THE number of people being referred for gender reassignment surgery on the NHS in Scotland has increased five-fold in four years, new figures reveal.

The surge coincides with a streamlining of the referrals process from 2012 onwards, when National Services Division (NSD) took over the responsibility from individual health boards, as well as growing public awareness and acceptance of gender dysphoria.

Figures obtained by the Herald under freedom of information from NSD reveal that there were 63 referrals for genital alteration surgery last year, compared to 12 in 2012/13. The number of people being referred for chest reconstruction - where breasts are removed and a masculine torso created - has also soared from five in 2012/13 to 90 last year. The figures do not include trans patients receiving breast augmentation as part of male-to-female surgery as this is still performed via individual health boards, not NSD.

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Patients receiving genital surgery or female-to-male chest reconstruction are sent to private and NHS hospitals in London, Brighton and Lancashire as there are no specialists based in Scotland. However, NHS Scotland will cover the cost.

James Morton, manager of the Scottish Trans Alliance, said the figures tied in with an increase in the number of people - especially young people - seeking help from gender identity clinics. However, he said that he believed the upturn experienced in recent years was now beginning to plateau.

Mr Morton said: "I think that we've seen the peak - we've seen the dramatic rise. The figures for young people coming forward to the gender identity clinic showed a particularly strong leap around 2014, which makes sense because that was also the time when trans became part of mainstream consciousness.

"I think that makes it so much easier for people to then go 'actually, I'm going to tell my family and friends and start this process'. What we have now is probably closer to the rate it always should have been if people hadn't been so scared.

"But I don't think it's going to continue going up at the same speed as it has in the past few years - I think it will settle off now. I'd be very surprised if there was anything like 150 genital surgeries in a couple of years. More like maybe a 100."

Mr Morton added that the figures on chest reconstruction partly reflected some confusion in the initial phase after referrals were centralised through NSD, as some health boards continued to handle female-to-male chest surgery referrals themselves meaning they would not appear in the statistics under NSD. He said the true figure for 2012/13 was more likely to be around 15, not five.

More recently, the criteria for chest reconstruction has also been opened up to non-binary trans patients who do not identify as either male or female and are seeking surgery to achieve a more "gender-neutral" physical appearance. Previously, the procedure was restricted to patients who were transitioning to male and who had been on testosterone hormone therapy for several months.

Scottish Conservative shadow health secretary Miles Briggs said: “There are cases where a compelling argument can be made for gender reassignment on the NHS.

“It’s therefore understandable to see these numbers increase in recent years, and they remain relatively small.”

A Scottish Government spokeswoman said: “The Scottish Government expects everyone who needs to access gender identity services to get timely access according to clinical need. There are gender identity clinics across NHS Scotland which are doing a fantastic job at caring for people who need their support and we expect NHS Boards to ensure that they are resourced appropriately.”