"Why is this the right time?"
As a medical student and, later, as a psychiatrist-in-training, it was drummed into me to always ask the question: why now? Why is this person sitting in front of me now, at this point in their life?
As an established gender specialist, I ask the question directly of my patients. It's a valid question, particularly given the fact that gender dysphoria - the distressing sense of mismatch between physical sex and psychological gender - typically dates back into childhood, sometimes as far back as it's possible to remember.
A sad, if sadly not uncommon, answer is: "it's not the right time; the right time was years ago". If dysphoria dates back to early childhood, so does the awareness that it mustn't be talked about. How strong must be the prevailing tide of cisgender normativity within our culture that children of three or four know that to swim, explicitly, against that tide is verboten?
What, then, I persist, makes this the right time for overcoming that long-held taboo? When I first entered this field in 2002, the Internet, then coming into its own, was cited as the primary means of discovering that one's gender feelings weren't unique.
The Internet remains pivotal but, in the last five years or so, an increasingly common response has been "it's easier now". There's a clear sense of cultural change in the UK, a sense that now is, indeed, a relatively good time to be trans. There's talk of 2015 being a kind of Trans Moment.
("Trans" here, is a sort of shorthand for "trans, non-binary and intersex". Terminology, too, is ever-evolving.)
Also cropping up regularly is a name: Caitlyn Jenner. Cue eyeroll.
Discussion of Jenner is unavoidable. For all that she's a hugely imperfect role model - stratospherically wealthy, politically iffy, prone to dubious generalisation and, frankly, as reflective of the wider population of trans people as Hannibal Lecter is of psychiatrists (disclaimer: I like fine dining, I like fine tailoring) - Jenner's high-profile transition has actually filtered down to my consulting room. As a direct consequence, people who might never have registered the existence of trans people are having conversations on the subject; for many, a frame of reference now exists where, previously, there was none.
This is perhaps most apparent in talk of "coming out" to cisgender family, friends, colleagues. While hardly unproblematic, the phrase, "you know Caitlyn Jenner? Well, I'm like that," has been a useful starting point for some.
Which is not to say, obviously, that bad habits have been swept away. I've had disappointing conversations with otherwise perfectly nice, sound friends, in which they've disagreed vehemently with some of the things Jenner has said (which is fair enough; she's made some pretty crass statements). Less reasonable is the tendency, sometimes, to criticise Jenner by misgendering her, as if recognition of her gender identity were a special favour or gift, to be snatched back at the first sign of dissent. Recognising someone's gender identity isn't contingent on their being wise or noble or sympatico. Trans people can be arseholes, same as anybody else - and, crucially, that's okay. They're allowed to be.
Was 2015 really a watershed for trans people? If we're talking specifically about transitioners in the media, then it's been the latest of several, a veritable continuum of watersheds. Before Caitlyn Jenner, there was Laverne Cox, Chelsea Manning, our own Paris Lees (making Question Time memorable), and so on. Just as each "trans pioneer" stands on the shoulders of those who came before, there is no one Trans Moment, but a succession of Moments.
On the inside of UK trans healthcare, though, there really is a feeling of tectonic plates shifting. Next year marks the 50th anniversary of my own Gender Identity Clinic, at Charing Cross Hospital, and it's perhaps apposite that NHS England has finally - finally! - acknowledged the "Cinderella service" status of gender medicine, and has committed, in the coming years, to addressing what amounts, in essence, to decades of underfunding.
Funding is, however, only part of the problem. The really big issue now is training: it takes time and experience to build up the necessary skill set and, at present, there's no specific training route to becoming a gender specialist other than the apprentice model. The disconcertingly named BAGIS - the British Association of Gender Identity Specialists - is working on core competencies but the fact remains that, at present, there aren't enough professionals coming into this field. We need to be attracting, recruiting and training people right now.
So, a call-to-arms. Join us! It's always the right time and, as far as I'm concerned, the Trans Moment is just beginning. Come, be a part of it!