Why Iran is a hub for sex-reassignment surgery

“I REALISED QUITE early on that I was gay,” says Soly, a 25-year-old chef from Tehran. As a young boy, he would strut about the house in his mother’s high heels and developed crushes on male cartoon characters. But after he was expelled from school for wearing eye-liner, his parents took him to a psychologist who offered a different explanation. “He told me I was transgender and had to change my sex.”

Attitudes towards sexuality can be rigid in Iran. A conservative former president, Mahmoud Ahmadinejad, once declared that the country didn’t have any gay people. So it seems an unlikely hub for sex-reassignment surgery. But the procedure has been permitted since the mid-1980s, when Ayatollah Ruhollah Khomeini met a trans woman called Maryam Khatoon Molkara, who had been thrown into a psychiatric institution and forcibly injected with male hormones. Moved by her story, he issued a fatwa allowing the procedure, which a cleric later compared to changing wheat into bread. Today the government even helps with the cost.

But the regime’s encouragement of sex-change surgery is related to its intolerance of homosexuality, which is a capital offence. Gay Iranians face pressure to change their sex regardless of whether they want to, say activists and psychologists in Iran. Therapists tell patients with same-sex desires that they may be transgender, not gay. “I thought I was trans until I was 18, because the only information online and in newspapers was about transsexuals,” says a psychologist in Tehran who is a lesbian. “It is a system where homosexuals are not educated and the law does not protect them.”

Before going under the knife, patients must receive counselling to ensure that they have gender dysphoria and are prepared for the procedure. But often this process is rushed and standards are not properly observed. Shahryar Cohanzad, a urologist who performs the operation, received 75 referrals in 2017, but only operated on 12 people, having concluded that 63 were gay or confused due to a lack of information. Questions have also been raised about the quality of the procedure in Iran: the United Nations has detailed grisly stories of botched operations.

Even though the clerics allow it, those who transition say there is still a stigma associated with being transgender in Iran. Some tell of being disowned by their families and having to work as prostitutes, for lack of other choices. “For almost four years after my transition no theatre director hired me,” says Saman Arastoo, a well-known transgender actor and director. Soly’s father, by contrast, threatened to kill him after he refused to transition, so he fled to Canada, where he enjoys his new freedom. Sometimes he even walks to work in high heels.