In Pakistan, where gender affirmation surgery was recently legalised, Bunty is one of the few trans women who could afford to get it done safely.

Despite winning the right to medically transition in 2018, many transgender people in the Muslim-majority nation still turn to unqualified surgeons because of a lack of trained doctors, high costs and cultural taboos.

Bunty, who no longer uses her family name since her transition, said she went to the only doctor in the northeastern city of Lahore who performs breast augmentation surgery for trans women -- a qualified, experienced professional.

While the procedure was successful, she said it took place in an "underground" manner and cost twice the normal rate for a cisgender woman.

"I was kept at the hospital for only two hours and then I was forced to leave so that no one would find out," she told AFP.

"I was in extreme pain."

It was the latest ignominy for Bunty, who said she was shunned by her family over her gender identity, then sacked from the job that funded her hospital bills, pushing her into sex work.

She said the hospital did not want news of her procedure to spread among doctors and patients who might disapprove.

"Gender transitioning is still controversial. Doctors fear they will be judged," said Mudassir Mahboob, a doctor who carries........

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