needs ahead of the demands of gender ideology.

Jo Bartosch is a journalist campaigning for the rights of women and girls.

Picture by: drazhakeem.com.