The Scottish Trans Alliance has accused NHS Scotland of homophobia as it limits access to chest surgeries for transgender people.
Trans activists in Scotland have said that the process to access top surgery is causing “distress” among trans folk.
Those transitioning from male to female must have their cases reviewed by local health boards.
However, those transitioning from female to male do not have to go through this process.
James Morton, manager of the Scottish Trans Alliance have said that the difference in process is “discriminatory”.
“It’s really discriminatory at the moment and trans-phonically motivated as far as we can see.
“It’s the classic thing where it’s not seen as medically necessary but as a lifestyle choice,” Morton said.
Activists have said that “severe psychological distress” is the outcome of the way that trans people are being treated in the NHS Scotland system.
Speaking to the Sunday Herald, 61-year-old Eleanor Matthews explained that she had been rejected from top surgery as well as some facial reconstruction work to her nose.
She said that she is being discriminated against because of her trans identity and that a cis woman would not have to overcome the same obstacles as she does.
She said: “I don’t understand the logic to it all.
“If you’re a trans woman with asymmetrical breast growth, you don’t get any surgical support, you don’t get any funding.
“But for a non-trans woman, if surgical intervention was necessary they would consider funding that. But because I’m a trans woman – no.
“It’s horrible,” she added.
Scotland was knocked off the top spot by Malta as Malta achieved a score of 88.04%, primarily due to its more progressive gender recognition laws and hate crime protections.