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Monday, November 9, 1998 Published at 16:43 GMT


Transsexuals fight NHS sex change ban

Dana International: Sex change transformed her life

Three transsexuals have launched a High Court bid to overturn a health authority's refusal to allow them to have sex change operations on the NHS.

In the first case of its kind, the three claim that North West Lancashire Health Authority acted illegally by arguing it could not afford to fund the surgery.

All three plaintiffs have already started hormone treatment, which has led to "irreversible" changes to their bodies, including the growth of female breasts.

The High Court heard that they are now in an "acutely distressed mental and physical state".

Their QC, Nicholas Blake, said four similar cases had already been settled.

The three were the first to come before the court on a full application for judicial review.

Mr Blake accused the health authority, which covers Blackpool and Preston, of operating an unlawful blanket ban since 1995 on funding sex change operations.

The authority had said it would fund where there was an "overriding clinical need", but that phrase was "meaningless", said the QC.

Psychological distress

He argued that to refuse funding to patients who had already started sex change treatment on resource grounds was a false economy. The on-going cost to the NHS of psychological distress would be considerable.

Judge Mr Justice Hidden was told that "Miss A", aged 21, "Miss D" and "Miss G", both aged 50, are already living their lives as women.

"Miss A" had actually undergone three operations before the health authority adopted its policy and all treatment ended.

The three, who are legally aided and cannot be named for legal reasons, are seeking funding to complete their sex changes.

None can afford the cost of private treatment, which they say can be as high as 110 an hour.

They were refused gender re-assignment surgery in 1996 and 1997 after it was decided none of them had shown a demonstrable overriding need for treatment.

'It is an illness'

Mr Blake argued that the health authority was under a duty to take into account the nature of an illness when deciding whether or not to provide funding.

All sides were agreed that gender identity disorder was an illness.

The health authority had decided that counselling could help the three to accept that they were men, Mr Blake said.

But this was a "useless" form of treatment "which merely added to their distress".

Mr Blake argued once a patient had been assessed as suitable for a sex change the only proper course was to continue with surgery.

It was not a case of "operations on demand". For every 100 males who started out on the process, only 15 were assessed as suitable for surgery, according to the Charing Cross clinic in London for gender identity disorder.

Mr Blake added: "It is only in cases of proven and demonstrable clinical need that drastic treatment is offered or recommended as suitable in the first place."

The health authority had wrongly compared sex change treatment to treatment designed to improve self-image, beauty or lifestyle, such as breast enlargement or tattoo removal, Mr Blake said.

"These simply cannot compare with the psychiatric illness and disorder caused by gender identity disorder," he said.

"This is just not cosmetic surgery to make yourself look more attractive.

"This is a disease, an illness, a serious disorder recognised internationally and with an appropriate form of treatment."

Gerard Clarke, representing the health authority, will argue that the decision to refuse treatment was based on a correct clinical judgement.

The hearing is expected to last for two to three days.

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