Iran promotes gender transition surgeries for Westerners despite abuses against LGBTIQ+ people

New YorkFor 40 years, Iran has performed more gender transition surgeries than many other nations, largely as a result of pressure on gay and gender non-conforming citizens—people who don't conform to traditional stereotypes—to undergo unwanted operations or simply to avoid the possibility of punishment.

Now, faced with a crippled economy by war and sanctions, the Islamic republic is marketing its experience to a global audience, hoping to attract transgender foreigners with the promise of inexpensive surgeries, along with luxury hotel stays and sightseeing.

Desperate for foreign investment, Iran's theocratic government has set a goal of generating more than $7 billion annually from medical tourism, according to Iranian state media—roughly seven times what it earned last year. This goal has resulted in the proliferation of medical tourism companies, which market not only rhinoplasties and hair transplants, but also vaginoplasties, mastectomies, and penis constructions.

They advertise through English-language websites. "We take care of everything from start to finish and offer the best medical services to ensure a stress-free experience," says Farideh Najafi, manager of two medical tourism companies, MabnaTrip and MedPalTrip. "This includes booking hotels, hospitals, transportation, and more," she adds.

Iran is one of the few places in the Muslim world that allows transgender people to access gender-affirming medical care, and even subsidizes it. For many foreigners who travel to Iran for transition surgery, and indeed for many transgender Iranians, these operations can seem vital. However, the country's reputation as a pioneer in the field hides the operations' abusive history and the harsh reality for most LGBTIQ people.

In Iran, gays and lesbians can be punished with public flogging and the death penalty. As a result, the United Nations Human Rights Council has found that many gay and lesbian Iranians who are not trans are "pressured to undergo gender reassignment surgery without their free consent."

Still, the country's low prices are attracting transgender people from as far away as Australia, the United States, the United Kingdom, and other European countries, according to medical tourism operators and surgeons. Many more patients, they say, come from neighboring countries, such as Iraq, where such treatments are strictly prohibited.

"In the United States, the cost of surgery is about $45,000, and in Thailand it's approximately $30,000," according to one operator's website, IranMedTour. "The cost of gender confirmation surgery in Iran is lower, with prices under $12,000." Other companies advertise procedures in government hospitals for as little as $4,500.

The fatwa that allowed the surgeries

Although precise figures are unknown, a 2022 British Home Office report estimated that approximately 4,000 people undergo transition surgery each year in Iran—higher than the combined annual totals for Britain and France. Experts say a vast majority of patients come from within Iran.

Iran’s experience with transition surgery stems from a fatwa issued in the 1980s by Ayatollah Ruhollah Khomeini, the Islamic republic’s founding supreme leader, which declared that transgender people could obtain it if they underwent transition surgery. At first glance, this policy reverses what many in the West expect of Iran, where gender norms are so strictly enforced that women They are punished for not wearing hijab in public.

But transgender Iranians and experts say the government’s embrace of the surgery in no way correlates with advocacy for trans people. Iranians who don’t adhere to traditional norms of masculinity and femininity—including trans people who don’t undergo surgery—are targeted for violence, extortion, or pressured into surgery.

“For the Islamic republic, being trans means you have to go through this surgery—from male to female, from female to male,” says Zara Saeidzadeh of Orebro University in Sweden, a gender scholar who has spent a decade researching trans identity. “If you identify as trans but don’t want to undergo any kind of body modification, then you are breaking the rules and you will be stigmatized and your life will be threatened.”

Raha Ajoudani, a 20-year-old trans woman and activist, made the opposite journey from many foreign tourists. She fled to Germany from Iran in 2024 to avoid forced transition surgery and escape state persecution for her activism.

Ajoudani says she was detained twice by authorities in 2022 after an ex-boyfriend collaborated with the Iranian Intelligence Ministry to facilitate her arrest. Her family, she added, was routinely besieged to stop her activism. “I never wanted to undergo gender reassignment surgery,” she said. “I defined myself outside of this binary. I didn’t want to live by the government’s definition of cultural expectations of being a woman or a man, nor did I submit to Khomeini’s fatwa.”

Tour companies include language to allay these fears of foreigners in their marketing materials. And amid glossy before-and-after photo illustrations of idealized pecs and breasts, and text promising “affordable” procedures, fast-track visa approvals, and help in achieving “a powerful sense of happiness and relief,” the tour companies are also selling patients on what one calls “transgenderism.”

The aforementioned tour manager, Farideh Najafi, admits that some foreigners feared trouble with authorities or locals, but says that patients who have traveled with her company “have never had any safety issues.”

© The New York Times