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The inspiring article by Daniel Wilson describes many of the issues central to working with men with learning disabilities who have gender identity needs, and highlights key areas on which learning disability services need to focus. I work as a clinical psychologist in a community learning disability team in East London, and have a particular interest in sexuality and gender. In this article, I will discuss some of the issues that resonate for me in thinking about how services have responded to the needs of people with gender needs, considering possible comparison with responses to people with needs relating to sexual diversity. I will then go on to discuss some of the personal and professional dilemmas that have arisen for me in my work with a man who cross‐dresses.

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