There has been a surge in patients wanting to reverse their transgender surgery, according to a leading doctor in Serbia, the global hub of transgender corrective surgery.
Dr Miroslav Djordjevic, a urologist in Belgrade, has been treating patients from all over the world for about 10 years.
His clinic in the capital of a country that is openly hostile to LGBT groups, became an unlikely haven for transgender patiets.
But now, Dr Djordjevic has told The Telegraph that he is seeing an increase in the number of patients seeking reversal surgery.
He warns the majority of people exploring reversals did not receive sufficient psychiatric screening before undergoing the procedure – and he urges the medical community not to antagonize people that change their mind.
‘Definitely reversal surgery and regret in transgender persons is one of the very hot topics,’ he told the newspaper.
‘Generally, we have to support all research in this field.’
Dr Djordjevic, who splits him time between Serbia and New York’s Mount Sinai Hospital, says he has performed seven reversals in the past five years at his clinic in Belgrade.
A further eight are in consultation or undergoing operations.
Most are seeking reattachment of male genitalia, a complicated procedure which costs upwards of $20,000.
The news comes amid a huge rise in the rate of gender reassignment patients.
The American Society of Plastic Surgeons found a nearly 20 percent increase in vaginoplasties, phalloplasties, top surgery and contouring operations in just the first year of reporting.
Increasingly, insurance companies are offering coverage for surgery for patients with gender dysphoria – a disconnect between how an individual feels and what their anatomic characteristics are.
Gender confirmation procedures can include everything from facial and body contouring to reassignment surgeries.
In 2016, more than 3,200 surgeries were performed to help transgender patients feel more like themselves.
Surgeons in the field claim that figure is a conservative estimate – and would likely three times higher if all hospitals had a uniform way of documenting such surgeries.
However, Dr Djordjevic warns that while the medical community is beginning to embrace this kind of surgery, there is a stigma surrounding reversals.
A vaginoplasty is a far less costly and far more successful procedure than the female to male procedure.
In the surgery, the testicles and most of the penis are removed while the urethra is shortened.
The skin of the penis is then inverted and used to create a vagina.
In some procedures a neoclitoris is also created with that skin from the tip of the penile glans which allows for sensation.
The prostate meanwhile is not removed during the surgery, though it does shrink because of the hormones that are taken during the transition process.
After the surgery, patients spent three days in the hospital and must not do any strenuous activities for two weeks.
Initial recovery time is between four and six weeks for most patients, and after 12 weeks the patient is fully recovered.
Dilation must be performed by the patient multiple times a day for at least 12 weeks after the surgery for 15 minutes at a time, and at least once a week after that for the rest of their life.
Some doctors recommend daily dilation for life with the largest dilator or dildo the patient can comfortably fit into their new vagina.
At 12 weeks, the patient can have sex again and in most cases those who have had the surgery report that they are able to experience orgasms.
The procedure can cost anywhere from $5,000 to $100,000, with the average US surgery cost $20,000.
Bleeding, swelling and vaginal discharge are among the common side effects after surgery.
A phalloplasty is the construction of a penis using skin flaps from the thigh, groin or abdomen, and scrotum construction using the labia. Nerves can be connected to a reconstructed urethra, and the clitoris can be repositioned to sit at the base of the penis.
Sexual intercourse is possible post-surgery, sometimes using a prosthesis to create an erection, though some patients say that is not necessary.