A British court has ruled that a transgender woman is not entitled to have breast enlargement surgery paid for by the state-funded National Health Service.
The 59-year-old, who was identified in court only as C, was born male. She claimed she was left in physical and psychological limbo after her breasts failed to develop following hormone treatment.
She challenged the refusal of local health authorities to pay for enlargement surgery.
The High Court ruled last year that she was not entitled to public funding for the operation, expected to cost about 2,300 pounds ($3,700).
Three appeals court judges on Friday upheld that decision, saying health officials face "very difficult choices as to what procedures to fund and not to fund."