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Why would a young Doctor choose to specialise in Psychiatry? Why would he choose to work in a field that's frowned upon by many of his peers? To cap it all, why would he work in a clinic that had (in the past) acquired a very negative reputation among patients?

Dr Stuart Lorimer works at Charing Cross Gender Identity Clinic in Hammersmith, London. It's a busy place. In 2008, 771 people were referred there with various degrees of gender dysphoria. At any time the clinic is treating well over 1500 people. Some (not all) are seeking support for one of the biggest challenges anyone can undertake: successfully changing the way they live and present to accord with their internal sense of being a man or a woman.

In Britain as a whole, over 300 people apply for legal recognition of permanent gender changes each year. Many others, with less intense dysphoria, take cross-gender hormones or simply find that their feelings can be expressed within their existing gender role.

Helping people make informed decisions about the steps they take is a tough challenge, which is made no easier by having to help them cope with the enormous levels of discrimination which many of those patients will face on the way. The clinicians face challenges too -- not just from fellow Doctors who can't or won't understand, but from patients who arrive with negative expectations about the institution.

Stuart was at pains to stress that he cannot speak on behalf of the clinic he works in. This interview focusses upon him as one of a wholly new generation of specialists in the field, and his own thoughts about some of the controversial issues that have raged for years in this field. In sharing his own thoughts, however, he paints a picture of a team still struggling with an inherited reputation, constantly learning and evolving -- and wanting to do their best in difficult circumstances.

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