Gender Reassignment Surgery In Iran People

DENIZLI, Turkey — Sorena sought out the mullah after committing a sin she feared could not be forgiven.

It was the winter of 2014, and Sorena was just 17 years old. She lived with her family in Shiraz, a city of 1.5 million people in southwest Iran. Sorena had been to consult the mullahs before as they dispensed advice from tables in the city park, mostly about how to reconcile the beliefs of her mother — who belonged to Iran’s minority Sunni sect — with the teachings of Shia Islam, the faith of her father, and Iran’s official religion.

But never had she come to discuss something so personal — or so potentially dangerous.

“My desires are not matched with my body,” she told the mullah. “I think because I’ve fallen in love with someone who’s the same sex as me that I’m committing a sin.”

Sorena’s family had raised her as their youngest son, but she saw herself as a woman when she dreamed. She’d also recently had sex with a man for the first time, and the fear that she had sinned beyond redemption drove her into a panic that lasted weeks.

Sorena didn’t tell the mullah about having had sex; she just told him about her desires. But her revelation didn’t shock the mullah, even though homosexuality is punishable by flogging and execution in Iran. He did not denounce her as a sinner or a pervert.

Instead, he told her, “Don’t feel sinful … this is completely acceptable to us.”

In the Islamic Republic of Iran — unlike any other country in the Persian Gulf region — sex reassignment is not only allowed, but also subsidised by the government.

“You are transsexual, and you have to go for the surgery,” he pronounced. “It is accepted in our religion.”

Almost 30 years before Sorena went to see the mullah, a trans woman named Maryam Khatoon Molkara marched up to the armed compound of Iran’s supreme leader, Ayatollah Khomeini, to seek his blessing.

Molkara, who was then 33 years old, was dressed in full compliance with the laws regulating how men should dress, including a full beard. Her breasts, which had been developed through hormone therapy, were tightly bound beneath her shirt. She’d been trying to get Khomeini’s permission for sex reassignment surgery for years; in 1978 she had unsuccessfully sought an audience with him in Paris, Khomeini’s headquarters during the last months that Iran was under the rule of Shah Mohammad Reza Pahlavi, the country’s last monarch.

The following year, a revolution toppled the shah and established the country as an Islamic republic. Khomeini returned from exile and was installed as the country’s supreme leader, head of a council of clerics that had veto power over any legislation deemed “un-Islamic.” Khomeini positioned the country to be a leader of Muslim nations in a battle against the United States — which he dubbed the Great Satan — and other Western nations considered imperialist enemies of Islam.

The new republic’s laws included rules for how men and women should dress and the death penalty for homosexuality. This meant trouble for Molkara, according to interviews she gave before her death in 2012. She lost her job at a TV station, was locked in a psychiatric institution, and was injected with male hormones against her will.

Still, Molkara believed that Khomeini would side with her if she only could speak to him directly. So in 1986, she went to his house in northern Tehran to try again. She carried a Qur'an and hung a pair of shoes around her neck, a Shiite symbol meant to convey that she was seeking shelter.

But Khomeini’s guards beat her when she insisted on speaking with the ayatollah. She was saved only because Khomeini’s brother, Hassan Pasandideh, happened to pass by. He called off the guards and invited her inside.

There she unraveled, Molkara told The Guardian in 2005. She began screaming, “I’m a woman!” She opened her shirt to reveal her breasts, and women in the room ran to cover her with a chador. Molkara was first given the chance to tell her story to Khomeini’s son, Ahmad, who she said was moved to tears. Then she was allowed to make her case to the ayatollah himself.

“The atmosphere, the moment, and the person were paradise for me,” Molkara said of the encounter. “I had the feeling that from then on there would be a sort of light.”

Molkara left the meeting with a hand-written fatwa — a ruling on religious law — giving her permission for sex reassignment. “God willing, sex reassignment, if advised by a reliable doctor, is permissible,” Ayatollah Khomeini wrote.

Hundreds have undergone sex reassignment surgery in Iran since Molkara’s meeting with Khomeini. Almost 1,400 people applied for permission for the process between 2006 and 2014, according to government figures published in Iranian media, and the country’s State Welfare Organization even provides some funding to help cover the cost of surgery. Iran has also become a destination for transgender people seeking surgery from other Muslim countries; most countries in the region persecute homosexuals and transgender people alike.

A major reason Iran’s rules on gender identity are so different from its neighbors’ is that Iran is Shiite, while most countries in the region are Sunni. That’s according to Iran’s most visible authority on the theology of sex reassignment, Hujjat al-Islam Kariminia, a cleric and legal scholar at Tehran’s Imam Khomeini International University.

Sunni teaching holds that someone’s “true gender” cannot be altered, Kariminia told BuzzFeed News, but Ayatollah Khomeini’s understanding of Shiite teaching is that surgery reveals their “true gender” that may be hidden within.

In fact, Khomeini had ruled that sex reassignment was allowed by religious law two decades before Molkara showed up on his doorstep. He wrote about the issue in 1965, just after he was sent into exile by the shah for challenging an agreement allowing US troops to be stationed on Iranian soil.

“If they get the surgery, the gender will not change but [their] real gender that has [long] been hidden will become visible,” Khomeini wrote in a collection of judgments on religious law. Surgery is allowed if “a man finds in himself tendencies similar to a woman’s, or a woman finds tendencies [like that] of men,” he explained, but added that until the whole reassignment process is complete, “they [must] not act as the opposite sex does and has to, since this is haram [forbidden].”

The path to changing legal gender in Iran

But the legal and medical process can take years, and many Iranians — including government officials — often don’t see much difference between transgender and gay Iranians. Legally transitioning requires passing through 10 separate steps as well as obtaining approval from multiple government agencies, according to a new report from the New York–based LGBT rights group OutRight Action International. The surgery is expensive — especially if you want one of the few surgeons who know how to perform the surgery properly — and the government program to subsidize the procedure is chronically underfunded.

Until the process is completed, transgender people are constantly at risk of violence or arrest on accusations of being gay or for violating laws requiring gender-appropriate clothing. And despite the country’s official position allowing sex reassignment, transgender people often encounter roadblocks from authorities even though they’re following the country’s laws.

That’s what happened to Saman Arastou, an actor who became famous playing women in Iran’s state-funded film industry before transitioning in 2006. For seven years after his transition no director would hire him, he said, and he spent a year and a half battling government censors before getting permission to put on a play about his transition that ran in Tehran earlier this year.

“We are in a country where we have to be either women or men and nothing else,” Arastou told BuzzFeed News.

The authorities claim, “‘We give authorizations [for sex reassignment] and are proud,” Arastou said. “But it is not true — there is no support.”


Despite the mullah’s blessing, Sorena didn’t feel that her problems were solved by their meeting in the park back in 2014.

One of the biggest of those was figuring out whether she was trans, or if she was actually a gay boy. It didn’t make it easier that the stakes were so high: One path required major surgery she wasn’t sure she wanted; the other meant risking arrest or worse. (Sorena asked to be identified only by the name she used in her "gay life" out of concern for her security.)

Sorena began entreating God for help answering this question when she was 16. “God, please let me ... try to know myself,” she recalled praying.

She believes God answered by leading her to Facebook. Her family had just gotten the internet at home, where she could go online without worrying about someone peeking over her shoulder in an internet cafe. She used the new privacy to create a Facebook profile with the name “Sorena Gay Boy,” and within a month she went on her first date with a man. He was 30, and opened the whole world of Shiraz’s “gay life” to her.

“See, you’re not the only one like this,” he told her while showing her around Manjam, the gay dating site popular throughout the Middle East. Sorena remembered seeing thousands of profiles — many where users had posted pictures of their faces— and was “jumping inside” with the realization that “all of them are like me [and live] in my city!”

But her joy turned to panic after they first had sex, and she ran out of the house in the middle of the night. Her boyfriend ultimately took her to a psychiatrist known as an advocate for gay men. The psychiatrist told her being gay was “natural” but encouraged her to leave the country because “your identity here is a crime.”

Leaving home was unthinkable for Sorena. She couldn’t sleep at night if she didn’t say goodnight to her mother, and was so close to her twin sister they were like “one person,” while her four older brothers “behaved like [her] fathers.” They even found her femininity endearing for most of her life. One of her earliest memories is being caught praying while wearing her mother’s hijab when she was 7 — her brother laughed when he saw her, “What is all this silliness?”

“You are transsexual, and you have to go for the surgery ... It is accepted in our religion.”
“We are in a country where we have to be either women or men and nothing else.”

In Iran, homosexuality is a crime, punishable with death for men and lashings for women. But Iran is also the only Muslim country in the Persian Gulf region that gives trans citizens the right to have their gender identity recognised by the law. In fact, the Islamic Republic of Iran not only allows sex reassignment, but also subsidises it.

Before the 1979 Islamic revolution in Iran there was no official government policy on transgender people. After the revolution, under the new religious government, transsexuals were placed in the same category as homosexuals, condemned by Islamic leaders and considered illegal.

Things changed largely due to the efforts of Maryam Khatoon Molkara. Molkara was fired from her job, forcible injected with male hormones and put in a psychiatric institution during the 1979 revolution. But thanks to her high-level contacts among Iran’s influential clerics, she was able to get released. Afterwards, she worked with several religious leader to advocate for trans rights and eventually managed to wrangle a meeting with Ayatollah Khomeini, the “supreme leader” of Iran at the time. Molkara and her group were able to eventually convince Khamenei to pass a fatwa in 1986 declaring gender-confirmation surgery and hormone-replacement therapy religiously acceptable medical procedures.

Essentially, Molkara, the Iranian religious leaders she worked, and the Iranian government had reframed the question of trans people. Trans people were no longer discussed as or thought of as deviants, but as having a medical illness (gender identity disorder) with a cure (sex reassignment surgery).

“The Iranian government doesn’t recognise being trans as a category per se, rather they see trans individuals as people with psychosexual problems, and so provide them with a medical solution,” says Kevin Schumacher, a Middle East and North Africa expert with OutRight Action International, a global LGBTIQ-rights organisation. The policy is based on Islamic notions that gender is binary and that social responsibilities should be split between men and women. “If you’re born a man and your body is a female then in order to protect you and the wellbeing of society,” says Schumacher says, “the government is responsible for fixing the issue.”

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An uncomfortable truth

For Sarah, life in Iran was divided into two very distinct parts: before and after she had gender confirmation surgery.

As a young child growing up in the late 1980s in Tehran, Sarah (who, because she is not openly trans, did not want to publish her full name) was uncomfortable wearing the clothes and playing the games traditionally associated with being a boy, and felt she did not belong at the all-boy’s school to which her parents sent her. “You are alone against all the social norms that dictate what you should do, what you should wear, how you should live,” she says.

She was a good student, but in high school, when puberty hit and gender roles grew starker, Sarah began to have difficulty coping with schoolwork and dropped out. “I had to deal with sexual harassment from my classmates and from other people in society on a daily basis, from everyone that thought that [I] was a girlish boy, a sissy boy,” she says. “My life as a teenager was total hell.”

Despite the official policy about trans individuals, trans issues are not openly discussed in Iran. And because the government heavily censors material available on the internet (a 2013 analysis found that nearly half of the 500 most popular sites on the internet are blacklisted in Iran) Sarah couldn’t research what it means to be transgender or connect with others in the community.

Meanwhile, she felt guilty about her inability to fit in. “Everybody expected me to behave like a man and be like a man and I hated to be like that,” she says. “I wondered why I couldn’t be like other people. Why I couldn’t meet the social expectations.”

At 16, she decided to make a change. “If I’m not a woman, if I’m not a man, I thought at least I should be a productive person and live a…happy life,” she says. So she enrolled in university in Tehran, and began to study languages and translation skills. Even though she continued to live as a man, she grew more confident in her gender identity thanks to the more tolerant atmosphere at the university, and from her academic successes—though she was still years away from realising she was trans.

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The official view

Officially, an Iranian can be diagnosed as having gender identity disorder only after a complex series of medical tests and legal procedures including obtaining a court order, multiple visits to a psychiatrist, and physical and psychological examinations at the state’s Legal Medicine Organisation. Even if you somehow figure out how to navigate this process—and Sarah did not—it can take over a year, according to a report compiled by OutRight Action International, a global LGBTIQ-rights organisation.

When people do approach doctors in Iran about being transgender, the experience is not always pleasant or helpful. Amir, a 26-year-old trans man from Shiraz, Iran, told OutRight that when he approached a medical professional about his condition, the doctor tried to intimidate him:

It all started when I was eight or nine years old. My parents took me to see a doctor because I kept saying I was a boy. The doctors never talked to me. They just told horrible and terrifying stories to shut me up. They said things like “you will die if you undergo [sex reassignment surgery],” or “many girls who wanted to become boys died during the surgery”

All of them treated me like I was delusional…. They would tell me: “It’s not possible, you were born like this.” But I knew I had to do this operation and change my sex. I was convinced there was a way and I was just looking for some kind of confirmation, from someone, who would tell me “yes, it’s possible!” Instead, one of the doctors gave me pills, and another other one injections…. [Another] told me to “get out and close the door behind [me],” as if I was a dirty and untouchable person.

If an Iranian is officially diagnosed with gender identity disorder, the government issues the authorisation for them to legally start the sex reassignment process, and at the end of that process the court issues a new identity card, with a new gender listed. In other words, while Iran does not mandate that all trans individuals have the surgery, it is not possible to change your gender marker on official documents without undergoing the surgery.

Over the last decade, with high-profile clerics and academic centres advocating for trans rights, social awareness on the issue has grown, says Schumacher. In 2007, Molkara established the Iranian Society to Support Individuals with Gender Identity Disorder, the first legally registered trans advocacy group. In 2008, the BBC reported that Iran was second only to Thailand in the number of sex-change operations performed, and the country’s surgery industry still attracts patients from all over the Middle East and Eastern Europe. Between 2006 and 2014, nearly 1,400 people applied for permission for the process according to government figures published in Iranian media.

There are even Iranian movies about accepting trans identities: 2012’s Facing Mirrors was something of a social turning point, giving local journalists a chance to address the issue publicly. The film’s release was even covered by state-run television and radio channels.

Nevertheless, stigmas remain, reinforced by the notion perpetuated by the government that being trans is a medical problem. Outright’s report found that trans individuals are often subjected to bullying, domestic violence, and social discrimination. In some cases, family members disown trans relatives. Openly trans people often can’t get jobs, and when employers find out an employee is trans they are often fired. Trans individuals can’t rent houses or apartments easily and find it hard to get married because families don’t welcome the idea of having a trans son- or daughter-in-law.

All of which is why when Sarah finally realised that she was trans, when she was in her early 20s and already graduated from college, she did not feel comfortable coming out in public. “Only my family members and few of my close friends knew about it,” she says. “I had to hide everything.”

Making the decision to go through with gender-confirmation surgery was fraught with uncertainty. “On one hand I really wanted to do that and be free and liberated from all the problems of my past,” says Sarah. “On the other hand I was so scared of the ramifications of what I was going to do, because I thought I [would] lose everyone and everything that I had fought for. My university degree, my job, everything. I saw myself having to stand against the entire world.”

Practically, she did not have the means to go through with the surgery and live independently. According to OutRight’s report, the cost of the gender-confirmation surgery in Iran is $13,000 and hormone-replacement therapy costs $20-$40 a month—and the average Iranian’s monthly income is about $400.

The government does offer some limited financial support for gender-confirmation surgery, hormone-replacement therapy, and psychosocial counselling. But funds are limited and government officials decide on a case-by-case basis which individuals qualify. In 2012, the government announced that health insurance companies must cover the full cost of sex-change operations, according to a BBC report. But OutRight has found that insurance companies still often decline to cover some forms of transition-related care, on the basis that they are cosmetic and not medical.

“The government pays a lot of lip service but the actual services that they provide are extremely limited,” says Schumacher. “You talk to many people and they tell you that they have been waiting for many years, hoping to receive some government assistance for these medical bills, but they are still waiting.”

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The challenges of being trans in Iran

For those who don’t get the surgery, life in Iran is exceedingly difficult.

Sharia-based laws mandate segregation of men and women in schools and public transport, and Iranian law requires men and women to wear “gender-appropriate” clothing in public spaces. Women are expected by law to wear a hijab, which means they must dress modestly and cover their head, arms, and legs. Traditionally, this is interpreted as a long jacket, called a manteau, accompanied by a headscarf. Failure to conform to this is a crime and could result in arrest or assault at the hands of vigilantes.

“If their appearance is not completely male or female, they are even stopped in the streets by the moral police in Iran,” says Saghi Ghahreman, president of the Iranian Queer Organisation based in Canada. These are the undercover agents deployed by the police to patrol public spaces looking for men and women dressed or behaving in a manner deemed un-Islamic, The Guardian reported in 2016. The moral police crack down on loose-fitting headscarves, tight overcoats, shortened trousers for women and necklaces and shorts for men.The laws are often extended to cover new fashions. For instance in 2010 Iran banned ponytails, mullets, and long, gelled hair for men; in 2015 the country cracked down on “homosexual” and “devil worshiping” hairstyles along with tattoos, sunbed treatments, and plucked eyebrows for men.

Hasti, a 30-year-old Iranian trans woman from Khansar, told OutRight that she was frequently harassed by Iranian police for her feminine appearance and makeup. “The [police] would lift up my dress, look at my ID card and ask me if I was a man or a woman,” she said. “In the end they would force me to sign a pledge letter [to promise that I would no longer dress as a woman] and then release me.”

Because women are expected to get married at a young age and produce children, trans people who have not gone through the surgery are sometimes forced into marriage.

Worse, a trans person who is not legally recognised can be accused of homosexuality and face the death penalty. In fact, in some cases gay people in Iran decide to undergo the surgery because the alternative is death. “The sex change operation is most of the time forced on trans people by the culture and by the government,” says Ghahreman.

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Making the transition

Sarah spent six years preparing mentally and financially to go through with the surgery. She describes that period as one of the darkest phases of her life. “I was so depressed and anxious about everything,” she says. “At that time almost all the transgender people I saw in Iranian society were involved in prostitution, were isolated, were ostracised by the society and their family. I didn’t see any successful transgender people. I was afraid if I did it myself, my life would turn into a kind of new misery.”

But she stuck with the plan: she worked in a managerial job, living and dressing like a man, while saving for the surgery. When she had enough money, she decided to travel to Thailand for the surgery; despite the high number of gender confirmation surgeries performed in Iran, the quality of the work is poor. “The operations are done by surgeons that are not professionally trained,” says Ghahreman. “Almost all of the trans people who have operations in Iran are suffering from many side effects that disable their body. Every trans person I have met in the past 10 years, they have a lot of pain because of the surgery and they cannot have normal or pleasurable intercourse.”

When she was 28, Sarah had sex reassignment surgery. “I turned into a whole new version of myself which I loved so much,” she says, likening the process to dying and being reborn. I felt more liberated than what I was in the past. Because in the past I was imprisoned within the framework of my body and my former identity. After the surgery, I got liberated from all those things. For me, anything was better, anything. At least after the surgery I got to enjoy some basic rights that I didn’t enjoy before the surgery.”

Afterwards, she was surprised to find that “almost everyone was very welcoming and very supportive.” Sarah had worried government officials would harass her during the legal process after the surgery, but “everyone treated me like a saint,” she says. “They adore me so much and they admire me so much for doing such a courageous thing—they respect me on a whole different level. I didn’t even expect that—to be respected by people for being a transgender. But it all happened after the surgery.” And, all of a sudden, she could wear the clothes she wanted, change her name, and live the lifestyle of her choice.

Not everyone has such a positive experience with Iranian officials. Assal, a trans woman who travelled back from Iran after undergoing the surgery in Thailand told OutRight she was harassed by Iranian border police agents who passed around her medical documents to each other and laughed at her. “I felt I was a monkey at the zoo,” she told OutRight.

And despite the support, Sarah never came out officially. Instead, she began to live as a woman in Iran. “The people who know me from the past, they know that I am a transgender, but the people who know me after the surgery, they have no idea of who I was,” she says. “They just think that I am a straight woman.”

Sarah stayed in Iran for six years after surgery. Now 36, she lives in Canada and works as a freelance journalist and translator. But she returns to the country of her birth frequently, and helped found an organisation for trans rights there with Maryam Khatoon Molkara. “The culture needs to change,” says Sarah. “The society needs to change its mindset towards people who not like the mainstream. It doesn’t matter if they are gay, bisexual, or trans.”

This article was originally published on Quartz: Click here to view the original. © 2017 All Rights reserved. Distributed by Tribune Content Agency.

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