It is well known today that Iran is one of the most dangerous countries for LGBTQ+ people. Same-sex activity is illegal for both men and women (though the law is generally harsher towards gay men than lesbians) and it is punishable by life imprisonment, corporal punishment, or execution.
One thing that may surprise you, however, is that, after Thailand, Iran carries out more sex reassignment surgeries than any other country in the world. In fact, the number of these surgeries carried out in one year in Iran is greater than the number performed over a decade in France, and the Iranian government provides financial assistance to individuals looking to change their legal gender.
Now, before we go any further, several things must first be clarified. One of the reasons for the high numbers of sex reassignment surgeries in Iran is because it is seen as a ‘solution’ to being gay. Many gay men and women face pressure to transition in order to avoid legal and social persecution. Furthermore, transgender people are not inherently recognised in Iran; sex reassignment surgery is a requirement for legal recognition, and access to surgery can only be gained after undergoing incredibly invasive tests, inspections, and psychological counselling, plus the (approximate) 106,442,994.45 rial (£2000) fee.

Many queer Iranians undergo sex reassignment surgery not because they are transgender, but because it theoretically makes their lives easier and safer. They do however still face the prospect of being disowned and rejected by family and friends, and transgender individuals (whether they transition or not) are much more likely to face hate crimes and persecution by the police and government than gender-conforming people.
Tanaz Eshaghian’s 2008 documentary film, Be Like Others (available to watch on Amazon Prime in the US at the time of writing), takes a look behind the scenes at Tehran’s foremost gender reassignment clinic and explores the lives of some patients, both before and after their surgeries. I personally have not been able to find a method of watching it, but the film received high praise and was nominated for a GLAAD award in 2010.
Now we are past that disclaimer (though please do keep it in mind), we turn to the story of how this became possible. Sex reassignment surgery was legalised in Iran by means of a fatwa (a ruling on a point of Islamic law when there is no clear direction from the Quran or Sunnah) in the mid-1980s. This was thanks to the efforts of one woman.
Assigned male at birth, Maryam Khatoon Molkara showed many of the typical signs of being transgender from an early age. She hated wearing boy’s clothes, and she was caught playing with her mother’s makeup as early as two years old.
Before the Iranian Revolution in 1979, there was no ruling either way on transgender people and surgery for intersex people had been carried out since the 1930s. The influential Ayatollah Khomeini had written in his 1963 book that there was no religious scripture preventing gender confirming surgery, but this was only in relation to intersex people. Besides which, he was a radical in exile at the time so his words held no actual weight.
Khomeini would play a deciding role in Molkara’s – and Iran’s – future, but that is for later. For now, Molkara had got a job as a caretaker for an elderly woman living in her neighbourhood. This led her, unbeknownst to her parents, to a part-time job at a health centre, where she met a post-op trans doctor. She confided to him her feelings that she was more woman than man, and he introduced her to the concept of being trans, encouraging her to pursue gender reassignment surgery.
When I was very small I used to scream when they tried to dress me in boy’s clothes and when I was taken to toy shops I wanted dolls instead of boy’s toys. I played at cooking with the neighbouring girls and every night I prayed for a miracle but in the morning I looked at my body and it hadn’t happened.
Maryam Khatoon Molkara, speaking to The Independent in 2004
From there, Molkara began her journey into Tehran’s queer scene. She began presenting more openly as a woman, moved in with her boyfriend, and gathered the courage to come out to her parents. Sadly, her mother refused to accept her, and Molkara subsequently developed some doubts about the right path for her, especially with regards to her faith, as she was a devout Muslim. Seeking answers from a higher power, she reached out to a religious expert, the Ayatollah Behbahani. He performed a traditional Iranian ceremony called istikharah, which means allowing the Quran to fall open to a passage and determining a reading based on that passage.
For Molkara, it landed on the verses about the Virgin Maryam, which Behbahani believed meant Molkara would, like Maryam, have a hard life. He suggested she contact Ayatollah Khomeini for further guidance.
Then, Molkara had a job in a nail salon and had started hormone therapy, supported by her coworkers and Iran’s queer community. In 1975, she contacted Khomeini, in exile in Iraq, for the first time, explaining her plight, and he wrote back telling her to carry out her Islamic duties as a woman. Three years later, she flew to Paris to meet him and lobby again for her rights as a trans woman, but she was unsuccessful. Further attempts would be thwarted by the outbreak of the Revolution, spearheaded by Khomeini.
The Iranian Revolution was a huge step backwards for the queer community. They were heavily persecuted, some being locked up or even killed. Molkara was fired from her job and forced to take testosterone injections in an attempt to ‘correct’ the breasts that had begun forming due to the oestrogen she was previously taking. She was also beaten and imprisoned, saved only by her connections to high-ranking clergy.
Molkara was aware that she could get the surgery abroad, but she wanted documentation so that she could live freely in her own country. So, in 1983, she decided that the only course of action was to confront Ayatollah Khomeini in person once more.
Dressed in a man’s suit and sporting a full beard, Molkara walked into the Ayatollah’s compound in Tehran. She carried the Quran and wore a pair of shoes tied around her neck, a Shia symbol meaning a request for shelter. Despite this, Molkara was greeted by the security guards beating her brutally, only stopping when Khomeini’s brother happened upon the scene and allowed her into the house. Dazed and emotional, Molkara at this point could only utter the words, “I’m a woman, I’m a woman.”
The guards were concerned the band around Molkara’s chest meant she was hiding explosives, so she ripped it off to expose her breasts, which the women in the room quickly covered with a chador, an outer garment worn by some Muslim women, particularly in Iran. Khomeini’s son, Ahmad, then entered, and he was moved to tears by Molkara’s story, so she was finally allowed in to see the Ayatollah, but she was so overwhelmed that she collapsed.

She woke to Khomeini shouting at his guards for mistreating her when she came in search of shelter. “It was behesht [paradise],” she recalled. “The atmosphere, the moment and the person were paradise for me. I had the feeling that from then on there would be a sort of light.”
Khomeini listened to Molkara’s story and, some time later, she emerged victorious with the fatwa that would change everything. Sex reassignment surgery was now legal in Iran, and hundreds of surgeries have since been carried out in the country’s capital alone.
Molkara herself did not undergo the surgery until 1997 and she travelled to Thailand to do it, being dissatisfied with the procedures in Iran. However, it was still paid for by the Iranian government.
Maryam Khatoon Molkara dedicated the rest of her life to helping transgender people in Iran, including bailing them out of jail even though she knew she would face violence for it. She also used her own property to provide legal advice and medical care to individuals, and, in 2007, she set up the Iranian Society to Support Individuals with Gender Identity Disorder, which was Iran’s first state-approved organisation for trans rights. The organisation helps to fund surgeries and it is subsidised by the government.
Molkara suffered a heart attack and died on 25th March 2012, aged 62. She changed her country radically, and while homophobia and transphobia are still prevalent in Iran (as in many countries across the globe), there is no doubt that Molkara’s actions were a huge step forward.
Sources:
- Doan, Petra, ‘Disrupting Gender Normativity in the Middle East: Supporting Gender Transgression as a Development Strategy’, in Development, Sexual Rights and Global Governance, 1st edn (Routledge, 2010), pp. 145–54
- Ishak, Natasha, ‘Meet Maryam Khatoon Molkara, The Trans Activist Who Helped Legalize Gender-Confirming Surgeries In Iran’, ATI, 2010 <https://allthatsinteresting.com/maryam-khatoon-molkara>
- McDowell, Angus and Stephen Kahn, ‘The Ayatollah and the Transsexual’, The Independent, 2004 <https://www.independent.co.uk/news/world/middle-east/the-ayatollah-and-the-transsexual-21867.html>
- Making Queer History, ‘Maryam Khatoon Molkara’, Making Queer History, 2017 <https://www.makingqueerhistory.com/articles/2017/3/18/maryam-khatoon-molkara-a-woman-who-changed-her-country>
- Tait, Robert, ‘A fatwa for freedom’, The Guardian, 2005 <https://www.theguardian.com/world/2005/jul/27/gayrights.iran>