Iran's Tragic Approach to Sex Change

Iran's Tragic Approach to Sex Change

By Fritz Schaap

A woman walks alone in Tehran, Iran.
SourceMichel Setboun/Corbis


Because even if a country allows sex changes, it might be doing more harm than good.

By Fritz Schaap

Shirin lies under a blue sheet with only her feet and face exposed. Already weak from the drugs ahead of a medical procedure, she moves her arm over her face and takes one last selfie — as a man. The next morning, while recovering, Shirin (not her real name) says, “I feel unbelievably liberated.” She beams, knowing that she can finally start the right hormone therapy, that her body hair will no longer grow and that, starting today, in Tehran, she’s officially allowed to dress like a woman. “I feel like I’m reborn.”

Happily ever after, right? Hardly. For many transsexuals in Iran, this is only how their new chapter begins. In what may be a surprise to many abroad, sex-change operations are not banned here. That’s because the Quran doesn’t mention them, says the cleric Muhammad Mehdi Karaminia, one of the country’s authorities on sex-change issues. If you can naturally turn grain into bread or a tree into a chair, the theologian argues, then you can also turn men into women. Sex-change surgeries aren’t just legal in Iran; up to half of their costs are covered by authorities. More of these operations are performed here than almost anywhere else in the world — second only to Thailand.

But transsexuals are still socially unacceptable throughout much of the country. It’s not unusual for knife-wielding fathers to turn up at surgery. Some doctors even tell of murders in their waiting rooms. For those who make it, life can be a never-ending purgatory that, at an alarming rate, often ends in drug addiction, prostitution and even suicide. Indeed, Bahram Mir-Jalali, the Iranian surgeon best known for specializing in sex changes and who has performed more than 1,000 procedures so far, estimates that fully one-third of his patients opt for suicide sooner or later.


How widespread is the problem? No one tracks it on a large scale, just like nobody knows the overall number of transsexuals in Iran or how many operations are conducted annually (even the chair of the only transsexual organization here simply shrugs when asked). Some estimates are as high as 150,000 transsexuals and 450 sex changes each year.  

Bahram Mir-Jalali (C) visits a transsexual patient after a sex change operation in Tehran, 17 August 2004.

Dr. Bahram Mir-Jalali visits a patient after a sex-change operation at a hospital in Tehran.

One challenge is how highly Iranian society values males over females. Men inherit more, and a man’s statements in court carry twice as much weight as a woman’s. So a man who has an operation to become a woman is voluntarily climbing down the social ladder. He meets not only with incomprehension but also with contempt.

Another problem is that men who undergo a sex change often lose their job. Meanwhile, prostitution is highly profitable here; the men can earn $540 or more a night. “Nearly all transsexuals are forced into prostitution,” says one local madam, who organizes the prostitution of transsexuals as well as homosexuals. “They’re exotic and different. Men like that here.” Yet the money often serves as income for the drugs they need to numb themselves for work or to finance their sex changes, especially for those who can’t afford all the procedures at once.

We’re lonely girls. We’re born alone, we live alone and we die alone.

To get a sense of how difficult post-op life can be for some, look no further than Taraneh. She and Shirin came from the same village and have known each other since they were children; Taraneh is now helping Shirin during her recovery. About 10 years ago, Taraneh, which is not her real name, went through sex-change surgery herself but just wanted to share her love with other men. “In a physical respect, I’d rather have stayed a man,” says Taraneh.

She’s not alone. Many therapists, who must be consulted before each operation, privately estimate that 40 to 50 percent of all Iran’s transsexuals are actually gay men who feel pushed into having the operation in order to finally be with men and avoid persecution. So while permitting a sex change is something that may initially seem like tolerance — the state allows charitable organizations to pay for a quarter or even half of the roughly $4,300 to $8,600 for a sex-change operation — it’s in fact a means of keeping homosexuals far from public sight. Many gay people say their own therapists have advised them to either have an operation or leave the country.

Shirin, on the other hand, sees her operation as the end of her suffering and the start of a new life. She has felt like a woman for as long as she can remember. Even when she was a child, she preferred taking her sisters’ colorful clothes from the small box at the foot of the bed to her own. Now she dreams of having a husband and opening her own beauty salon on the Caspian Sea. She wants to be a role model.

Meanwhile, Taraneh has lost count of the number of times she’s tried to kill herself. “We’re lonely girls,” she says. “We’re born alone, we live alone and we die alone.” When it comes to marriage, with two already behind her, Taraneh knows how it usually goes: Once the in-laws hear of her past, divorce quickly follows. Yet she remains silent because she doesn’t want to crush Shirin’s hopes. She quietly remarks that the postoperation euphoria really is the best phase.