SCOTLAND'S health service has been ordered to improve its treatment of sex-change patients in a move expected to reduce delays for surgery.

Long waits for gender re-assignment treatment have led to depression and suicide attempts among men and women who feel they are living in the wrong body, according to research and support groups.

Now the Scottish Government has issued new guidelines to health boards that set out how patients suffering from gender dysphoria should be cared for, including the provision of hair removal, hormone therapy and surgery.

Around 100 people seek help from specialist gender identity clinics every year and approximately 30 progress to a surgical sex change.

The revised guidance says transsexuals should live for one year as their desired gender before they undergo the surgery.

However, health boards have been told they should pay for men who want to be women to have hundreds of hours of electrolysis to remove unwanted facial hair before then.

Hormone drugs can also be given earlier, and women who wish to become men can also have breast removal operations sooner.

The journey can be taken by patients as young as 16.

James Morton, co-ordinator for the Scottish Transgender Alliance, said transsexual patients had experienced a postcode lottery, with some waiting long periods to be seen by the right clinician or to have funding for treatment approved.

Women who want to become men have experienced a "Russian roulette" securing breast removals, sometimes waiting months to see a surgeon who would then refuse to perform the operation, he said.

Both male and female patients have described confusion about their treatment, with referral letters apparently going missing, adding months to their wait.

Mr Morton said: "Because there was no clear protocol, patients were just waiting, not knowing what was going to happen next or if they were ever going to get treatment.

"People could not plan for their lives.

"That can cause a lot of anxiety and sociophobia and depression. People were getting to the point of self- harming, and there have been suicide attempts."

Female-to-male transsexual Benjamin Kidd, 41, from Dumfries, has waited more than three years for surgery and went through a year living as a man without any hormone treatment, something he described as "impossible".

He said: "People do not believe you are who you say you are."

Katherine Burrows, a trans- woman from Perth who helped conduct research for voluntary organisation Engender on the problems transwomen experience with NHS Scotland, said she was shocked to learn how many had considered suicide amid lack of treatment.

"It was not just a case of people waiting for a long time – they were wondering if they were ever going to get treatment," she said.

Organisations such as the Scottish Transgender Alliance hope the production of the guidelines, which have just been issued to all health boards, will ensure consistent care nationwide.

A Scottish Government spokesperson said: "The protocol has been produced to clearly set out the way transgender patients should be treated and to ensure equity of access for patients.

"It will also mean that patients will know what care is available to them and what to expect."