Serbia is becoming a transgender surgery hub, experts say, in part because genital reassignment surgery is costly, controversial and complicated and is shunned in many other countries in the region,.

Even in medically advanced Western European countries like France, some surgeons complain that they cannot get proper training or that they are even rebuked by colleagues for performing sex reassignment, prompting many transgender people to go to Belgium for treatment.

Dr. Marci Bowers, a gynecologist in San Mateo, Calif., who has performed 1,100 sex reassignment operations over the past 10 years and is herself transgender, noted that in the United States, a global center for sex changes, only about five surgeons were performing the operation regularly.

Foreign patients say they are attracted to Serbia by the price tag of about $10,000 — compared with $50,000 or more at some clinics in the United States for the more expensive female-to-male procedure.

Cher’s transgender son, Chaz Bono, recently told the radio personality Howard Stern that he hoped to come to Belgrade for the surgery.

In Serbia, the surgery is performed in a single six-hour procedure, saving the patient from the trauma of multiple operations. Complications can include postoperative regret, functionality problems or infection.

To qualify for the surgery, a patient needs two letters of recommendation from psychiatric specialists attesting that he or she is suffering from gender identity disorder, in which a man or woman identifies better with the opposite sex.

Cristian, the transgender activist, said he and his wife seldom encountered discrimination, even though in the past he had been taunted and had even received death threats for being different.

For all the challenges of being transgender, Cristian said, being brought up in Serbia in the 1990s had bred a certain resilience. “When bombs are falling from the sky and people are at war,” he said, “sexual identity is not your main concern.”