Washington, United States |  Eight years ago, when Thomas Coughlin joined a Washington clinic's small team devoted to transgender care, around 200 people came knocking at the door. This year, there were 1,200.

Coughlin has witnessed a dramatic rise in the number of people coming out as transgender, bolstered as much by celebrity role models as by a shift in US public policies that now rank among the most progressive in the world -- to the point of triggering the backlash seen in the standoff over access to public bathrooms.

For him, the matter hits very close to home.

"I began my gender transition 16 years ago so it's been a while. It was very different back them," the 53-year-old, who was born female but identifies as male, told AFP in an interview.

It was through word of mouth that Coughlin found doctors, support groups, and eventually a new profession as a mental health counselor for transgender people.

"I didn't know anybody that was trans until I reached out on the Internet to somebody and then they connected me with another person."

"It was my own experience seeing and meeting folks who didn't have the privilege that I had as a white person, as an educated person, as a male... I thought I can be of service to them and I can help them find their way."

A former videographer and editor in the TV production field, the New York native went back to school to become a therapist at Whitman-Walker Health, a non-profit focused on the needs of the LGBT community, whose health center in the heart of Washington has a department for transgender care.  

- Accessing surgery -  In his 30s when he transitioned from female to male, Coughlin says the challenge was made easier by his age and the fact he wasn't financially dependent on his parents -- who in any case eventually supported his decision. 

His siblings showed some reluctance, unsure how to explain to their children that their aunt would become their uncle.

But "16 years later, everybody is on the same page, I'm Uncle Tommy now," said Coughlin, who sports glasses and a beard and has been married to a woman, a French teacher, for two years now.

According to a study published in 2011 by The Williams Institute, an LGBT think tank, an estimated 0.3 percent of the US population is transgender. 

Coughlin has seen a spectacular increase in the number of patients coming to Whitman-Walker Health for hormone therapy and mental health support since he arrived in 2008.

Part of that is down to a 2014 change in healthcare policy in the US capital, where residents are now guaranteed either private or public insurance coverage for hormone treatment and gender reassignment surgery.

"I think a lot of folks who are coming to the clinic now are seeking support in accessing those surgeries that are available now and which were never available. 

"These are expensive surgeries, it's in the thousands to tens of thousands, and so to be able to get them covered by insurance is a big deal."

- 'Confusion' -Since coming out a year ago, Caitlyn Jenner has ruffled more than a few feathers in the transgender community -- many of whom seen the Olympian and reality TV star as a poor spokesperson on trans issues.

But in Coughlin's view, the coming out of celebrities -- most spectacularly Bruce Jenner's transition to Caitlyn which captured headlines the world over -- undeniably raised awareness, and in doing so helped the progressive agenda.

"It has tremendous impact on folks' ability to accept themselves and for others to accept them," he said.

Because acceptance isn't a given everywhere. 

This year Coughlin will not be visiting the in-laws in North Carolina because his wife does not want to go somewhere where he would face discrimination.

In March, the state pushed back hard against moves to accommodate transgender people, with a law requiring them to use public restrooms matching the sex on their birth certificate -- triggering a national outcry and a legal showdown with the White House.

A number of conservative states and cities are mulling or have passed similar legislation such as Mississippi where a law allows religious groups and private businesses to deny services to same-sex couples and transgender people.

President Barack Obama's administration has thrown its weight behind the transgender community with a directive telling public schools to let youths access the restroom of their choice -- which 11 states are now challenging in court.

Coughlin says the so-called "bathroom" battle is a source of anxiety.

"For a lot of my clients, we have talked a lot about the emotional impact and the fear that these types of rulings have on individuals, and what that might look like for their future and their ability to move about the country freely."

"There is this confusion, or conflating, of transgender folks with sexual predators and... to separate those two is going to be a very important distinction to be made." 

But the national debate has also brought powerfully supportive voices to the fore, including that of Attorney General Loretta Lynch who defended the rights of transgender people in a passionate speech.

"For so many years I just wanted people to acknowledge my existence," Coughlin said. "To have somebody in the administration say 'Yes, we see you, we're here for you, we support you,' was just amazing."