Trans by Trigger Press: a unique approach to understanding gender identity

Transgender is everywhere: trans stories in popular drama, trans politics debated in news stories, trans in the workplace sending HR departments into a spin, questions surrounding health outcomes accompanying campaigns for visibility, equality and awareness, all of which feed into an evolving view of gender and gender identity in society.

Trans edited by Dr. Az Hakeem published by Trigger Press – in association with the Shaw Mind Foundation – asserts itself as being the first book of its kind, to present an easy-to-read, jargon-free guide to understanding the condition known as Gender Dysphoria.

Trans coverThe book is divided in to five sections: the first looks at terminology: all the different words and phrases associated with trans; second, evolution of trans psychology and the clinical diagnosis model; different services and treatment pathways available including parental approach; a diagnostic tool in the form of a clinical questionnaire and concludes with a section exploring trans politics.

Az-1Dr. Az Hakeem is a Consultant Psychiatrist who ran a specialist Gender Dysphoria service in the NHS for 12 years.  He is described as a ‘top gender expert’ with a wealth of media experience including being resident psychiatrist for Channel 4’s Big Brother and psychotherapist co-presenter of E4’s Wife Swap: The Aftermath.

Other contributors include other specialists in psychiatry, gynaecology, sexual health, transgender surgery, gender variance counsellors and trans scholars and advocates.

What makes this book different from other titles in the field, is the unique way it combines specialist clinical knowledge with the experiences of trans people, to attempt to create a balanced, unbiased approach to the subject.    

There are innumerable questions surrounding gender identity, Trans looks at some of them including, one still most confused by society, the differences between gender and sexuality.

Figures on how many people may experience a gender dysphoria – Greek derivation: unhappiness or dissatisfaction with one’s gender –  are widely disputed. Academics and clinicians have traditionally used a sample that included just those who have sought surgical intervention, but as this book alludes to, there are as many different approaches and outcomes, as there are people presenting with feelings of dysphoria.

With the book being aimed at both a professional and non-professional audience, some of the chapters exploring psychological approaches, clearly speak directly to the therapist: warning the therapist not to be dragged into binary positions of transgender politics.

The prevailing attitudes of the medical profession as to the right approach to treating GD, has a huge determining factor on whether particular treatments and/or intervention, will result in a ‘successful’ outcome.

Viewpoints, theories and best practice are tested and exemplified by use of real life vignettes, collated from service users within group therapy sessions by Dr. Hakeem, who in 2001 piloted then delivered – for over a decade – a specialist gender dysphoria psychotherapy service.

“All too frequently the focus is on the body of the trans person, but as a psychiatrist and psychotherapist, my aim with this book has been too consider the psychology of trans and the emotional impact transgender has on the trans person, their families and those around them.”     Dr. Az Hakeem    

As someone who transitioned before the introduction of the law – known as the Gender Recognition Act – that governs how trans people can get their gender identity legally recognised, it is heartening to see that the understanding of gender identity and dysphoria has advanced in the intervening years.

Dr Hakeem conveys in Trans, that the focus must be on a patient-centred approach, moving away from notions of binary positions on gender i.e traditional views of masculine and feminine. In the past there were certain gender services in the UK, who based decisions on treatment progression, on whether a trans person presented – in terms of demeanour and appearance – according to very rigid definitions.

Trans looks much deeper at the relationship between the gender service and the trans person, exploring the patients notion of the clinicians as authoritative figures and  gatekeepers to be appeased: patients have described jumping through hoops to achieve their desired outcome.

There are still very few specialist Gender Identity Clinics in the UK, those that do exist are subject to the same cuts in funding as other NHS departments, with many GD patients having to travel out-of-area to receive specialist support.  There is clear evidence for the north/south divide in service provision. I can’t help but point out that Dr. Hakeem’s own specialist psychotherapy service was in fact London-based – it was made available to all patients provided they were able to travel.

I recall when I pushed for some form of therapeutic support, I received notification that because I was a ‘gender case’ there were no existing services available to me.

With the advances in understanding GD, you might be inclined to believe that diagnosis, treatments and patient outcomes have improved. Any improvements to services have been further tested by the rise in the number of people, presenting with some form of gender dysphoria. This has led to an increase in waiting times: referral to specialist clinics can now take up to 2 and a half years from the time of GP referral.

The book avoids the outdated notion of being ‘trapped in ones body’ by again taking a lead from the trans folk who experience a dysphoria themselves: patients report feelings of something being ‘not quite right’.

It goes on to look at theories of early childhood behaviour reinforcing gender stereotypes and subsequently leading to a feeling of gender dysphoria:how patients may then use these early gendered experiences, as evidence for GD having always being present: resulting in patients using phrases like ‘It’s been like this since I can remember.’

Rather bravely in a book dedicated to exploring gender identity Dr. Hakeem says, ‘I have no idea how Gender Dysphoria arises,’ before further exploring a number of explanations and theories including that psychological or biological causes, being the determining factors: pre/birth or post birth.

The extended title of the book is Trans: Exploring Gender Identity and Gender Dysphoria it offers readers a chance to understand the many complexities of how gender is perceived by oneself and others. Throughout the book by using the wealth of information and lived experience, provided by the contributors and patient reporting, the idea that previous, one solution fits all approaches, are proved to be wholly unsatisfactory.

Parents and teachers will benefit from reading this book, so that they might be better prepared to help and support children in their care.  Academics seeking a different approach and perspective when discussing gender identity as well as clinical specialists will find this book useful.

As someone who received a diagnosis of Gender Dysphoria, made in what I regard as less enlightened times, I learned a lot about current thinking and treatment pathways available, which prompts the question whether I’d have experienced a better outcome transitioning today?

Other questions prompted whilst reading this book are around early transitioning, an issue that causes controversy each and every time it is raised. There is a chapter called Young and Transgender written by Luka Griffin from Queensland Australia, who was the first transgender teenager successful in securing testosterone treatment, through the family court. Another chapter is ominously titled, “What Do We Tell the Children?’ which looks at some of the ways a parent who is considering gender transition, might approach the subject to best avoid, alarm, distress and confusion.

In my opinion, if a better outcome – whatever that may mean for the trans person – is expected the earlier intervention is sought, then surely that would be the best approach for the trans person?

Again using myself as the example, would I have transitioned better at an earlier age? Would I have been able to cope at a younger age? This book presents these often divisive, socio-political issues without fear or favour, without the associated moral panics and looks at them objectively.

Trans: Exploring Gender Identity and Gender Dysphoria by Dr. Az Hakeem is an important addition to a scarce library on the subject, that presents a wide range of information with real-life experiences and clinical knowledge side by side, with the single aim to promote a better understanding of gender identity and gender dysphoria.

Trans: Exploring Gender Identity and Gender Dysphoria by Dr. Az Hakeem (MBBS, FRCPsych, Msc M. InstGA) is available at http://www.triggerpublishing.com/

Buy Trans by Dr. Az Hakeem Now. 

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