Transsexual NHS breast operation refusal upheld

A transsexual who wants the NHS to pay for her to have a breast enlargement operation has lost a High Court appeal.

The woman, of Reading, Berkshire, was fighting a test case against a refusal by West Berkshire PCT for funding.

The 59-year-old, who has been living as a woman for more than 10 years, had argued it amounted to a violation of her human rights and unlawful sex discrimination.

The PCT argued there were no health reasons for the procedure.

Three appeal judges ruled the decision was one the PCT was entitled to reach and not irrational.

'Appropriate size'

The woman, who has gender identity dysphoria (GID), cannot be named for legal reasons.

Her lawyers argued that despite hormone treatment which began in 1996, her breasts had failed to develop to a size "appropriate to her size and frame", leaving her feeling she had not completed her transition from male to female.

The woman's lawyers said the surgery was expected to cost about £2,300 and argued she was entitled to it as part of her medical treatment for GID.

Lawyers for the PCT said surgery was not an essential part of GID treatment and there was no good evidence that it would be cost-effective or clinically effective in her case.

'Difficult choices'

Master of the Rolls Lord Neuberger, sitting in the Court of Appeal with Lord Justice Sedley and Lord Justice Hooper, upheld an earlier decision by High Court judge Mr Justice Bean which backed the PCT's stance.

Lord Justice Hooper said he understood why the woman felt aggrieved that the PCT funded "core" gender reassignment procedures, in spite of the absence of evidence relating to clinical effectiveness, but not breast augmentation operations for people with GID.

But he said the answer in law was that the PCT "has to make very difficult choices as to what procedures to fund and not to fund, and the choice made in this case is not irrational".

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