BELGRADE -- What seems like a lifetime ago, Kristian Randjelovic became the victim of an agonizing, unrelenting medical mistake.

As an infant born with indeterminate sexual characteristics in the then-Yugoslav capital, he was surgically "assigned" the female sex by doctors applying binary ideas of appearance in an effort to spare him a lifetime of trauma.

But the result of Randjelovic's "sex normalization" operation was a childhood full of self-doubt, bullying, and torment before psychotherapy and, eventually, sex-reassignment surgery (SRS) at the age of 19.

'Sex Normalization' Surgery

For nearly two decades, Randjelovic, who grew up with a female name but identifies as male, was tormented by the physical and psychological consequences of a misguided operation whose damage seemed obvious to him. He says that he does not know the details of the surgery performed on him as a child and that his family did not give him any answers.

"Very early on, the question for me was, 'What is this that I have?' and, 'Why can't my body perform something that I'd like to do?'"

Such operations were carried out on an untold number of intersex infants in Randjelovic's native Serbia as recently as a decade ago, before monitoring, overwhelming medical evidence, and intense international scrutiny convinced doctors that their surgeries were doing more harm than good.

The World Health Organization (WHO) defines intersex individuals as people "born with natural variations in biological or physiological characteristics (including sexual anatomy, reproductive organs and/or chromosomal patterns) that do not fit traditional definitions of male or female."

There is no correlation with gender identity or sexual orientation.

It's an experience with echoes around the world and implications for millions of individuals born into societies with evolving understandings of sex and gender. The UN estimates that up to 1.7 percent of the world's population is intersex, which would translate into more than 110,000 people in Serbia alone.

Accidental Activist

Progressive laws on intersex births are rare and even more uncommon in socially conservative postcommunist societies. As recently as 2017, intersex activists noted that Russia's Health Ministry boasted of an Italian surgeon's clitoridectomy and vaginoplasty on a 3-year-old intersex girl in the northern Komi Republic. The surgery, they said, was broadcast live to a conference of dozens of specialists, with video later shared on the Internet and in other media.

Since seeking psychotherapy as a teen and being invited by doctors to discuss his experience, Randjelovic has become an accidental activist and the only publicly declared intersex individual in Serbia.

But there are certainly others.

The European Commission complained in its latest report on Serbia's progress toward European Union membership that intersex citizens are invisible "socially and legally" in the country.

Social scientists say a Balkan culture of hostility toward diversity makes surviving as "gender neutral" especially difficult. Serbia's Law on Civil Records continues to require the immediate classification of newborns as either male or female -- with no option for a third gender or leaving the "sex" line blank, as Germany has allowed since 2019.

"Socialization is possible only in binary affiliation: You're either a boy or a girl, and that's the end of it," says Zorica Mrsevic, a former jurist and professor in Belgrade specializing in gender and rights issues.

In April, the European Commission Against Racism and Intolerance (ECRI), a monitoring body of the Council of Europe, criticized Serbia's complete lack of official data on "sex normalization" operations on intersex children.

Numbers are difficult to find. Serbia's umbrella facility in preventive medicine, the Institute of Public Health-Dr. Milan Jovanovic Batut in Belgrade, which publishes national health data, did not respond to RFE/RL's request for intersex figures for Serbia.

'Are You A Boy Or A Girl?'

Vladimir Kojovic is a specialist in pediatric surgery and urology at Serbia’s state-run facility for intersex children and maternal and children's health care who has been dealing with intersex issues for 25 years. He says that neither his institute nor any other facility in the country performs the controversial surgery on children -- and haven't for about a decade.

But his team at the Dr. Vukan Cupic Institute in Belgrade sees around 10 cases a year of newborns whose sex cannot be conclusively determined through visual, hormonal, or chromosomal clues.

"At birth, we [usually] have a baby with signs of both genitals -- so genitals of both sexes," Kojovic says. Intersex comes in many forms, though, and he acknowledges that "you can't guess which sex that person will develop into."

Infants who underwent "sex normalization" operations in Serbia were monitored later in life, Kojovic says, and "we saw that mistakes were made."

Their only publicly acknowledged victim, Randjelovic, concedes that the prevailing view at the time might have been that such an operation in the first years of life "was the easiest [thing] to do in that period and was least traumatic for the child."

But, he says, that "didn't turn out to be correct."

Instead, he recalls elementary school classmates bullying him and asking, "Are you a boy or a girl?" or, "You have a female name, [but] you don't look like a girl."

He says there was a lack of information in the media growing up and remembers first seeing medical experts talking about sexual minorities in magazines and on television in the 1990s. Ranjelovic says he sought, and got, some answers through psychotherapy. He first knowingly met another intersex person at the age of around 30, he says, at a conference outside the country.

Now, Ranjelovic heads a nonprofit organization called XY Spectrum that promotes the rights of intersex people and provides support for the parents of Serbia's intersex children, including through cooperation with the Dr. Vukan Cupic Institute where "sex normalization" operations used to be performed.

"You first have to become clear to yourself," he says, "to know who you are, and then at some point you have to become clear to someone else and then enter into some category of relationship with others."

Written by Andy Heil based on reporting by RFE/RL Balkan Service correspondent Sonja Gocanin. Illustrations by Juan Carlos Herrera Martinez.