Operations to reassign gender by the NHS in Scotland have risen to almost 100 a year.
Campaigners said the NHS was more willing to conduct the surgery as societal attitudes changed, influenced by role models of celebrities who have undergone transition.
Figures show 386 cases were given funding in the four years to July with more than three times as many male to female gender reassignments than female to male procedures. Each costs between about £10,000 and £11,000.
About 135 male to female gender reassignments operations were performed compared with 41 female to male surgeries.
In the decade to 2013, figures show there were just 28 male to female gender reassignments paid for by National Services Division (NSD), the body that advises and supports NHS Scotland.
Advertisement
James Morton, manager of the Scottish Trans Alliance, told The Herald: “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.”
While official records and anecdotal evidence show a significant increase in the number of gender transitions the exact figure is unclear because before 2012 most referrals were funded directly by health boards and not by NSD.