Episode 64

64 - Pioneers Series: Psychotherapy Pre- and Post-Transition with Az Hakeem

Published on: 25th February, 2022

Dr. Az Hakeem was born and brought up in North Wales and has lived and worked in London since studying medicine. He is a Consultant Psychiatrist who previously trained in forensic Psychotherapy, Mentalization-Based Therapy and is a Group Analyst. He previously worked within the NHS in Forensic Psychotherapy specializing in Analytic Psychotherapy for conditions relating to sex, gender, sexual perversion, and violence at The Portman Clinic, part of The Tavistock & Portman Clinics.


Dr. Az Hakeem is unique in that he is the only consultant psychiatrist in psychotherapy who specializes in the specialist application of exploratory psychotherapy to persons suffering from gender dysphoria. He set up and ran the only specialist psychotherapy service for adults with gender dysphoria in the UK in the NHS and is the author of TRANS: Exploring Gender Identity and Gender Dysphoria.


After over 15 years working in the NHS, Dr. Hakeem now works exclusively in private practice.


In addition to his clinical work, Dr. Az Hakeem has worked as a consultant to the media, on-screen specialist, and TV Co-presenter on a number of TV programs in both the UK and Australia. 


Dr. Az Hakeem considers himself a “Gender Critical Psychiatrist.” Today we get to hear about Dr. Hakeem’s facilitated group therapy for gender-distressed adults. He ran these groups for twelve years from 2000 to 2012. Containing a mix of pre-medical-transition individuals who were often gender-euphoric and post-medical-transition individuals who experienced regret, these groups created a fascinating opportunity to give gender-dysphoric individuals more insight into the long-term experience of transition. In this episode. we discuss Dr. Az’s understanding of gender distress and how he contextualizes ROGD kids into this framework.



TRANS: Exploring Gender Identity and Gender Dysphoria: 



The Curious Incident of the Dog in the Night, by Mark Haddon:



“Development and validation of a measure for assessing gender dysphoria in adults: The Gender Preoccupation and Stability Questionnaire” Hakeem, A., Črnčec, R., Asghari-Fard, M., Harte, F., Eapen V. International Journal of Transgenderism (26th August, 2016) Tandfonline.com/doi/abs/10.1080/15532739.2016.1217812?journalCode=wijt20


“Psychotherapy for Gender Identity Disorders” Hakeem, A. Advances in Psychiatric Treatment (2012), vol.18, 17-24 Cambridge.org/core/journals/advances-in-psychiatric-treatment/article/psychotherapy-for-gender-identity-disorders/D10025B4A7EBBC2250E71EA6A12465F0


“Study Protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder” Robinson, P., Barrett, B., Bateman, A., Hakeem, A., Hellier, J., Lemonsky, F., Rutterford, C., Schmidt, U., Fonagy, P. BMC Psychiatry 14(1): 51. 2014



“Deconstructing Gender in Trans-Gender Identities” Hakeem, A. Group Analysis. The International Journal of Group Analysis Volume 43 Issue 2, June 2010



Extended Notes

  • How did Dr. Az get involved in gender identity?
  • Dr. Az was really curious to understand what was really going on inside the heads of people with gender dysphoria.
  • Dr. Az knew about two gender dysphoria groups, one who regretted their sex change and another who were thinking about doing a sex change. Dr. Az decided to merge them together.
  • Why is a group setting slightly different/better than a one-on-one session with a therapist? Dr. Az offers his thoughts.
  • Unfortunately, there have been no follow-up studies on those who deeply regretted their gender transition.
  • From observation, Dr. Az saw a lot of these transitioned patients feeling inauthentic in their skin.
  • Why are pronouns, in particular, so important for people with autism?
  • What is an “autistic meltdown”?
  • Dr. Az thought for the longest time he was the only one who was seriously questioning and criticizing gender transitions. It seemed everyone in his field was going along with it.
  • The general critique Dr. Az got in the public eye was, “Why are you here? You’re terrible and not gender-affirming.”
  • Let’s talk about the difference between sex and gender. The idea that we don’t have biological sex is complete insanity to Dr. Az.
  • There’s a demand to be recognized and seen by the outside world.
  • You can’t have gender ideology without gender stereotypes.
  • Dr. Az breaks down all the confusing terminologies being used in gender identity right now and how it’s very hard to get a good grasp of it all.
  • Dr. Az finds it very sad that we’ve decided to ditch reality and science for fiction and fantasy.

This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more.


For more about our show: Linktr.ee/WiderLensPod

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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

Thank you to our sponsors:
Genspect - an international organization which offers an alternative to WPATH. Providing a range of education, resources and supports to anyone impacted by gender distress, Genspect unites many different organizations globally, and gives voice to 1,000s of previously untold stories. For more info, visit genspect.org.

GETA - an association of therapists who believe that individuals experiencing gender related concerns ought to be treated using a whole person approach. GETA connects like minded clinicians, provides educational resources and trainings, and helps people with gender dysphoria find support. For more info, visit genderexploratory.com.
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

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Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.