The dissenting doctor
A leading psychiatrist is worried that a new government bill threatens his groundbreaking talking therapy for gender dysphoria
This article is taken from the July 2023 issue of The Critic. To get the full magazine why not subscribe? Right now we’re offering five issues for just £10.
Dr Az Hakeem is a renowned psychiatrist with a long interest in gender dysphoria and its treatment. During his 12 years treating adult patients at the Portman Clinic he developed an innovative approach to gender dysphoric therapy.
But since he moved on from the Portman in 2012, Dr Hakeem (“Dr Az” to patients and colleagues) has become increasingly concerned about the impact on vulnerable patients of an orthodoxy gaining ascendancy across medical institutions — including the Royal College of Psychiatrists (RCPsych) of which he has been a Fellow since 2010.
“We’ve been saying for years religion is dead in this country. It isn’t, it’s having a resurgence. People may not be going to church, but they’re completely brainwashed by ideology. Social justice theory has a lot to answer for.” He says “Medical Colleges have been duped. They’ve been hijacked by the ideology crowd. The RCPsych is one of the worst. It’s a mockery of science.”
In 2021, RCPsych’s President, Adrian James, announced the college had signed up to both Stonewall’s Diversity Champions Programme and its Workplace Equality Index. James was “delighted” when just two years later, RCPsych received a Stonewall Gold Award for LGBTQ+ Inclusivity.
Dr Hakeem is less impressed. He is one of a group of dissenting psychiatrists in the Clinical Advisory Network on Sex and Gender. (CAN-SG), a group he describes as “rooted in science and biology. We are very concerned about how gender ideology has taken over.” Members are particularly troubled by the Royal College’s trajectory and its close relationship with Stonewall.
They are critical of RCPsych’s proclamations, such as those in its 2018 Mission Statement “Supporting transgender and gender-diverse people”, which is suffused with the ideological language of “cisgender”, “sex assigned at birth”. It defines conversion therapy as “treatments for transgender people that aim to suppress or divert their gender identity to make them cisgender. This may include barriers to gender-affirming medical treatment.”
When psychiatrists requested that RCPsych survey its members to establish if the statement had widespread support, the request was refused.
The government’s bill to ban conversion therapy for trans-identifying people will be ready by autumn. Dr Hakeem foresees that the threat of criminal sanctions will have a chilling impact on clinicians who use an exploratory approach to gender dysphoria. “People like me will no longer take on patients who experience dysphoria. If you look at what is happening internationally, therapists are being attacked, reported to their regulatory authority, threatened with prison. This means there will be no therapy at all except the medical pathway.”
The affirmative approach directs clinicians to confirm the self-diagnosis of patients as trans and facilitate their access to drugs such as puberty blockers and hormones. Dr Hakeem is unequivocally critical of the pharmaceutical pathway, particularly when used to treat children, and paints a bleak picture of the irrevocable damage that is the consequence.
Puberty blockers used on children operate like a chemical castration
Puberty blockers used on children operate like a chemical castration. “We watch a film about Alan Turing and feel sorry for him and say how can we possibly have done this, but we’re doing the same thing to our children,” he says. “How can a child possibly consent to such treatment?”
Dr Hakeem spent a couple of years in the early part of his career at the NHS’s Gender Identity Development Service (GIDS) and saw how it dealt with young people at its Tavistock Clinic. He witnessed a dysfunctional dynamic and a lack of clinical curiosity about what was driving children to seek its services.
He described young children brought by their parents. “Johnny says he’s a girl. A five-year-old doesn’t know anything about anything. They were encouraged to socially transition, to change their name.” He believes homophobia played a key part in this. He also noted that Mermaids, the National Lottery-backed (backing that is currently paused) transgender advocacy group, seemed to be involved with approaches to treatment. He tried to raise his concerns with the Tavistock’s medical director, but was ignored. He believes the Tavistock demonstrated signs of institutional homophobia.
The interim report of Dr Hilary Cass’s independent inquiry into GIDS’s treatment of children and young people identified a failure to record follow-up data on patients as a problem. Dr Hakeem points out that since even minor surgical procedures trigger follow-ups why doesn’t controversial hormone treatment attract the same scrutiny? When he asked one gender clinic about the absence of this vital data on their patients, he was told, “We’re giving them what they want. We’re freeing them like butterflies into the world.”
At the Portman, Dr Hakeem noted a striking disparity between two groups of his adult patients. One was in a state of pre-treatment anticipatory euphoria, the other had post-surgery regret. He had the idea of combining both groups in the same therapy session. This group dynamic was particularly effective because “the analysis was done by the group to each other, and coming from each other that is much more powerful. People could be in the group for as long as they wanted.”
In particular, patients were able to explore why they had come to the conclusion they were the “wrong sex”. Comparing it to unravelling a maths equation, “They had never revisited why they came to that conclusion,” he says. “The group gave them the space to do that. Their fixed notions of gender were deconstructed. They didn’t have a problem with gender, they could accept themselves for who they were. After two years they had no gender dysphoria.” Less than 2 per cent of his patients went on to gender transition and he sees this as evidence of therapeutic success.
He observed that homophobia and trauma could be powerful motivations, especially in female patients. Some exhibited “internalised or externalised homophobia and experienced a culture where it was traumatic or oppressive to be female or a lesbian”.
He is deeply concerned about gay and lesbian young people being enmeshed in what he describes as a cult. “People are not thinking critically. They believe what they are told, reinforced by organisations such as Stonewall which got lots of credibility for the great things they did in the past.” He is a patron of the LGB Alliance which represents lesbians, gay men and bisexuals and regards accusations it is “transphobic” with derision: “It’s like saying Marie Curie is transphobic. What bizarre logic.”
Dr Hakeem grew up in North Wales, his parents having moved there to escape the sectarian violence engulfing India after partition. His was the only South Asian family he knew until he moved to London. He said he wanted to look like all the other kids at school. It was his mother who helped him “understand I could be anything I wanted to be just as I was”.
Art was his first love and an aesthetic sensibility forms part of how he perceives his identity
Art was his first love and an aesthetic sensibility forms part of how he perceives his identity. He regards “trans non-binary” as a youth subculture similar to goth (gothic punk) which captivated him as a teen: “Luckily for me there was no goth clinic where I could have my lips permanently tattooed purple. The biggest subculture at the moment is non-binary trans.” He talks about dancing on the liminal as a contrast to the rigid “groupthink” stereotypes he has seen in some patients. He has faced threats and intimidation because of his refusal to remain silent. “I’ve always been outspoken, I’m never going to stop being outspoken.”
Dr Hakeem makes a clear distinction between people struggling with their identity and extreme trans activists he describes as “terrorists” because they seek to wreck people’s lives. “They hide under ‘we’re an oppressed minority’. They set out to destroy, to ruin. That’s why doctors are scared to speak out. I’ve met so many people whose careers have been ruined because their employers eliminated them.”
He is concerned that the impending final Cass report into GIDS may be ineffective because “the establishment will interpret the report in the way that suits them”. He cites recent revelations that former GIDS employees are being recruited to conduct training for the new regional hubs and worries former Tavistock clinicians may seek to replicate the GIDS clinical environment elsewhere. He believes the rigid orthodoxy on gender dysphoria and its treatment will only end after a “generation has been led into something they regret.”
He is also concerned about the effect of a censorious culture on academic research. He was recently asked to peer-review an “excellent” paper for the British Journal of Psychiatry, but has learned it will not be published because of an objection to its author’s membership of the Society for Evidence Based Gender Medicine (SEGM).
In an era when gender ideology is ascendant across the medical sphere, Dr Hakeem stands out as a defiant critic. Most importantly, he does so as one informed by his clinical experience and empathy for those who dance on the boundary.
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