Early on Billy-Joe told his girlfriend he was transgender and wanted to become a man. That was five years ago. He was 21. "This is going to be difficult journey are you with me?" he asked. He had already once tried to take his own life. "The road seemed so long at the time."

Warning: Nude photos of the surgery below.

Since he was a four-year-old girl named Connie, Billy-Joe Newington has been desperate to be a boy. He started taking male hormones when he was 23 and had a double mastectomy last year, but it was not enough: he felt that to become a man he would need a penis.

"I couldn't carry on living with a vagina basically."

Billy-Joe lives in Wales. At the pre-op in London a cosmetic surgeon told him about an operation called a pubic phalloplasty. The surgeon would peel an oval shaped piece of skin from under his bellybutton and down below his pubic line.

"Where the tech stands at the moment the penis I'll end up with is realistic enough," he told Hack.

"I can stand to pee and with the erectile device I'll be able to have sex with it.

"What more do you want?"

Billy-Joe's first phalloplasty operation was late last year. The skin from under his bellybutton was rolled together - like a Swiss roll - and stitched up again to make the main part of the penis. Then they cut skin from the sides of his stomach to cover the exposed flesh.

"It took six to seven weeks for me to stand up straight."

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Whatsapp Billy-Joe Newington with the new penis after the phalloplasty.

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Whatsapp The penis being created during the phalloplasty operation.

Most of all, Billy is looking forward to peeing standing up. "Stuff naturally born males take for granted . . . Since I was a kid I thought why can't I stand up to pee? It's something that affects my dysphoria quite a lot. For me personally it's a massive deal."

And then there's sex.

His clitoris will be inside the base of the penis - he has been assured there will be no less of sensation - and a system of pumps and tubes will give him a "rock solid" erection.

Three separate operations to achieve this should take place over the next year.

Operation two will create a urethra from skin on his right forearm. The third will connect the bladder to the urethra. The fourth will install the erectile device; a bottle of saline fluid in his lower abdomen. Two straws beside the urethra fill with fluid when he presses a pump button.

"One testicle is the pump. You press the button six or seven times and it sends saline fluid from the bottom of the stomach to straws in your penis. It literally gets rock solid."

When that happens, he believes he will have reached the end of his transformation.

In psychiatry, gender dysphoria is a discomfort, unhappiness or distress due to one's gender or physical sex. It's also called gender incongruence.

Billy says when he was younger he felt he had to choose between living as a female and keeping everyone happy, or going through with the transition but losing his friends.

"I got very depressed at the time. I didn't want to lose everyone but couldn't imagine living as female." He and his girlfriend are still together. "Before I turn 30 I'm finally going to be man I was supposed to be and live life normally and not focus on any of this."

Dr Peter Haertsch, a plastic surgeons who does the bulk of gender reassignment surgery in Australia, said this kind of phalloplasty using stomach skin is not currently being done in Australia.

"It just a variation on what I'm already doing," he said.

He said he had three of four patients who were going to have penises made from groin tissue. He has also done operations to transform the clitoris into a thumb-size "juvenile penis".

He said there was a far higher rate of gender dysphoria among men than women: about one in 37,000 compared to one in 300,000.

The documentary Girls to Men (produced by Australian filmmaker Nick Sweeney) airs November 26 on Foxtel LifeStyle YOU at 8.30pm.

If you're struggling with your gender identity there's always someone you can talk to. Call QLife on 1800 184 527 or use their open online chat.

Listen to the full Hack interview below.