Transition or Die

Iran's Approach to the LGBTQ+ Issues

Quick—name a country other than the United States that does a lot of sex-reassignment surgeries? Anyone have Iran on their bingo card? That’s the answer.

After Thailand (which pioneered many of the procedures), Iran performs more sex-reassignment surgeries than any other nation on earth. This makes them doubly unusual, because they are also the only Islamic nation on earth that even recognizes sex-reassignment surgery and transsexuality. Iran not only performs the operations, it considers transsexuality a valid and respectable medical condition that can be cured with proper surgical intervention and hormone treatment. And in a lot of cases, the Iranian government will foot the bill.

However, Iran does not approach the topic the same way the West does.

In Iran, homosexuality remains a death penalty offense for men and a crime punished by brutal whipping for women. Up until 1979, Iran considered transsexuals to be the same as homosexuals, that is, criminals and a threat to decent society. In the late 1980s, Iran revised its opinion on homosexuals and transsexuals. The Iranian government and medical establishment now consider homosexuals to be people born in the wrong bodies. A man who is sexually attracted to another man is thought to have the soul of a woman trapped in the body of a man. With its strict gender roles, Iran sees transsexuality as the logical explanation of homosexuality. So starting in 1987, Iran started to address homosexuality as grave moral sin but one that might be humanely addressed with sex-reassignment surgery. In some cases, homosexuals apprehended for the crime of sodomy have been offered the option of gender transition surgery and a lifetime of hormone pills instead of the gallows.

If the homosexual chooses to transition, the government pays for all or most of the surgery.

Although sexual topics of any type are not widely discussed in Iran, the prevailing belief in modern Iran is that a homosexual man is a person who has the body of a man but the soul of a woman. In other words, homosexuality has been reframed as a unique spiritual disorder with a medical solution. By fixing the body, the person is re-aligned physically and spiritually. In Iran, it is thought that the soul is the truest part of a human, and there is nothing wrong with body modification to match the soul.

A person does not have to be arrested for homosexuality to undergo sex change surgery in Iran. Anyone who can pay for the operation can have the procedure, no questions asked. Well, some questions are asked. An interview, medical tests, psychological counseling, and a court order are prerequisites but rarely impediments. The court order is needed to initiate the changing of legal documents to list the new sex on identification cards, government records, and passports.

It is so easy to get a sex change operation in Iran that the nation has become a bit of a medical tourism destination for people in Europe or other parts of the Middle East.

It all started in 1979 with an Iranian activist named Maryam Khatoon Molkara, a biological male who identified as a woman. Molkara got in trouble for gender-bending back in the days when biological men were expected to talk, act, and dress like men. Molkara outspokenly would not conform and was incarcerated, beaten, and abused, but eventually managed to bring the case to none other than Ayatollah Khomeini. When Molkara stood before Khomeini, it was clear that torture had preceded the encounter. Khomeini was enraged at the mistreatment and listened carefully to Molkara’s story. To everyone’s surprise, Khomeini agreed that Molkara could and should be allowed to live as a woman and allowed to undergo the surgery. The ayatollah offered his blessing, because he viewed Molkara as a person tormented with a medical condition that was leading to sin and aberration. If surgery could fix this condition, the ayatollah considered that a good thing.

Unlike in the West, where homosexuality is widely accepted and legally protected, Iran has always considered it not just a grave sexual sin, but a very serious crime. With Iran’s strict complementary approach to gender roles (women in Iran can be stopped by police officers for not conforming to the dress code, such as not wearing a proper head covering), homosexuality was both a moral issue and a threat to the social order. This has not changed.

The hijab is required in Iran and Iran this very day (May 8, 2024) has launched a new campaign to crack down on women not wearing the proper head covering. Women in Iran have gone to prison for not wearing a hijab. Transwomen are held to the same dress code.

What changed in Iran is that transsexuality is now viewed as a spiritual condition where the body and soul do not align. Iran argues that transsexuals are not truly homosexuals, they are just suffering a soul-body mismatch that can be corrected surgically. A Muslim cleric wrote about this, stating that sex reassignment surgery preserves the core humanity of the individual, since “the change is simply characteristics.”

A person who is arrested for homosexual activity can claim transsexuality and avoid punishment. In fact, transsexuality is assumed as the basis of homosexuality, whether the person identifies as transsexual or not. While transsexuals are not necessarily esteemed and protected members of Iranian society, they are officially viewed as having a medical condition.

It is important to realize that Iran does not endorse gender-fluidity or the notion of multiple genders. Iran fully rejects the idea of a non-binary individual, because they adhere to the teaching that there are only men and women. Iran would not support the idea that a transition might occur multiple times, such as a person who is a man for a while and then a woman and then a man again. They expect that those biological men who identify as women will forever after assume women’s roles in the home, in the mosque, and in society. A transwoman in Iran is expected to wear the headscarf and meet other requirements just like a biological woman.

Here is a picture of a Pakistani man “cross-dressing.” He was arrested when he was apprehended harassing females. He was not wearing much under his burqa.

Drag queens exist (sort of) in Iran and other parts of the Middle East, but they are viewed as perversions. Thus, drag queens operate largely below-the-radar in Iran and other parts of the Middle East, which is not to say they don’t exist. It’s like saying crack houses do not exist in the United States because crack is illegal. But drag does not exist in Iran the same way drag exists in the United States. There is no TV program of drag queens competing with each other and political figures like Nancy Pelosi or Alexandria Ocasio-Cortez would not pose with notable drag queens to pander to them. A drag queen in Iran attempting to host a story hour for children would probably be arrested before the end of the first story.

A person in Iran with a same-sex attraction is seen either as a criminal and a sinner (those are the same in Iran) or as a person in the wrong body. Homosexuality is a crime, transsexuality is a medical condition. Homosexuality is punished, transsexuality is fixed.

This is not to say that transsexuality is openly discussed in Iran; in many parts of the country and across many social strata, sexual topics are all but taboo for public discourse. Not all Iranian physicians are comfortable referring patients to transsexual surgery. There are anecdotal reports that some transsexuals are disowned by their families and the rights of openly transsexual people can be limited. In Iran, it is legal to deny them jobs or leases based on their transsexuality. Honor killings—the murder of a family member who is thought to have dishonored the family’s good name—have occurred when transsexuals come out. In fact, Iran has no laws in place to protect the rights of transsexuals and no public programs to integrate them into society. Transsexuality is as rarely discussed in the Iranian media as Joe Biden’s dementia is discussed on CNN.

Recently, Iranian courts have allowed certain people to change their sex on their identity cards and papers without having surgery or taking hormones. The problem is that sex roles are policed by law enforcement as well as society, and women (or non-surgically changed transwomen) can get in serious legal trouble for not conforming to Iran’s strict dress codes. There are Iranian women in prison for defying the nation’s hijab laws. Likewise, people wearing makeup with plucked eyebrows can get stopped by police if they are not otherwise dressed as a woman. A man who chooses to live as a woman (even without surgery) must abide by all of the cultural rules and limitations Iran imposes on women.

Just like in other parts of the world, sex-reassignment surgery in Iran has a very high rate of complications. Many people who undergo these “bottom surgeries” are rendered sterile and incapable of orgasm. A common complication of male-to-female transition surgery is anal fistula, where some of the contents of the intestine can leak out of the newly created female organ. This is only sometimes correctable with a second surgery. While reports are starting to emerge in the United States of people who regret their sex-reassignment surgery or who suffered severe complications as a result, no such accounts are circulating in Iran. Of course, some Iranians undergo the transition surgery not because they want it, but to avoid a death penalty. It would be hard to regret not being sent to the gallows.

Thus, for Iran, sexual reassignment surgery is viewed as a type of irreversible “conversion therapy” to cure homosexuality, and it would be wrong to view Iran as some nation leading the march to LGBTQ+ rights. By the way, to all of those holding those odd “Queers for Palestine” placards at the pro-Hamas demonstrations across the nation’s college campuses: homosexuality, transsexual surgery, and abortion are all illegal in Palestine.