A transsexual has lost an Appeal Court battle in her bid to obtain NHS funding for a breast enlargement operation.
The 59-year-old, referred to as "C", who suffers from gender identity dysphoria (GID) and cannot be named for legal reasons, had challenged a decision of West Berkshire Primary Care Trust (PCT) not to provide the money.
Today three appeal judges ruled that the decision was one the PCT was entitled to reach and not irrational.
C, who lives in the Reading area, was born male but has been living as a woman for more than a decade.
Despite hormone treatment which began in 1996, her breasts have failed to develop to a size "appropriate to her size and frame", leaving her feeling that she has not completed her transition from male to female, said her lawyers.
She had been left in physical and psychological "limbo".
C's lawyers had asked the Court of Appeal at a hearing earlier this month to overturn a High Court ruling in May last year that she was not entitled to funding for surgery to increase her bust - expected to cost some £2,300 - as part of her medical treatment for GID.
She described facing "abuse and hostility" in public because she was still not seen as a woman. She said youths had called her "all kinds of names".
Her lawyers argued that having breasts was, in C's case, "clearly an important aspect of successful re-assignment to the opposite sex".
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 C's case.
Today Master of the Rolls Lord Neuberger, sitting in the Court of Appeal with Lord Justice Sedley and Lord Justice Hooper, upheld a decision of High Court judge Mr Justice Bean which backed the PCT's stance.
Lord Justice Hooper said Mr Justice Bean's ruling was "unassailable". The relevant policies on GID and breast surgery, including whether her case raised exceptional circumstances, had been properly taken into account.
The appeal judge said he understood why C felt aggrieved that the PCT funded core gender reassignment procedures, notwithstanding the absence of evidence relating to clinical effectiveness, but not breast augmentation operations for persons like her.
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".
The judge said that C, although she had lived as a woman since 1996 and adopted a female name in 1999, had not requested funding for genital reassignment surgery.
She had not applied for a gender recognition certificate under the 2004 Gender Recognition Act "and remains legally a man".
The appeal judges refused her permission to appeal against their ruling to the Supreme Court.Reuse content