"Then I remember lifting up the sheets and putting my hand down and feeling it all bandaged and packed. I just started bawling my eyes out and screaming I remember saying to myself, you f--king idiot, Andrew, how could you be so bloody stupid?" Twenty years after surgery that left him feeling like a "desexed dog", the grief can still overwhelm him. Now 42, Andrew tells The Sunday Age the operation he had as a confused 21-year-old has shattered him. After psychiatrists from Monash Medical Centre's Gender Dysphoria Clinic referred him for reassignment surgery  including breast implants, the removal of his genitals, and the creation of a makeshift vagina  he tried to make the most of his new life as a woman. He grew his hair long and wore make-up in a bid to fit in. Doctors told him it was normal to go through a period of adjustment. In time he would feel like a woman. But something wasn't right. "I remember thinking to myself, what would happen if I admitted the truth to myself? I'm a man and I've just been mutilated, that's all." Silent tears fall as he describes the anger he felt towards the doctors who led him down this path. But most of all at himself for believing them. It wasn't until the mid-1990s when, supported by a woman with whom he was having a relationship, he returned to the clinic seeking help to return to life as a man. He says his psychiatrist, Dr Trudy Kennedy, told him she could not see him.

"I rang her up, I was telling her, 'I'm suicidal, I'm not coping'. She said, 'Well, if you're that bad you should go to the emergency department'." Dr Kennedy says she has no memory of that phone call. But she concedes what happened to Andrew was wrong. "I think it was a terrible mistake that he was allowed to go ahead with it (surgery) instead of taking the time to think about it." She says Andrew's surgeon is now dead. But Dr Kennedy, who assessed Andrew's mental fitness, admitted to The Sunday Age: "I don't know if he was ready for it (surgery) or not. He said he was ready for it. He'd been hounding us since he was 18." It's true that Andrew thought he was a transsexual. However, the broken childhood that preceded his referral to the clinic is a recurring theme among those who feel they were misdiagnosed. Born to teenage parents, his earliest memories are of being hit and spat on by his father. Latching on to his mother, he became distraught when he had to leave her to go to school. Confusion about his sexuality was compounded when he was raped by two men at the age of 16. As he aged and started to resemble his father, he began to hate his male appearance. A chance discovery of a book about a transsexual was a pivotal moment. The story resonated with him. Perhaps this was what he was.

Another former patient, Angela*, was also an abused child. Sexually molested by a cousin between the ages of four and nine, she grew up hating her femininity. She recalls punching her breasts and working out obsessively at the gym to "remove anything that reminded me I was female". She was a 22-year-old university student when she was referred to the clinic by her GP, depressed and struggling with her identity. Dr Kennedy diagnosed her as transsexual at the first assessment, prescribing her male hormones and suggesting female-to-male surgery. Within months Angela's body was covered in thick hair, her voice deepened and she had a full beard. She had to shave under the covers every morning to hide the truth from her conservative Catholic parents. Two years later she had surgery to remove both breasts and was scheduled to have a full sex change. Angela could no longer conceal the truth from her family and began living as "David". Thankfully, she says, she realised there had been a mistake before undergoing full genital surgery. "I remember at one point looking at myself in the mirror with this beard, my breasts gone and thinking, 'Oh my God, what the hell am I going to do?' I felt ugly. I was the classic bearded woman, a monster trapped between two worlds." She claims her pleas for help were also ignored by the clinic and her return to life as a woman was a nightmare that involved two years of painful electrolysis to get rid of facial and body hair and surgery to reconstruct her breasts.

Now married to a "wonderful" man, Angela has three young children and has slowly rebuilt her life. Looking back, she acknowledges she gave consent for the procedure but believes it was not informed consent. She feels she was mentally ill and that her childhood abuse played a part in her gender confusion. This nature or nurture argument is at the centre of the controversy surrounding the Clayton clinic. Like many psychiatrists, Trudy Kennedy maintains people with gender dysphoria are born with a genetic predisposition. While the condition is classified as a psychiatric illness, they believe it has a biological basis and can be cured only by gender-altering surgery. They reject suggestions that a history of abuse, conflict with parents or underlying psychological problems can cause gender dysphoria. Indeed, just months ago, Melbourne scientists added fuel to this argument with the discovery of a gene that seemed to be responsible for feelings of being born the wrong sex. But what worries other psychiatrists is the mounting evidence that surgery may not actually improve the lives of those who feel they were born with the wrong body. A review of more than 100 international studies of post-operative transsexuals by the University of Birmingham found there was no scientific evidence that surgery was effective and, in many cases, patients were left feeling more distressed. Baltimore's Johns Hopkins University  which housed one of the pioneer gender clinics  no longer performs sex-change surgery due to such concerns. A recent British review found suicide rates of up to 18 per cent among people who had undergone gender reassignment surgery. Doctors from London's Portman Clinic say they see many patients who feel trapped in "no-man's land" after surgery, finding themselves with a body which is no longer recognisable as male or female. Psychotherapy, the experts believe, may have saved them from such a fate but few gender clinics offer it.

Reviews of the Monash clinic found psychotherapy was rarely, if ever, offered. While a patient would require a diagnosis as a "true transsexual" from two psychiatrists before being offered surgery, both opinions were from inside the clinic  one that operates under the fundamental ethos that surgery is the only cure. Andrew describes his experience as like "being on a conveyor belt"  prescribed hormones on the first visit and getting breast implants and a nose job within months. He says he consented to the procedures, and the sex-change surgery, because he believed it was his only option. Another former patient, a 66-year-old man who was sexually abused by his mother as a child, had his genitals removed in 1996 after a referral from Dr Kennedy, who said the abuse played no part in his feelings of gender confusion. The man says his GP described him as a "walking cloud of despair" following the operation, which he says he will never get over. However, Vikki Sinnott, a Melbourne-based psychologist specialising in transgender issues, has seen many clients who have benefited from surgery. She believes the regret rate in Australia is "tiny between 1 and 2 per cent". But she concedes no studies have been conducted to test this. Indeed, one of the most glaring problems uncovered by the government reviews of the Monash clinic was lack of patient follow-up. Ms Sinnott says this could be due to a lack of funding. "But it's also about people's willingness to be involved. Quite often people will say, 'Thank you very much, I'm happy with where I'm at, I'll now go and continue with the rest of my life'," she says.

None of the misdiagnosed patients spoken to by The Sunday Age deny gender reassignment can be beneficial to people who are correctly diagnosed as transsexual. Some have even offered to be part of any research conducted by the clinic. However, the transgender community has harshly criticised them for telling their stories, accusing some of lying to doctors about their transsexuality in order to get surgery they later regret  an opinion voiced in the past by Dr Kennedy. Angela's husband, who has campaigned for years to make the clinic accountable for his wife's ordeal, says even if that were true, a competent psychiatrist would detect the deception and conclude an underlying psychological problem was driving it. "When patients report feeling like the opposite gender, that is genuinely how they feel at the time," he says. "They are no more lying than someone with anorexia is lying when they say that they feel fat." For Andrew, it's the small victories that keep him going. "I will never be able to have sex again. Ever. It's taken a long time to come to terms with that, but now I can say it without crying," he says. Loading

"You can't be angry forever. You've got to let it go for your own health, and the people who love you." *Names have been changed.