SAN FRANCISCO (AP) -- San Francisco is preparing to become the first U.S. city to provide and cover the cost of sex reassignment surgeries for uninsured transgender residents.

The city's Health Commission voted Tuesday to create a comprehensive program for treating transgender people experiencing mental distress because of the mismatch between their bodies and their gender identities. San Francisco already provides transgender residents with hormones, counseling and routine health services, but has stopped short of offering surgical interventions, Public Health Director Barbara Garcia said Thursday after the vote was announced.

The idea for a new program that included surgeries came out of conversations between public health officials and transgender rights advocates who wanted mastectomies, genital reconstructions and other surgeries that are recommended for some transgender people covered under San Francisco's 5-year-old universal health care plan.

At the urging of the San Francisco Board of Supervisors and the San Francisco-based Transgender Law Center, the commission agreed this week to drop sex reassignment surgery from the list of procedures specifically excluded from the Healthy San Francisco plan.

But Garcia described the move as "a symbolic process" for now because the city currently does not have the expertise, capacity or protocols in place to provide the surgeries through its clinics and public hospital.

"The community felt the exclusion on Healthy San Francisco was discriminatory and we wanted to change that as the first step," she said.

Instead of expanding the existing plan, the Health Commission approved the establishment of a separate program that covers all aspects of transgender health, including gender transition. Garcia hopes to have it running by late next year, but said her department first needs to study how many people it would serve, how much it would cost, who would perform the surgeries and where they would be performed.

"Sex reassignment surgery is not the end all. It's one service that some transgender people want and some don't," she said. "We can probably manage this over the next three years without much of a budget increase because we already have these (other) services covered."

San Francisco in 2001 became the first city in the country to cover sex reassignment surgeries for government employees. Last year, Portland, Ore. did the same. The number of major U.S. companies covering the cost of gender reassignment surgery for transgender workers also doubled last year, reflecting a decades-long push by transgender activists to get insurance companies to treat such surgeries as medically necessary instead of elective procedures.

Kathryn Steuerman, a member of a transgender health advocacy group in San Francisco, said the city's latest move would help residents avoid going into debt to finance operations related to gender transition, as she did.

"I am filled with hope and gratitude that we are achieving this level of support for the well-being of the transgender community," Steuerman said.

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