Nathaniel Taylor, right, with fiancee Phillie Holmes in Invercargill. Taylor struggled to tell family members he was transitioning from female to male.

Two weeks ago, Jess Taylor's future parents-in-law got a letter.

The 22-year-old left it on the kitchen table of their Invercargill home before going to work.

In the letter, Taylor requested to be referred to as a "he" from now on. His new name would be Nathaniel.

The letter took an hour to write but "forever" to compose, Taylor says.

"It's such a huge thing to have to tell people - 'Hey, this is the person you thought you knew' - I'm still that exact same person, I just might not look that way."

Taylor recalls coming to breakfast the next morning and hearing a voice call out: "Morning, Nate."

"That was the best feeling in the world."

As a child growing up in Sydney, the young Jessica Taylor would pray to God to wake up a male.

"I grew up and I thought, 'No, I can't do this'," Taylor says."So I pretended to be someone else."

About two months ago, Taylor decided he could no longer lie to himself or those in his life.

Taylor raised the subject with his fiancee of three years, Phillie Holmes, while at the supermarket.

"I said, 'I'd like to see a gender counsellor'," Taylor recalls. "And then we carried on down the chip aisle."

Holmes says the news did not come as a surprise. In fact, "it was kind of a relief".

For a long time, Taylor was deeply unhappy in himself, Holmes says.

"You kind of don't know if it's ever going to get better. Then they make this change, and it's like the person I fell in love with has come back to me."

Taylor's letter to Holmes' parents was one step in a series he has taken recently, including coming out to his colleagues and his Sydney-based parents.

Taylor has begun binding his breasts and this week made himself a new Facebook account.

Positive responses to his new identity have been "hugely surprising", he says.

In a YouTube video Taylor made about coming out, he says the worst reaction he has had is: "I don't know what to say to that."

Taylor says being himself has improved his relationships with his fiancee's parents and, more significantly, with his own.

His father, whom Taylor had barely spoken to in a year, replied to his email within three hours, offering his full support.

Taylor says it took 22 years "to face the fact that I'm not a woman, that I'm definitely a guy".

It is a situation the Southern District Health Board (SDHB) is ill-equipped to deal with.

Taylor asked his GP to refer him to a psychiatrist for a gender dysphoria assessment, which is required for an endocrinologist to prescribe hormone therapy.

The SDHB sent a letter saying it could not help him.

Instead, Taylor will see a psychiatrist in Christchurch.

Lynda Whitehead, president of trans support agency Agender, says the lack of services available to trans people is not news to her, but it was impossible to say how many people were affected.

She says any psychiatrist could talk to someone with dysphoria.

"Generally speaking, while they may not be an expert in gender dysphoria, they're all aware of it. There's bound to be someone in Invercargill."

Taylor's endocrinology consultations and prescriptions would likely be subsidised, but his psychiatric assessment and mastectomy would not.

The Ministry of Health offers funding for gender reassignment surgery but for Taylor, such surgery would be years away.

For now, an online fundraiser has enough money for him to legally change his name.

He plans to hang the certificate on the wall.

"There are going to be days where I look down at my body and go, 'This doesn't look right'," Taylor says. "But then I can look up at the wall and go, 'That's right. I'm Nathaniel'."

The SDHB did not respond to requests for comment.