Admitting you were uncomfortable with your gender or wanted to change it was virtually unheard of years ago.
But that didn't mean it didn't exist. Many people instead lived an oppressed existence rather than risk losing their family and friends, and being shunned by society.
Although attitudes are now changing, it is only happening gradually and it is thanks to places like Exeter's West of England Specialist Gender Identity Clinic, better known as The Laurels, that acceptance is beginning to be achieved.
The city-centre based clinic in Dix's Field is one of only seven in the country, the next nearest being London, and it welcomes people from all over the UK.
It relocated there in 2010, but has been part of community mental health services for around 30 years and is run by Devon Partnership NHS Trust (DPT).
In the past 10 years, it has gone from receiving around five referrals a month to 70, and 90 per cent of those are people living in the South West.
The massive growth in demand is reflected in its waiting list which currently stands at 12-months for a first appointment, followed by an additional wait of between six to nine months to be given a medical diagnosis by one of the clinic's four doctors.
Clinical team leader Maria Morris is the first to acknowledge such a long wait is "unacceptable" but says she is hopeful the service will improve now that extra funding has been promised by NHS England - who commission all gender services in England - to reduce waiting lists and make the service more effective and accessible.
Discussions are also being had over the possibility of a satellite clinic to help reduce Exeter's waiting list and keep up with demand.
Maria said: "We have 580 people on our waiting list at the moment. Gender services have not been included in the NHS 18-week to referral to treatment target, but there are conversations between NHS England and the NHS because the current waiting times are unacceptable."
"A couple of years ago we were seeing people within 16 weeks. Unfortunately they are not low now and we have a 12-month waiting list, but so do all the other gender services."
"Between all the seven gender clinic lists there is something like 5,000 people waiting for treatment."
"People are referred by their GP, and we should be able to see them within 18-weeks. It would scare me to death if I thought I was on a waiting list for 12-months. It would be awful."
The reasons behind the growth in demand at the Exeter clinic are believed to be due to a number of reasons, including it now being located in more a central and accessible location, and society gradually becoming more acceptable of people wanting to change their gender.
Maria said: "The whole world of gender identity concerns is quite fluid at the moment. You get people who are quite clear they have a sense of being a binary person such as I'm female but I feel like I should be a binary male."
"In between those you have people who consider themselves non-binary, asexual or gender-fluid. You can have a roomful of people and they will all have a different description of what they call themselves."
"That's quite scary for society as they don't know what to call them."
"At The Laurels it's about reaching gender comfort and what is best for that person. To achieve that for some people it means surgery."
People are referred for surgery either in Brighton or London which has specialist gender operation surgeons.
Most treatment pathways at The Laurels last four years during which time people receive varied help including psychological support, speech therapy, family therapy and physical support such as hair removal advice.
Maria said: "It's not an easy process and people feel like they have to go through hoops, but I don't apologise for that if they are seeking non-reversible changes."
"If it wasn't very important to them they would never do what they have to go through."
"Depending on the pathway they take, someone can be with us between 12 months to four years so it's almost like they become family."
"When they first come they are quite nervous and may need a lot of support, and then they suddenly blossom and leave with a quality of life they thought they would not have. It's quite powerful to have been part of that."
"Sadly there are people who get harassed and bullied and have lost their family."
The Laurels caters for adults only. The only gender identity clinic for under-18s is London's Tavistock and Portman NHS Foundation Trust which has seen referrals double in the past year to nearly 1,400.
Maria says there is no 'typical' client and even the average age of people is now changing.
She said: "If you had asked me a couple of years ago who was our typical client I would have said for males to females the age range was between 40 to 50 years old, and for female to male the age was a bit younger."
"It's now changing as the age of both is dropping. We are seeing a lot of young people coming to us and even find that some people choose to come to Exeter University because our clinic is based here."
"The eldest person we have had referred to us was 84-years-old. There is no age limit."
While most people's first memories are of playing or being somewhere as a young child, Stephanie Moore's is very different.
Her earliest memories are of feeling that something wasn't quite right. Despite being born as a male and named Stephen, she says she never felt comfortable with her gender but was forced to conform to the stereotypes of being male.
She went on marry three times and had a daughter and raised two other children. It wasn't until her mid-50s that she decided to stop living a lie and sought the help of The Laurels.
The 58-year-old is now living a happy and content life in Devon, and has shared her story in the hope of helping and educate others.
"When you arrive on this planet you are treated as masculine and male purely because you have a penis. To be a successful male there are expectations put on you, and very early on in life I remember very clearly feeling some form of dissidence and thinking this is not working for me."
"I would say things to my mum but like all mums they want their children to be successful and love you back into conformity."
"I found myself doing things I was supposed to do, even though it felt uncomfortable. It was almost like living a lie really."
"I was the eldest child and had two brothers and my dad was in the Army so saying to him I was a girl really wouldn't have worked so it was quite an interesting childhood."
"I ended up in a fairly repressed placed which carried on for many years. I got very good at being a man. It was the way I dealt with it."
"I had to go to boarding school when I was eight. The first one was a mixed school but the second was all boys and was an absolute nightmare."
"It was clear I was different and the only reason I survived was I turned out to be a really good swimmer and got as many medals as I could which gave me a certain kudos and meant I was not beaten up."
"I was also incredibly good at lying to myself and society. But I was really unhappy in myself and ended up living a fairly risky life as it felt valueless. I used to ride motorcycles and really had no fear."
"The biggest distraction was work and running lots of demanding projects. I started off in technical disciplines then marketing and used to travel all over the globe. That was my way of not looking at me."
"When I got made redundant at the age of 46 for the fifth time I crashed and burned. I moved to the South West after a pretty messy divorce."
"By then I was wearing female clothing under my clothes which is known as under dressing."
"Every time I went anywhere near my sexual organs it was like I had an alien in my pants. I couldn't think of anything any more repugent than looking at myself."
"In adolescence I was convinced it was going to drop off and then everything would be okay."
"For most people, if you're lucky enough to be born with your gender in alignment that's absolutely fine."
"Imagine getting up everyday and loathing your body. I've never had any doubt in my mind I was female."
"I never looked in mirrors because I would think, 'who the hell are you?'. What I saw in the reflection was alien to me."
"When I got to the age of 54 I decided I couldn't live a lie anymore. I went through cycles of being much more who I am and would then throw all my female clothes away and become a man again."
"All the conditioning early on in life makes your head work one way but your emotions work in a completely different way. There were cycles of guilt."
"What stopped the cycle was when I went to see a GP. I prayed it would be a middle-aged woman but it was a 28-year-old Army captain."
"So there I was - this 6ft man built like a rugby player - telling him I thought I was a woman. But he was absolutely brilliant."
"It was very different to when I was in my mid-30s and I had a go at dealing with my feelings and a therapist told me I was gay. I knew I wasn't and that the answer was completely wrong."
"Thanks to the GP I was referred to a physiatrist as back then you had to before being referred to The Laurels. I ticked all the boxes for being gender dysphoria."
"It took about a year before I was seen and I remember walking through the doors of The Laurels, and for the first time in my life people were talking the same language as me and understood. From that moment I became Stephanie."
"The most difficult thing wasn't the surgery but going through transition as you have to forget all the conditioning, all the rules and all the things you're supposed to do."
"Having led a repressed life where you're forced to conform to stereotypes and then it's like that's almost flipped over and suddenly you can do what you like."
"That's why you see some transgender people wearing pink frilly or tarty clothes because it's like going through adolescence again."
"I have always worn fairly androgynous clothing which is my personal choice. I have the build of a man so could yoy see a dress on this body? I don't think so!"
"Transition is about coming to terms with yourself and how your express yourself in society, and coming to terms with you being happy with you. I don't think I have finished transitioning."
"My daughter, who is 34, has spent a lot of time helping me get through transition. Then she married someone who doesn't like transgender people."
"My brothers said, 'thank goodness for that', when I told them because they always knew that there was something I was hiding so there was a sense of relief."
"It was quite tricky telling my dad when I was in my mid-50s. He put his hand on my leg and said, 'Can't you just keep doing what you're doing now?'. I said, 'Not really as it's not worked'."
"Being a military man he really struggled with it, and so did my mum, but now my dad loves having a daughter who can still wield power tools."
"What you've got to remember is our memories we create is us and we just use our body to hang the memories off."
"When I finally had the surgery it was akin to the morning after when it snows. It was the first time it had been quiet in my head."
"I can't speak highly enough of The Laurels and how it has fundamentally changed my life. I now have a life worth living."
"I am now in the most wonderful relationship with a woman who is absolutely fine with my history. We are like a pair of old companions."
"You can never predict the person you will end up with but she is my soul mate."
Laurels volunteer's story
A Laurels client who wished to remain anonymous because she lives in Exeter has described how she didn't seek the help of the city's gender clinic until she was in later 50s.
In 2007, she began her treatment at The Laurels and says she wouldn't be alive today if it wasn't for the help she has received.
She is now a Laurels Advice Bureau (LAB) volunteer to offer support to those treated at the clinic.
"I felt like it didn't matter if I died. Many times I had considered driving into a truck coming the other way."
"I was 57 when I first went to the doctor. I had known something wasn't right from the age of eight. I was at a Cub Scout camp and I whispered to a friend, 'Have you ever worn your sisters clothing?'. I can't remember their answer but I remember asking the question."
"Most children reach gender stability about eight or nine. I didn't know what I was because I felt like a woman but I knew that couldn't be true as when I looked in the mirror I was a 6ft 2inch male."
"I felt like I was a woman but I didn't think I was as I was so deep into denial and you begin to believe your own lies."
"I never abhorred my body. My body worked and I was grateful for that - but it was the wrong one."
"But I had to step over the line when to find inner peace. I would not be here now otherwise if I hadn't of done."
"I had my surgery in Brighton and when I woke up from the operation there was this silence. The noise in my head had gone. I was not been ready for that and spent the whole day crying as I was so happy."
"I have a brother and he is gay, but he won't talk to me anymore. I have only met my son once after I have transitioned and I haven't seen him since. Both my parents died before it all came out and I'm grateful for that as they were from a generation who would not have understood."
"Unfortunately you have to make sacrifices doing what I did and I've lost people because of it, including my ex-partner. They don't want anything to do with me but if they can't deal with who I am and realise how happy I am then it's their problem, not mine. I haven't walked away - they have, and if they wanted to come back I would roll out the carpet and start again."
"I'm now 66. Some of my friends don't know my history so I still have to be mentally disciplined not to remember myself as a lad. But I have something to live for in the future. I have stopped smoking and I rarely drink."
"I live on my own and am happy on my own, but if the right guy comes along and is happy with my history then that is fine."
By Exeter Express and Echo | Posted: September 18, 2016
By Anita Merritt