All change

Jim says that he's "remodelling the house down south". He's not the new Laurence Llewelyn Bowen but he is a new man. Literally. He was born a girl named Jennifer but, as one of the "stars" of Sex Change Hospital, lets us into the operating theatre as he has a hysterectomy.

Vicki was born Steven, was married for 25 years and has two children. He's at Mt San Rafael Hospital in Trinidad, Colorado - the sex change capital of the world - for genital reassignment surgery and breast augmentation.

I think perhaps I can see the words "freak show" forming on your lips.

Any series that follows sex changes in intimate detail is bound to be labelled sensational. But this does take the time to get to know those going under the knife, showing why some are unhappy in their own skin.

Most viewers like to make judgments about how successful this gender bending is. Jim, I reckon, makes a very good man. Vicki, on the other hand, still resembles a man in drag, no matter what he has done to his body.

This is a programme in which even the surgeon, Dr Marci Bowers, has switched sex. She transitioned ten years ago. Trained in surgical gynaecology and obstetrics, she delivered 3,000 babies before going into the sex change business.

Both Vicki and Jim harboured worries about their gender from a young age. Despite getting a thrill trying on his mother's bra, Vicki got married, although neglected to tell his wife of his transsexual tendencies. Photographs of the happy couple show a very macho, moustached man with a wife and children.

Vicki now has a girlfriend, Cristina. They've been together four years, causing Cristina to question her own sexuality. "Am I a lesbian by default?," she asks.

Jim has had a tough time, attempting suicide seven times during a terrible ten-year period, indulging heavily in drink and drugs.

After chest surgery, he's "having all my plumbing removed", as he puts it. That means the removal of ovaries, cervix and uterus. Although clearly glad to see the back of them, he asks to see them after the operation - a nurse holds them up in a jar - and wonders if he can keep them.

Vicki becomes the proud possessor of a new vagina (you use skin from the penis and scrotum to make it, but don't under any circumstances try this at home). This leads to a disturbing scene - disturbing to me, at least - in which the packing is removed and she tells us that she's "yet to pee through my new vagina".

There really doesn't seem to be anything you can't show on TV any more. She even takes a photograph of her new vagina to show to her father, a state of affairs that no parents could possibly predict.

The programme ensures we know that those undergoing surgery aren't the only ones suffering. Imagine what it must be like for a parent of someone wanting a sex change.

Vicki's father is amazingly supportive and understanding as his son undergoes surgery. Afterwards, a tearful Vicki says he feels closer than ever to his father.

Cristina, her own sexuality thrown into chaos by hooking up with a man becoming a woman, feels the need to phone Vicki in hospital the night before the operation "to say goodbye to Steve".

Jim's parents find it more difficult to come to terms with losing a daughter and gaining a son. Unhappy from childhood, he was ashamed of who he was and what people thought of him. That made him reluctant to tell his parents.

His mother, Diane, took it hard when the truth emerged and went into a deep depression. She wondered if it was her fault. The thought of losing her only daughter was unbearable and not helped when Jim demanded she take down all the family pictures showing him as Jennifer.

She accepts the situation, reasoning that she'd rather having a son who's alive than a daughter who's dead. "I just want him to be himself and whole and happy and not want to commit suicide," she says.