Understanding Gender Dysphoria and Identity: The Autism Connection

Speaking with Dr Az Hakeem, I was struck by the way this conversation connected identity, distress and the importance of keeping difficult clinical conversations open and respectful. These subjects are often discussed separately, although in a person’s life they can influence one another continuously.

What stayed with me is the need to hold complexity without turning a person into a debate. Experiences involving identity, neurodivergence, family, body and mental health require careful assessment, humility and language that protects dignity.

The guest’s views in this episode represent an individual clinical perspective and should not be treated as a universal consensus. My purpose in hosting the conversation is to create space for examination, not to replace personalized advice or close legitimate professional disagreement.

My broader reflection is that balance is not a fixed destination. It is the capacity to notice what is happening, understand what may be driving it and respond with greater awareness. Professional support can help create that capacity, but it must remain grounded in the person’s circumstances, choices and safety.

Dr. Az Hakeem, Consultant Psychiatrist, Forensic Psychotherapist, and Group Analyst, joins me for a thought-provoking conversation about psychiatry, gender dysphoria, identity, trauma, psychotherapy, autism, burnout, and the importance of critical thinking in mental healthcare.

Drawing on decades of experience in both the NHS and private practice, Dr. Hakeem reflects on his work in forensic psychotherapy before discussing the gender dysphoria psychotherapy service he established in the UK. He shares his clinical approach to understanding gender distress, why he believes psychotherapy should play a central role before irreversible medical interventions, and how his views evolved through years of working closely with patients.

The conversation explores the relationship between biological sex and gender, the complexity of identity development, the role of autism and trauma in some patients presenting with gender dysphoria, and why Dr. Hakeem believes curiosity, careful assessment, and open dialogue remain essential in mental health practice. Abdullah and Dr. Hakeem also discuss parenting, supporting gender-questioning children, and the importance of creating space for conversations rather than rushing toward conclusions.

Beyond gender, the discussion examines forensic psychotherapy, the lasting psychological impact of trauma, sexual behavior, emotional development, and the realities of treating anxiety, depression, OCD, and burnout among high-performing professionals. Dr. Hakeem also shares practical advice on maintaining balance, protecting mental well-being, and avoiding the gradual path toward burnout.

Throughout the discussion, we return to the importance of looking beneath visible symptoms or behaviors. The aim is not to force one explanation onto every experience, but to understand the combination of history, relationships, body, environment and meaning that may be relevant for this individual.