Transexuals don't actually have a choice. It's the way they're born. Something happens when they're developing in the womb that ultimately leads to them feeling that they are a woman stuck in a man's body, or a man trapped in a woman's body. The feeling isn't a learned auto-erotic arousal like transvestitism - a male transsexual actually has a woman's brain. By Joe Gardiner

For one in 10,000 of the population, a hormonal imbalance in the uterus about six to nine weeks after conception is where it all starts. A study from the Netherlands examined the brains of straight and gay men, women and male-to-female transsexuals. They looked at part of the hypothalmus, an area of the brain that is affected by sex hormones during its development, and discovered that while the brains of straight and gay men were the same, the transsexual-to-female brains were almost identical to the brains of women.

However, knowing that the way you feel is due to a quirk of nature doesn't make life any easier, especially when puberty kicks in and your body starts to head off down a route that is diametrically opposed to the way you want to go.

"I have people turning up who are on the point of suicide," says Fran Springfield, specialist gender identity counsellor, "and self mutilation is not uncommon." But, in a strange way, these are the lucky ones - they've recognised their situation and have taken the first step. Others are not so lucky. "Many transsexuals go through periods when they attempt to suppress or deny their condition. Some choose hobbies or jobs that are hyper-masculine in order to try to prove that they are not transsexual."

Transsexuals can be found in all walks of life: Springfield has even had former SAS members come to her for help. Some transsexual-to-females who visit are in the 40s or 50s, have married and have children. Having made the initial contact the patient is now ready to embark on the journey from transsexual-to-female.