A 1986 religious ruling turned medical transition into state policy
In 1986 Iran’s Supreme Leader, Ayatollah Khomeini, issued an official fatwa declaring that the most Islamic way to deal with gay or effeminate men is to give them hormones and surgery so they “become women.” “Khomeini famously issued a fatwa that said that the most (Shia) Islamic way to deal with males seen as gay or effeminate is to give them cross-sex hormones and genital surgeries in order to make them more closely resemble females.” – MarkTwainiac source [citation:0c77cecf-0d31-486f-9768-2de541705fbe] This single decree turned clinics into state-run conversion centers.
The law punishes homosexuality while rewarding transition
After the 1979 revolution male homosexual acts became capital crimes, while female same-sex acts were punished by lashings. Transition offers the only legal escape. “It’s illegal to be homosexual, punishable up to death, but perfectly legal to be a ‘straight’ transsexual.” – HeForeverBleeds source [citation:15ddae02-bc74-499b-a43d-e17ffd4d50bd] Once a man is re-classified as a woman, his relationship with a man is symbolically re-labeled heterosexual, satisfying both religious law and social appearance.
Western praise misses the coercive reality
Activists outside Iran often cite the country’s free surgery program as “progressive,” yet the people affected describe it as forced conversion therapy. “In some countries like Iran, it is forced on people who dare to be homosexual or even just a cis tomboy girl or effeminate man… They force it on people because they know it is conversion therapy.” – bo1555 source [citation:d0b57cf4-0a87-49e6-a727-586c5e5f3e04] The choice is literally transition or risk execution.
The numbers reveal the pressure, not popularity
Despite the high profile of Iran’s program, the actual transition rate is tiny—less than 1 in 60,000—about 200 times lower than Western rates. “The entire Iranian trans population would basically be a rounding error compared to Western trans populations that have a transition rate of at least 1:300.” – recursive-regret source [citation:72c87627-bcd7-49c3-913f-e32c4d01ae97] The surgeries are not evidence of widespread gender diversity; they are evidence of a legal system that makes transition the only safe way to be different.
Conclusion: a cautionary tale, not a model
Iran’s status as a “global hub” for transgender surgery is the product of a theocratic bargain: medical transition in exchange for erasing homosexuality. The policy is rooted in rigid gender stereotypes and lethal homophobia, not liberation. Understanding this history underscores why non-medical paths—accepting people as they are, without forcing them into new boxes—are the truly compassionate route to safety and self-respect.