For most people, their sex and their gender identity are the same. But for an estimated 1% of the UK population, there’s a mis-match between these two identities - something known as “gender dysphoria”.
Some people with gender dysphoria decide they want to live according to the gender they identify with, rather than their sex. These people are commonly known as transgender, or trans.
Since 2014, the number of people from Wales being referred to a gender clinic has more than tripled. But despite a growing number of people coming forward, many say they face misunderstanding and prejudice.
A recent report by the charity Stonewall Cymru found that 44% of trans people avoid certain streets because they don't feel safe, while half say they've hidden their identity at work for fear of discrimination.
Jamie Morse, 20, has been living as a woman for six months. She says life as a student in Cardiff is easier than at home in Pembrokeshire, where she says she can “only be trans in the house”.
“In Cardiff I can at least be me day to day”, she said. “I might get a look but I’m not going to get pointed at or laughed at day to day”.
But life in Wales’ capital hasn’t always been easy. Jamie says she was recently denied entry to a nightclub because she is trans.
“We hadn’t been drinking and it was empty, and they just looked at me and sniggered, and wouldn’t talk to me but would talk to my friend and basically told us we were too drunk to go in. It was very clear from the laughing and the pointing at me as I left that it was because I was trans.”
But despite some bad experiences, Jamie says she’s happy with her decision to transition.
“My life would be way easier if I wasn’t trans.... But that sucked, I’ve tried that. And I’d rather just be me”.
Last year, 75 transgender people from Wales were referred to the NHS for gender identity treatment - a figure that’s tripled since 2014.
At the moment, the treatment - including the prescription of cross-gender hormones - happens at a clinic in London, where waiting lists are 18 months long.
Last year, the Welsh Government announced plans to open Wales’ very own gender identity clinic, which will be the first in the country.
It’s a step forward which many in Wales’ trans community have welcomed, including 20-year-old Ashton. He transitioned from female to male at the age of 14, but waited five years to see a gender specialist on the NHS. He eventually opted for private treatment, costing him £7000.
“Knowing that you should look different to how you look, it’s so traumatising”, he said. “At the end of Year 11 I just thought I need to start hormones. I can’t go to college not starting hormones. I knew I wasn’t going to start taking them until I was 19 on the NHS”.
Ashton is one of many trans people in Wales who have been consulted on the new clinic. It's come too late for him, but he hopes it will enable others to lead a normal life as a transgender person here in Wales.
"I've spent all my teenage years waiting for appointments, waiting for dates and I just feel happy to just chill out a bit I suppose and not worry about transitioning", he said. "I can just focus on uni now, going out with my friends, and just taking that time out to just be myself".
- The future
In 2004 the Gender Recognition Act was passed, allowing transgender people to legally change the gender on their birth certificate.
But the process is complicated, involving lengthy medical and psychological assessments, resulting in a person being diagnosed with gender dysphoria.
This year the UK Government will consult the public about updating the legislation. The Prime Minister says she wants to "streamline and de-medicalise" the process.
Veteran human rights campaigner Peter Tatchell has added his voice to the calls for reform.
"It's about a simple issue of respect", he told ITV Wales. "Listen to trans people, hear their feelings, and accept their self definition".
"Trans people feel very certain and very clear about their gender identity, and when they feel that way, why should the state or the medical profession obstruct their right to define themselves as who they feel they are?"
Asked about some critics' concerns that a change to the legislation could make it too easy for people to change their gender, Tatchell said trans people do not change their official gender "lightly, frivolously or in haste".
"This is something they've thought about for a very long time, they've often agonised about it, but when they've come to that decision, having gone through all the obstacles and all the difficulties, all the prejudice and discrimination they face, I think we should really listen to trans people".
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