You’re Wrong About Why People Change Gender - Dr Az Hakeem interview

[UtopiaPlanitia]

Andrew Gold interviewed Dr Hakeem at the Battle of Ideas and it’s, as usual with Dr Az, a fascinating interview. Thought I’d post it here for anyone who’s interested in watching:

CSH probably cross sex hormones? pre-CSH meaning either before a given child takes them or maybe before they were widely available?

OK, I think we were at cross purposes. I was just making the observation that Az Hakeem seemed to think that Jan Morris wasn't sexually driven at all, that he was an asexual transsexual. I think this categorisation is wrong.

Blanchard has recognised that some men who have genital surgery are as sexually motivated as those who get off on cross-dressing. I haven't watched the whole interview yet, so I don't know if Az Hakeem acknowledges this at all. But he must know that some men who have genital surgery are sexually motivated and it was just his mischaracterisation of Jan Morris that I was commenting on.

It is being a boy or girl or man or woman who hasn't been given cross sex hormones.

Just being a child or adult, if that isn't too 'generalising'.

Are you talking about children?

He always is.

It was very interesting, and a good watch, though I also was struck that the discussion was very male centred. He - both of them, actually - seemed to have little interest in or understanding of the situation regarding girls and young women, and an unusual focus on parallels between their own adolescent and young adult experience and that of ‘trans’ culture. That’s OK - professionals have their own interests and priorities - but I thought it emphasised the huge gulf between male and female ‘trans’ issues. Perhaps they need to be considered as entirely separate, societally and clinically.

I agree that that the book and interview are more focused on men and I think that reflects the fact that most of Dr Az's patients were male. He does acknowledge that the motivation of females are rather different, often associated with trauma and SA. Actual clinical gender dysmorphia seems to be rare.

I thought that was the value of the interview, tbh. They were talking quite often about male sexuality, male fears, male socialisation etc.

I agree that the difference between female and male experiences on this topic seem hugely divergent.

Fabulous interview - doesn't matter (IMO) if we agree with him about Jan Morris or not tbh because what he is advocating is simply thinking and talking about outcomes and causes before making any kind of medical intervention.

I think he really outlines the toxic effects of "affirmation" - and horrifying that he sees girl's schools as the worst offenders in this....

I think he really outlines the toxic effects of "affirmation" - and horrifying that he sees girl's schools as the worst offenders in this....

Yes, that was startling and valuable.

I wasn’t criticising the male-centric tone - merely found it interesting - because I think it illuminates much of the popular discourse around this issue. How many times have we noticed that discussions about trans issues, especially to do with the privacy of women, are conducted entirely by men, for example, a male interviewer, a male medic, and a transwoman.

I'm sure I recall reading that Jan Morris had homosexual relationships or perhaps hookups would be a better description. I don't know if they continued after his marriage (wouldn't surprise me) or surgeries. He was also a privately educated boarder, who stereotypically were up to all sorts of same sex shenanigans.

Memory being what it is I don't recall if AG or Dr Az talked much or at all about gay or bisexual men who get genital surgery to try to fake being the opposite sex. There's one gay man (been in the news recently) who, if his retelling can be trusted, was an out and unashamed homosexual but who still put himself under the knife. That puzzles me. I cannot see the motivation. I don't want to speculate about any particular individual, I don't think MN would like it. Just using this as an example of the phenomenon.

Multiple teams over multiple years have reported finding statistically significant evidence that, for at least some early-presenting trans people of both male and female chromosomal sex, there are particular neurological phenotypes (brain structure patterns) that are characteristic of people who experience gender incongruence. These are studies exclusively focused on observing the morphology of individuals presenting before any form of external hormonal intervention (which we know has a definite and quite profound effect on brain size and structure)

In short, the brains of at least some trans people seem to vary quite significantly from those of others of their chromosomal birth sex, especially in the right hemisphere, and sometimes in ways which, when adjusted for size and other influences, seem aligned with those of individuals of the opposite birth sex.

That isn't to say that there are exclusively 'male brains' and 'female brains' so much as brains are extremely complicated and sensitive systems that are vulnerable to environmental conditions during early development, and continue to develop over a person's lifespan.

I think it's extremely disingenuous to dismiss the very real experiences of trans people who spend lifetimes struggling with crushing gender dysphoria (sex dysphoria?) as just a fetish or unaddressed diagnostic overshadowing.

Butter point me to these multiple studies identifying brain differences of trans identifying people, the information I have is there exists zippo proof, Az states most studies involved trans people already on hormones of the opposite sex so data was totally unreliable.

There's been Multiple teams over multiple years, I'm sure Butters will be back with the links in a jiffy.

Sure. A Spanish team conducted a review of research in 2016: A Review of the Status of Brain Structure Research in Transsexualism - PMC

On the subject of brain imaging:

Dr Hakeem described this claim as a “trans fact” i.e. untrue. And, as you said, he also discussed the lack of reliability in studies that had been undertaken.

I remember reading an article (think it was in The Atlantic) discussing the closing of John Hopkins gender clinic in 1979 and it stated in the article that in previous decades doctors in gender clinics had routinely carried out brain scans on patients in an attempt to create diagnostic criteria to assess suitability for surgery & hormones but realised that there were no differences or useful diagnostic information showing on the brain scans and so stopped carrying them out.

I also remember that UCLA tried to carry out a study to determine any neurological elements of transgender identification but was criticised by activists as being suggestive of trying to find a cure. https://www.medpagetoday.com/special-reports/exclusives/91423

And the Spanish review mentioned upthread found:

“The review of the available data seems to support two existing hypotheses: (1) a brain-restricted intersexuality in homosexual MtFs and FtMs and (2) Blanchard’s insight on the existence of two brain phenotypes that differentiate “homosexual” and “nonhomosexual” MtFs. The studies on the effects of cross-sex hormone treatment on the brain of MtFs and FtMs consistently indicate dramatic effects on the gray and white matter after short- to medium-term treatments but the long-term effects on the brain require evaluation. Finally, the postmortem studies should be interpreted in light of these in vivo findings as well as of their underlying mechanisms.”

@ButterflyHatched stated: "Multiple teams over multiple years have reported finding statistically significant evidence that, for at least some early-presenting trans people of both male and female chromosomal sex, there are particular neurological phenotypes (brain structure patterns) that are characteristic of people who experience gender incongruence."

I'm sorry to say I can't find any evidence at all of this kind of study. There are studies in brain morphology, which don't show statistical significance in the area they are looking at (such as physical symptoms in children). I did previously find one study that looked at differences between brain morphology in males and females, but again, nothing was statistically significant and their results were inconclusive.

The Spanish study seems to be on the brains of homosexual trans people after the effect of wrong sex hormones. It's possibly misrepresentation of this very study that Dr Az was thinking of when he talked about trans-facts in the Andrew Gold interview.

From what I can gather, it's internalised homophobia, which leads to the overarching, extreme need to attract a male partner who isn't (apparently) gay.

There are two such men that I can think of, one who practically says that exact thing (although without the reasoning I supplied), and the other who was very disgruntled when a heterosexual man wasn't interested.

In terms of cognitive dissonance, it's got to be very tricky.

@ButterflyHatched Well i have just read the link. It was not an actual direct research study, it was a review of existing literature. So really an essay from one point of view to prove it.

Secondly it admits there is only one very limited study of humans brains of trans identifying people,

Thirdly it does not conclude what you say it does. Thanks Inky, cake and planet, saved me an essay.

I don't think you are necessarily wrong though I would not be shocked to find Morris was the one of the control/mummy issues types he describes rather than AGP with the focus on the body.

I get the impression that Dr Az might say that the various sub-categories don''t necessarily understand the distinctions he's making and their own motivations very well, and can be confused by the social messaging and medical pathways.

And I suppose any of these groups could have other issues laid on top of whatever is behind their cross gender identification, like personality disorders, or other paraphilias that will complicate their behaviour.

All of which is to say I suspect that as a therapist talking about someone like JM, there's inevitably an element of guesswork.

Maybe someone like Blair White might be an example of this.A homosexual male, but also one who experienced significant sexual trauma as a child.

So Dr Az's ideas about trauma might be relevant, but I think more likely, BW's own theory that it is about sexual shame and wanting to become another person seems very plausible. I think he's also questioned whether sexual trauma is related to his sexuality as well - that's not considered a PC thing to think these days, but when we consider that sexual abuse can be experienced by boys as both arousing and deeply shameful and traumatic that raises some questions about how it could present in an adult.

I did know a transwoman who was in fact a gay male, raised in Ireland in the 1920s. Transitioned surgically in middle age, but it wouldn't likely have been really possible before that - he lived a very peripatetic life as a young man I suspect for similar reasons of not feeling like he fit in.

The control/mummy point throws interesting light on the “these aren’t women’s clothes, they are my clothes” statement famously made by a comedian who now claims a trans identity.

This is often taken as a sign that he previously took a more sensible position on the issue, but I’m not at all sure it was that.

He wouldn't be drawn on Izzard, probably wise.

I liked AG trying to get AH to talk instead about his friend 'Meddie Mizzard' though😂