#azeem ibrahim

By: Azeem Ibrahim

Published: Aug 23, 2023

We cannot allow activists masquerading as experts to have the final word any longer. An open letter sent to the Wall Street Journal last month came and went without the public attention it sorely deserved.

Signed by 21 leading experts on paediatric gender medicine from nine countries, they wrote to take issue with the US Endocrine Society’s statement that so-called ‘gender-affirming’ care is best for minors presenting with gender dysphoria.

Gender-affirming care is code for the belief that hormones and surgery is the best and primary treatment for gender dysphoria since it purportedly “reduces the risk of suicide”.

The experts minced no words – the belief is “not supported by evidence”. Rather than cherry-pick studies which fit the narrative, the experts used far deeper meta-studies which found evidence of mental health benefits to be of “low or very low certainty”.

The risks for minors of puberty blockers and surgeries, including permanent sterility, regret, and lifelong dependence on repeat surgeries and medication are very real. Furthermore, the experts wrote that the claim that gender transition reduces suicides is contradicted by every systematic review. Even the Endocrine Society’s review found no reliable evidence that hormonal transition prevents suicide, yet they have no qualms promoting it.

This is something that every parent across Scotland, deep in their hearts, knew already to be true. That surgery and hormones are unlikely to resolve the underlying mental unwellness that troubles their children.

We live in a world where gender distress has increased in prevalence by several thousand percent in the last two decades – but to question the longevity of these feelings or to describe them in the context of mental health is denounced as transphobic and as provoking suicide. Parents face ultimatums about the suicide of their children despite their being no good reason to believe that puberty blockers will help them.

As Dr Paul McHugh noted all those years ago, “when children who reported transgender feelings were tracked without medical or surgical treatment at Vanderbilt University and London's Portman Clinic, 70%-80% of them spontaneously lost those feelings.”

In the vast majority of cases, the best approach is to love your children and take no medical intervention. Yet, according to The Telegraph, figures show that 98 per cent of children who were given puberty blockers went on to be given cross-sex hormones.

Blockers are dangerous and irreversible in their own right, but they also 'lock-in' children to even more devastating outcomes when they would likely have recovered from the dysphoria without intervention – if only doctors had let them. It is not reality that is causing most of these young people to commit suicide, is it collaborating with a mental disorder with body and mind-altering drugs.

Doctors are supposed to advise treatment on the basis of evidence and fully inform their patients. The Tavistock Clinic scandal shows that even the most (formerly) prestigious institutions were letting children down.

In court, the Government’s Gender Identity Service (GIDS) couldn’t even provide data on the outcomes and consequences of puberty blockers on the minors who were given them. Even if the children were old enough to consent, the consent wouldn’t have been informed.

In order to skirt around questions of consent, we are told convenient myths. Puberty blockers are described as a “physically reversible treatment if stopped” by GIDS. This is an improvement, as until 2020 the claim had been that “treatment with GnRH analogues are considered to be fully reversible”, but it is still scandalously misleading to my mind.

The new definition tacitly concedes that the puberty blockers are not and have never been psychologically reversible – they had been promoted as harmless despite little research having gone into finding out whether this was the case. It also allows the words “if stopped” to do an inordinate amount of linguistic legwork.

The fact that the GnRH drugs shut down large parts of the hypothalamus – the hormonal structure of the brain that regulates our perception of the world around us – should have given clinicians pause for thought before allowing them into the developing brains of children. Indeed, these same GnRH analogues are used for chemical castration. But ideology comes first and children come second.

In many cases, the children affected are girls – now around 75% of them – and many also suffer from autism and other issues which are known to affect socialisation. There are strong correlations between such mental disorders and gender dysphoria.

Parents who attempt to remove vulnerable children from suggestive environments, offer a counter-message, or even attempt to make children more comfortable in their natural sex in the meantime are condemned as transphobic. So are those who insist that minors are not capable of consenting to use chemicals which impact their future so profoundly.

In Canada, a father has been jailed for opposing his child’s gender transition. He insisted that his child, who was 13 at the time, was still a ‘she’ – an utterance which is (quite literally) considered criminal violence in Canada.

He refused consent for her to be given puberty blockers. Dragged through the courts, fined thousands, and imprisoned, the father was unable to stop his child being given not just puberty blockers, but cross-sex hormones, causing them to go through puberty with testosterone and changing his child’s life forever.

In Scotland, children as young as nine have been prescribed puberty blockers. Despite activists' best efforts, minors who want surgery and cross-sex hormones in the UK must wait until the frail old age of 17. This is still a child, but it could be so much worse.

The World Professional Association for Transgender Health’s (WPATH) insist that children as young as nine years old can be given cross-sex hormones. Their ‘guidelines’ also permit mastectomies, implants and prosthetic genitals once these children have been on hormones for 12 months, with no mental health assessment.

Tragically, after 12 months, the risk of cancers, infertility and negative psychoactive effects are already high. It is barbaric to do this to children. Doctors who endorse this course of action should not be trusted. In fact, only a third of WPATH’s ethics committee are medical doctors. As with the Endocrine Society, we cannot allow activists masquerading as experts to have the final word any longer. We need our ethics to be based on compassion and understanding rather than politics.

Paul McHugh's seminal 2014 essay should still serve as a critical point of reference on the use of puberty blockers. McHugh, a distinguished former psychiatrist-in-chief at Johns Hopkins Hospital (an institution which was an early pioneer of such surgeries), wrote candidly at a time before the transgender issue became the cultural powder keg it is today.

McHugh identified three subgroups of transgender people who might be given surgery or medication. The first is the opportunist, such as Isla Bryson, who have obvious motives to change sex. The second group are internally and externally suggestible, similarly to anorexia nervosa patients, who are convinced that a physical surgery will fix their psycho-social problems. The third group are often prepubescent children who, in the process of naturally exploring how they fit into the world, begin to imitate behaviours of the opposite sex.

The following is an excerpt from the new book The Rohingyas: Inside Myanmar's Hidden Genocide by Azeem Ibrahim (Hurst, 2016):

The reality facing the Rohingyas, a Muslim confessional ethnic group living in Rakhine province in western Myanmar, is the threat of genocide. Ever since Burma became independent in 1948 they have been targeted whenever ambitious (or desperate) politicians need to deflect attention from other matters. Both government officials and party leaders have called for their expulsion from their homeland, and the main opposition ignores their plight. The build up to the elections in late 2015 witnessed the final destruction of their civic rights in Myanmar (completing a process that began with the 1947 Constitution) and increasingly they are detained in what are now permanent internal refugee camps, where they are denied food, work and medical care.

If the regime fails to reign in the persecution of the Rohingyas (which only sustained international pressure will achieve) we will see a repeat of the by now familiar refugee crises, as the Rohingyas flee oppression. Moreover it is almost inevitable that there will be further inter-communal violence, aimed at forcing the remaining Rohingyas either to run away or succumb to mass murder. The charge of genocide is a serious one to make; the current situation in Myanmar fully justifies the use of this word.

Till recently the Rohingyas had attracted relatively little attention from the international press, even in the critical period leading up to only the third round of parliamentary elections to be held since 1990. If there is a common narrative it is that Burma (the name ‘Myanmar’ was adopted as part of a new set of laws in 1989) was a closed country of little direct interest to the world; that Aung San Suu Kyi, leader of the opposition National League for Democracy (NLD), having endured years of house arrest, is fully committed to a democratic future for all of Myanmar’s ethnic and religious groups; and that instances of inter-ethnic or inter-confessional violence are to be expected in a country making the difficult transition from authoritarian military rule to democracy. The problem is that all three of these beliefs are false.

Burma may have turned its back on the British-led Commonwealth when it gained independence in 1948, but it maintained substantial external links as a democracy (until 1962), under military rule (1962–2011) and subsequently. It is just that those links have been essentially pragmatic (especially under military rule), designed to allow the ruling elite to make money by trading away the country’s wealth while at the same time buying arms. As we will see, the military regime (which remains essentially in power despite the notional return of democracy and the electoral defeat of its political party in 2015) does not like international criticism of its actions, but is far more responsive than is often believed. This means those who decide not to criticize it, or to set it red lines, are failing in their duty under international law.

As in its response to the political dynamics in regions such as the former Soviet Union and Yugoslavia, the Western media likes to identify clear heroes and villains. In Myanmar Aung San Suu Kyi clearly fits the hero category for this type of analysis. She has spent over twenty years of her life imprisoned in her own home, she has been awarded the Nobel Peace Prize, and she leads the main opposition party. However, as so often in the former Soviet Union, our chosen heroes are actually far more nuanced than our narratives demand. The other side of the story is that Aung San Suu Kyi herself is part of the Myanmar elite. Her father fought for the Japanese during World War II (albeit reluctantly) and was one of the leaders of the independence movement; her mother was a government minister from 1948–62. The NLD’s deputy chairman was the commander in chief of the Burmese Army until 1976 when he was ousted after leading a failed coup. Equally, while the NLD may aim for democracy, in an ethnically complex country its electoral support comes almost entirely from the ethnically Burman community. Thus, in terms of its senior officials and the ethnicity of its electorate, the NLD shares much with the regime and the wider elite, and has had a difficult relationship with the ethnic minorities in Burma ever since independence. In particular, Aung San Suu Kyi has usually opted to avoid direct comment when the question of the systematic persecution of the Rohingyas is raised.

Another easy assumption is that Buddhism is a peaceful religion that shows no sign of the intolerance to other faiths that scars some forms of Christianity, Hinduism and Islam. Unfortunately this is not the case. Some who subscribe to Theravada Buddhism (which is also dominant in Sri Lanka and Thailand, where it is also associated with inter-communal violence) argue that for Buddhism to be safe all other religious beliefs must be eliminated. They also tend to look to the state for support and in a few extreme cases regard those who are not Buddhists as less than human.

In Myanmar, extremist Buddhist organizations have been at the heart of inter-communal violence ever since the return to relative democracy in 2011. Both the major political parties (the regime’s Union Solidarity and Development Party, USDP, and the opposition NLD) are reliant on these organizations for much of their electoral support, giving them substantial influence over the political process. Equally there is emerging evidence that the old military regime funded and supported one major faction among the extremists to foster unrest. In turn, the existence of inter-communal violence keeps open the possibility of a return to military rule—in order, of course, to save the nation from violence.

This matters, as it means that Myanmar is not on a clear road to democracy. The violence against the Rohingyas is not an unpleasant, though predictable, side-effect of a society moving from authoritarian rule to liberalism. The repression of the Rohingyas is orchestrated, in part by those who believe there is no place in Myanmar for anyone who is not a Buddhist (and especially if they are Muslim), in part by ethnic extremists in other communities who want a racially pure state, and in part by the military regime, which is content to see a degree of unrest.

Global indifference supports the regime and is leading to genocide. There is nothing to gain from not challenging the military and the notional opposition since, if they are left unchallenged, each year will see refugee crises, which are already destabilizing the region. And, sooner or later, the world will wake up to a genocide on the scale that shocked the world in Rwanda in 1994.

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The recent conviction on terrorism charges of a British Muslim convert, Richard Dart, known as Salahuddin, is a chilling reminder of the extremist threat amongst us, writes AZEEM IBRAHIM. Dart pleaded guilty to plotting to target Royal Wootton Bassett, the Wilshire town where mourners gathered to pay their respects to British troops killed in Afghanistan. Evidence was heard that he was radicalized by British Islamist Anjem Choudary and trained at terrorism camps in Pakistan.

Featured in a documentary made by his half-brother, Dart showed a fanatical belief and unquestioning adherence to his new “family”, more typical of cult and gang members. Out of step with their own provincial community, the young British converts shown in the documentary are obviously caught up with the new language, symbols, clothing and rituals and the camaraderie of like-minded “brothers”, inspired by the radicalism instead of the religion itself.

Alienated youth in Western and Middle Eastern countries are attracted to the message of violent action and Muslim converts can be dangerous activists if influenced by radical well-funded Islamist movements. The tragedy of extremism is evident especially in Pakistan, where the violent deaths of victims of religious fanaticism are reported almost daily. There is a rising fury among the Shia Muslims in Pakistan that the sectarian violence should continue with Muslims killing Muslims in the name of Islam.