Despite repressive laws against homosexuality, gender reassignment surgery remains legal in Iran. But Iranians who seek sex change operations are faced with a harsh approval process and a high risk of botched surgeries.
When Arya came out as transgender, his family immediately rejected the idea. "They did not accept that I was trans," says Arya, who wishes to remain anonymous. "They told me, 'Because you were born as a girl, you need to live as a girl.'"
Arya, 38, who identifies as a gender non-binary person, came out to his family in Tehran, Iran's capital, when he was 25, and spent two years seeking approval for a sex change operation.
Despite repressive anti-LGBT laws, gender reassignment surgery remains legal in Iran. However, the path to getting legal approval to transition is fraught with humiliating procedures, including virginity tests, court trials, extensive questioning and mandatory counseling.
Even after people get through the surgery and are legally able to change their sex on their identity cards, many are left without families, homes and work, while others face lasting physical damage from the procedure itself.
"Your rights will be violated before, during and after the surgery," says Shadi Amin, the director of 6rang, an organization that helps LGBT people in Iran. Approval often takes around one to two years, but can take much longer than that in some cases.
"When the argument went on and on, they brought me to the psychologist, which was the first step," says Arya.
Early on in the process, Arya says he was handed a questionnaire with a long list of questions, including: "Imagine that you are in a room and inside that room there is a fire starting, and you need to save your mom or a bunch of cats, which one do you choose?" and "Would you describe yourself as a circle, a triangle or a square?"
Based on these questions, he says, psychologists began to assess whether Arya was truly transgender or whether it was "just a phase."
Others, says Amin, are subjected to virginity tests, which are, "for a lot of them, a painful procedure."
"If you are not a virgin anymore and you are not married, it will be a problem."
Additionally, those going through the process have to have a family member accompanying them at all times, which only added to Arya's stress, as his mother was with him during each session. "So you need to go through public therapy, and then after years and years of that you need to go through the court process, and after that you need to go through the surgery," says Arya.
A medical risk
Despite the years spent in counseling and court sessions to obtain legal permission to have the surgery and reassign his gender identity, Arya changed his mind about the procedure when he saw the aftermath of other operations.
As sex change surgeries are often conducted by unqualified doctors, the end results can leave patients not just with scars, but also with lifelong injuries. "They have damages because most of the doctors are not specialists on transsexual issues. Most of the doctors are beauty surgeons," says Amin.
"In some cases, they do the entire surgery in one day." Afterwards, many people do not have enough money to pay to stay and recover in the hospital, and many do not have homes to go back to.
"That is the reason for two deaths that we could report," says Amin. "The person is there in a hostel and is dead because of the bleeding after the operation."
In addition to living with the results of botched surgeries, some people face difficulties as a result of a misuse of hormone therapy. While some patients administer their own hormones without the supervision of a doctor, many of the surgeons are also not well versed in how to administer the therapy, according to Amin.
"A lot of people who want to do the hormone therapy, they buy it from the black market, and they use it in overdoses because they want to have a faster change," says Amin. "A lot of them have high blood pressure, heart problems, kidney problems, and when you see them, you can really immediately know that this person is not healthy anymore."
The visual results of the surgery are also often far different from what the person may have envisioned. Arya not only feared for the way he would look afterwards, but also for the health problems that could ensue.
"There are a lot of pains after the surgery, lots of unwanted outcomes. You can't have sex after that because you are in pain, you have infections. You don't feel comfortable getting naked in front of people because you have lots of scars."
"When I saw the results of the surgery, I realized that I don't want to do that. I can't accept this," says Arya. "So I decided to just live as a girl."
Transitioning as a matter of life or death
While Arya chose to pursue a sex change in Iran due to his gender identity, others, who do not feel as if they are transgender often apply for the surgery so that they don't have to live in fear of being hanged, imprisoned or lashed for homosexuality.
"The sex change process is also a way of cleansing homosexuality in Iran," says Amin. "You have to change your sex or you have to change your sexual orientation."
Although there is no direct method of forcing homosexual people to apply for transitions, Amin says that social and familial pressure, combined with a fear of death, are enough to push people to transition.
"They medicalize the transsexuality issue. They say that transsexuality can be cured by sex change operations, but the homosexuals, they are immoral and unhuman," she says.
For many, going through the transition is the only way that they can legally live with their partner without fearing for their lives.
"That's why when they know that they have no rights as a homosexual, and they want to live with their partner, the only way they have to do this is by undergoing sex change surgery."
Living as a transgender person in Iran
Once the transition is made, many are forced to break ties with their families, friends, and all of the people who they knew before. Many move to other cities to start new lives, and are often faced with homelessness and forced into sex work to support themselves.
Additionally, adopting the norms of their legal gender can be another major adjustment in Iran, where men and women are separated in almost every aspect of life, including public transportation and classrooms.
"You should imagine that [after] you change your sex, you go to another society which is totally foreign for you, totally new for you, and you have to deal with that," says Amin. "You have lived as a woman all of your life, and now you are a man and you have to do all the things that a man did before."
"Even after the surgery, you must act as if you are not transgender," says Amin.
For Arya, going through the surgery meant he would have to let go of his family, too. His parents felt that his transition would be shameful if other relatives knew. "One of the main things that my family told me, is that if I went through the surgery, 'We are going to say that something happened to you,'" says Arya. "You cannot have any relationship with anyone from your past life."
He thought, "So I'm going to go through my future without any support, without any love, without the people that I knew before."
This process of starting a new life also makes it difficult to maintain data on what happens to people once they transition.
"We don't have any statistics about how they feel after the operation because most people will be lost in other cities," says Amin. "They don't want to show their history. They don't want anything to do with the people they had a connection with before."
A new beginning
Arya left Iran three years ago. He first moved to Portugal and now lives in Berlin. He started his social transition, or the process of making others aware of his gender identity, in September of last year, and his medical transition in March. However, due to the coronavirus pandemic, he has had to put the medical portion of his transition on hold for the time being.
In Europe, he says he has found a new life and a sense of freedom that he didn't have in Iran.
"I am free to be myself. I am free to tell other people how I feel. I am free to do something for my friends who are in the same situation inside the country," he said. "It's like living a dream."