Their counsel, Stephanie Harrison, told the court that health chiefs had misunderstood their illness. The surgery was not on a par with tattoo removal or cosmetic operations to reduce the size of breasts or noses. All three were living as women but retained the physical characteristics of the sex 'they feel strongly and profoundly they don't belong to'. They were enduring 'distress and humiliation' and had difficulty making and maintaining social and personal relationships. Similar cases had ended in self-harm or suicide.
Most sufferers are physically men, and the condition has been wrongly linked to homosexuality.
Recent research has suggested that, in one foetus in every 10,000, an area of the brain responsible for gender develops in contradiction with the external sex organs. Some 7,000 patients, including several married men with children, have undergone sex-swap operations in britain.