For four decades, Iran has been an unexpected global leader in gender transition surgeries. This prominence, however, comes with a disturbing history: many gay and gender-nonconforming Iranians have been coerced into these operations to escape the death penalty or other severe punishments.
Now, with its economy struggling under the weight of war and sanctions, the Islamic republic is leveraging this controversial expertise. It’s actively promoting itself as a destination for transgender foreigners, offering affordable surgeries alongside luxury hotel stays and curated sightseeing tours.
Driven by a desperate need for foreign investment, Iran’s religious government aims to generate over $7 billion annually from medical tourism, a sevenfold increase from last year’s earnings, according to state media. This ambitious target has fueled the rapid growth of medical tourism companies. These firms now market not only common cosmetic procedures like nose jobs and hair transplants but also complex gender-affirming surgeries, such as vaginoplasties, mastectomies, and penis constructions, all through slick English-language websites.
Farideh Najafi, manager of MabnaTrip and MedPalTrip, two prominent medical tourism companies, emphasizes their comprehensive services. “We handle everything from start to finish, providing the best medical services to ensure a stress-free experience,” she stated. “This includes booking hotels, hospitals, transportation, and more.”
Iran stands as one of the few Muslim-majority nations that permits and even subsidizes gender-affirming care for transgender individuals. For many foreigners traveling to Iran for transition surgery, and indeed for a segment of transgender Iranians, these procedures can genuinely feel life-saving. Yet, the nation’s reputation as a surgical pioneer starkly contrasts with the abusive origins of these operations and the harsh realities faced by most LGBTQ+ people within its borders.
In Iran, gay men and lesbians risk public flogging and even the death penalty. Consequently, as noted by the United Nations Human Rights Council, many gay and lesbian Iranians who do not identify as transgender are pressured into undergoing gender reassignment surgery against their will.
Despite this grim backdrop, Iran’s significantly lower surgical costs are attracting transgender individuals from as far afield as Australia, the United States, Britain, and Europe, according to local medical tour operators and surgeons. Even more patients, they report, travel from neighboring countries like Iraq, where such treatments are strictly prohibited.
For instance, IranMedTour’s website highlights the drastic price difference: “In the United States, the cost of surgery is around $45,000, and in Thailand, it’s approximately $30,000. However, the cost of gender confirmation surgery in Iran is lower, with prices less than $12,000.” Other companies even advertise government hospital procedures for as little as $4,500.
Sam, a 32-year-old trans man from Orange County, California, is currently in Tehran for a hysterectomy and metoidioplasty, a type of penis-construction surgery. Speaking anonymously about his sensitive medical journey, he explained his choice was driven by a belief that Iranian doctors were “more confident” than those in the U.S.
However, not all view these initiatives positively. Saman Arastu, a transgender Iranian man and actor who has undergone both top and bottom surgeries, expressed skepticism. “The goal of these medical tours is probably to portray Iran as a paradise for trans people, which it isn’t,” he said. “In my opinion, these are nothing but a show. The situation for trans people is dire.” (Arastu is also featured in the lead image of this article.)
While exact numbers remain elusive, a 2022 report from Britain’s Home Office indicated that approximately 4,000 transition surgeries are performed annually in Iran—a figure exceeding the combined annual totals of Britain and France. Experts believe a vast majority of these patients are Iranian nationals.
Iran’s history with gender transition surgery traces back to a fatwa issued in the 1980s by Ayatollah Ruhollah Khomeini, the Islamic republic’s founder. He decreed that transgender individuals could achieve legal gender recognition, but only if they underwent transition surgery.
Superficially, this policy seems to contradict Western expectations of Iran, a nation where gender norms are so rigidly enforced that women recently faced punishment for not wearing hijabs publicly. Yet, transgender Iranians and experts assert that the government’s endorsement of surgery in no way translates to genuine advocacy or support for trans people.
Iranians who deviate from traditional masculine and feminine norms—including trans individuals who do not desire surgery—are vulnerable to violence, extortion, or intense pressure to undergo operations. “For the Islamic republic, being trans means you have to go through this surgery — from male to female, female to male,” explained Zara Saeidzadeh of Orebro University in Sweden, a gender scholar researching trans identity in Iran. “If you identify as trans but don’t want to do any form of body modification, then you’re breaking the rules and you are going to be stigmatized and your life is threatened.”
Raha Ajoudani, a 20-year-old trans woman and activist, took a path opposite to the foreign medical tourists. She fled Iran for Germany in 2024 to avoid forced transition surgery and escape state persecution for her activism. Ms. Ajoudani recounted being detained twice by authorities in 2022 after an ex-boyfriend collaborated with the Iranian Ministry of Intelligence, leading to her arrest. Her family, she added, is regularly harassed to compel her to cease her activism.
“I never wanted to undergo gender reassignment surgery,” Ms. Ajoudani stated. “I’ve defined myself outside of this binary. I didn’t want to live according to the governmental definition of cultural expectations of being a woman or a man, nor did I submit to Khomeini’s fatwa.”
Undergoing surgery in Iran does not guarantee acceptance or safety. Transgender individuals there continue to face murder, violence, and harassment. Tour companies, however, attempt to alleviate these fears in their promotional materials. Amidst glossy before-and-after photo illustrations of idealized bodies, and promises of “budget-friendly” procedures, swift visa approvals, and assistance in achieving “a strong feeling of happiness and relief,” these companies also tout what one calls Iran’s “relatively progressive stance on transgender rights.”
Ms. Najafi, the tour manager, acknowledged that some foreigners expressed concern about conflicts with authorities or locals. Still, she maintained that patients traveling with her company had “never had any security issues.”
Despite promotional claims, gender transition surgeries in Iran are complex procedures with a questionable safety record. Some activists have even alarmingly compared the country’s gender clinics to “butcher” shops.
Saghi Ghahraman, who formerly led the Iranian Queer Organization, noted that while treatment standards have supposedly improved, this progress has come at a high cost, with many gay individuals feeling forced into what she described as “experiments.” A 2015 U.N. report on Iranian transition surgeries detailed botched procedures resulting in severe complications, including “severe bleeding, severe infection, scarring, chronic pain and abnormally shaped or located sexual organs.”
Adding to the risks, some tour companies promote rapid procedures, which experts caution should involve months of careful planning. Certain marketing materials even advertise stay timelines as brief as one week. Dr. Shahryar Cohanzad, a Tehran-based urologist who has performed approximately 300 transition surgeries, expressed concern over companies aiming to perform as many procedures as quickly as possible, deeming it unsafe. “From what I know after 35 years of performing surgeries, it’s critical for the surgeon to spend as much time as possible with the patient,” he emphasized.
Eric, a 45-year-old trans man from Canada who chose anonymity to protect his family, explained he sought treatment in Iran due to its affordability. However, he recognized the inherent tension of receiving care in a country where such procedures are often forced upon its own citizens. “I have heard a lot, especially among trans women, that because they are gay, and they cannot be gay in Iran, they try to do the surgery,” Eric said. “I’m really sad that gays and lesbians are not recognized in Iran, but on the other hand I’m happy for trans people because they can do what they’re willing to do.”