THE health service in Scotland is funding nearly a hundred gender reassignment procedures a year since the referrals process was overhauled.

Figures obtained by the Herald show that National Services Division (NSD) approved funding for 386 referrals for surgery between April 2013 and July this year, including 135 male-to-female and 41 female to male genital surgeries and 210 chest reconstructions for trans-men, where breast tissue removed to create a masculine torso. On average, male-to-female genital surgery costs around £10-11,000 per patient.

It comes amid a growing public awareness of gender dysphoria in the wake of high-profile celebrity transitions such as Caitlin Jenner - formerly known as Bruce Jenner.

Case Study: 'I just thought 'enough of this'"

The figures compare to just 28 male-to-female surgeries paid for by NSD between 2003 and 2013. However, it is unclear exactly how much the operations have increased as, prior to 2012, most gender reassignment referrals were funded directly by health boards - not by NSD.

In many cases transgender patients faced a postcode lottery for treatment and lengthy delays. In 2012, NSD took over responsibility for all referrals in Scotland to simplify access to transgender surgery, but most patients still wait five to six years.

James Morton, manager of the Scottish Trans Alliance, said: "That whole period pre-2012 was an absolute nightmare in trans-equality terms. A lot of the health boards were very problematic. The funding was erratic and poorly recorded.

"There are people who started their transition in 2001 and didn't manage to get any surgery until 2013 because the health boards were so obstructive, and it was only once it came under the national remit that they were able to access any surgeries.

"There has been an increase in the last few years because more people feel able to transition. There is no longer as much fear about losing your family and your job and being a pariah in society. We have more legal protection under the Equality Act, and there's more role models of people living successful lives post-transition.

"When I started my transition 15 years ago the small number of stories you heard were usually pretty tragic - it was very hard to find stories of people who just went on living an ordinary life.

"It was very off-putting."

Eleanor Matthews, 61, from Edinburgh was driving to work ten years ago when she realised she had to stop living as a man.

At the time she was married with two sons and had spent her career "hiding" in male-dominated professions.

She said: "I was going to work one day in my car and I had an epiphany. I just said to myself 'I can't do this anymore'. It was that sudden, that much of an impact. I've known [I'm female] since I was nine years old.

"My mother knew when I was 14 and took me to the doctor, who was quite determined to institutionalise me, to give me ECT to solve my 'problem'. You don't want to upset your parents, so you go back into the closet and you hide there. I hid for 40 years.

"I was police officer for six years and a firefighter for 29 years. Then I worked as a civilian officer within Scottish Fire and Rescue. We hide in plain sight."

Eleanor is now separated from wife, Lorna, but says both she and their two sons - now in their 20s - and fire service colleagues were "very supportive" when she began hormone treatment six years ago.

She added: "They all understand that if I hadn't done this, I would be on the railway tracks or off the Forth bridge. I know that's where I would have gone. I'm not doing this for fun."

All transition surgeries are performed at sites in England as there are no specialist gender surgeons in Scotland.

Dr Mike Evans, director of the Nuffield Hospital in Brighton, where Scottish patients are sent for male-to-female genital surgery, said they are now training a third surgeon "to meet growing demand".

He added: "The number of surgeons in the UK is still very low; there are fewer than a dozen practitioners in the UK for a growing patient demand."