San Francisco is set to become the first city in the United States to offer free sex change operations for uninsured transgender residents.

Transgender advocates want mastectomies, genital reconstructions, and other surgeries covered under San Francisco's universal health care program.

The city's Health Commission voted on Tuesday to create a program to treat people experiencing mental distress due to gender identity issues.

Health department officials say the program will take effect late next year after studying how many people it would serve and how much it would cost.