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Since 2000, Dr Az Hakeem has run a national Specialist Psychotherapy Service for persons with transgender and other gender identity conditions. Whilst gender reassignment procedures of cross-sex hormones and sex-reassignment surgery are certainly useful options for people with a fixed gender identity of the to the opposite gender to that of their sex at birth, there are people who have other less fixed, less binary gender identity conditions for whom gender reassignment may not be helpful, and there are also people with gender identity conditions who choose not to pursue physical gender reassignment. For these people a specialist form of psychotherapy for issues relating to gender may be useful. Such patients may include those with autogynaephilia, those with non-binary gender identification, and those with intermittent fluctuation between gender dysphoria and transvestism. Other patients may have previously had physical gender reassignment procedures and have since changed their mind and once again find themselves with a gender identity incongruent with their physical body. If a person is assessed and is clearly seeking physical gender reassignment and has no uncertainty about this then they are referred to the appropriate gender clinic. For other patients who may have more atypical gender presentations such as those described above they may be suitable for a specially tailored psychotherapeutic intervention aimed at further clarifying and establishing an understanding and certainty of their sense of gender which may or may not correlate with their biological sex. The aims of the specially adapted psychotherapy are two-fold: firstly to reduce the degree of distress or preoccupation a person may have in relation to gender in their day to day lives, and secondly to promote a sense of stability and confidence in their own uniquely tailored gender identity, whatever that may be, irrespective of whether that corresponds to their biological sex at birth, a ‘trans’ gender identity or a non-binary gender identity. The therapy utilises Mentalisation Based Therapy in a group setting although some people may be seen in an individual therapy setting. The aim of the specialist psychotherapy for transgender is not to persuade or dissuade anyone with regards physical gender solutions. There is not any problem with therapy patients ‘cross dressing’ or accessing physical gender treatments such as hormones or surgery from gender clinics whilst they are in therapy. Traditionally, psychotherapists have had very little experience of working with transgender and speculative hypotheses have been constructed based on only a few cases. Having been involved in therapeutic work with over a hundred patients with transgender and other gender identities for over a decade; Dr Az Hakeem’s own understanding and attitudes to this field have been moulded and informed by his patients over this time. “My early published papers were reflective of a far more psychoanalytic approach to transgender which I have since moved away from having refined my understanding from both my transgender patients and also advances in our understanding of transgender from the areas of psychiatry, psychotherapy, psychology, social sciences, feminism, queer theory and other areas. Patients who have had professional contact with me will be familiar with my aim for them to explore what gender means to them and my encouragement for them to challenge and subvert normative binary frameworks of gender interpretation in themselves or which they perceive within society and replace this with an individually tailored authentic gender identity which they feel suits them irrespective of whether this fits in with a conventional binary gender framework.” –  Dr Az Hakeem, 2015