The man accused of removing a transgender woman’s testicles during a botched surgery was formally charged in a Denver court Tuesday morning.

James Pennington, 57, is charged with one count of second-degree assault – reckless, and one count of unauthorized practice of medicine.

His bond was set at $50,000. The DA’s office says he has posted bail.

The transgender woman at the center of the case wrote an open letter to the media about the incident, saying that she wasn’t a victim of Pennington, and that he’s not a monster.

Instead, she says she was the victim of a system that forced her to turn to a “back alley” procedure.

Police say Pennington does not have a medical license, and performed the surgery at an apartment.

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In the letter, the woman described as lifetime of struggle.

"I tried for many years to go through legitimate routes to get these surgeries," she wrote. "Yet every time something went wrong."

After the procedure, the transgender woman’s wife told police after changing the dressing on the incision, a large amount of blood poured out. She called 911, and paramedics called police.

Advocates like Rex Fuller with the GLBT Community Center of Colorado call this an extreme example that highlights a real problem.

"Many trans people still experience great difficulty accessing healthcare and health services of any kind," Fuller said. "It absolutely speaks to a real gap in knowledge regarding transgender healthcare needs."

The Colorado Division of Insurance says the state doesn't require carriers to cover gender reassignment surgery "primarily because there is no state or federal mandate to do so."

Pennington is set to appear in Denver court for a second advisement on June 6.