Homosexuality is punishable by death in Iran, but clerics in the Islamic Republic accept that a person can be “locked” in another's body. Back in the 1980s, Ayatollah Ruhollah Khomeini issued a fatwa according to which a person can change their gender, but must undergo the appropriate surgeries.
In the last 40 years, many people in the country have been forced to change their gender, and a number of members of the LGBTI community have fled to avoid this. Because people who do not conform to traditional norms of masculinity and femininity but refuse to undergo surgery are subject to violence and repression.
Today, when Iran is facing severe economic problems, the country's rulers want to use the knowledge that Iranian doctors have in these procedures to profit. Iran is offering gender reassignment tourism and is trying to attract people from abroad by offering them cheap surgeries, along with luxury hotel stays and excursions in the country, the “New York Times“ reports.
Billions from vaginoplasty and penis construction
The theocratic government in Tehran has set itself the goal of earning $7 billion a year from medical tourism, and in addition to rhinoplasty and hair transplants, it also offers vaginoplasty, mastectomies and penis construction.
The country's favorable prices attract transgender people even from countries such as Australia, the United States and the United Kingdom, as is clear from a number of Iranian companies that offer such tourism. Iran is also becoming a magnet for trans people from neighboring countries such as Iraq, where such procedures are completely banned. “In the US, the cost of the operation is around $45,000, in Thailand - nearly $30,000“, says the website of one of these companies - IranMedTour, quoted by “The New York Times“. “The cost of gender reassignment surgery in Iran is lower, with prices below $12,000.“
Tourist companies are also attracting patients by emphasizing “Iran's relatively progressive position on transgender rights“. The reality, according to LGBTI activists and representatives, is quite different.
Repression, harassment and forced surgeries
“The aim of these medical trips is to portray Iran as a paradise for trans people, which it is not“, emphasizes Saman Arastu, a transgender actor from Iran. “The situation of transgender people is tragic“, he says.
Raha Ajoudani, a 20-year-old transgender woman from Iran, was forced to flee the country in 2024 because she refused to undergo surgery after being detained twice. “I never wanted to undergo sex reassignment surgery”, she says. “I define myself outside of this binary system. I did not want to live by the government’s definition of cultural expectations for women and men, nor to obey Khomeini’s fatwa.“
A 2022 British Home Office report noted that around 4,000 people undergo gender reassignment surgery in Iran each year, a number that is higher than in France and the UK combined. At the same time, many warn that some of the operations are carried out in very questionable conditions. A 2015 UN report on gender reassignment surgery in Iran described failed procedures that led to complications such as “severe bleeding, severe infection, scarring, chronic pain and abnormally shaped or positioned genitals.”