Nagina Akram got married to a Pakistani expatriate Khalid in 2011. Khalid was working in Spain and would visit his wife in Pakistan once every six months as he attempted to complete the process which would allow him to bring his wife back to the European country.
When the couple struggled to conceive a baby naturally, Khalid asked Nagina to consult a local gynecologist, Dr Tahira Khalid who, after observing some changes in Nagina's body, recommended her to undergo some tests at Karachi's Agha Khan hospital where it was revealed that Nagina's body was going through gender changes.
When Nagina reported the findings to Khalid, he broke all contact and sent back the dowry received in marriage. Subsequently Nagina underwent a sex change operation and is now known as Usman Akram and has opened a tyre shop to earn a living. "For eight months, I shaved my face to encourage facial hair to grow, so that I would look more like a man", Usman said, adding that he is now looking for a suitable bride in order to begin a new married life.