Sex Changes: Cheap, But Not Cheerful

An Iranian citizen journalist, who writes under a pseudonym to protect her identity, wrote the following article on the ground inside Iran.

In the year 1986, a man by the name of Fereydoon Molkara went to see Ayatollah Khomeini, the founder of the Islamic Republic. He had an important question to ask him. He wanted permission to have a sex change. Although he had the body of a man, Fereydoon believed he was a woman.

Shortly after the encounter, Ayatollah Khomeini issued an edict that allowed sex changes. The fatwa said that individuals who felt this way were permitted to undergo sex-change surgery once they had received medical approval.

And so Fereydoon Molkara, like many others, was given the freedom to change his gender. He became Maryam (Mary), a she.

In the 1990s, just several years after the fatwa was issued, transsexuals began to grow in confidence in Iran. More and more, they appeared in public and they even set up several gathering places that transsexuals would meet up at in Tehran. And, although they continue to be harassed and discriminated against, both by the Iranian people and the security forces, they are now much safer than in the past. It is safer for them to admit to being a transsexual and to having had a sex change than they were previously. However to be eligible for the surgery, they first need to acquire a judicial permit, according to the 2012 Family Protection Law.

The easing in atmosphere towards transsexuals is evident through available statistics. Between 2006 and 2010, the number of sex changes rose in Iran to 1366, fifty-six percent of which were from men to women and the rest from female to male.

Sex changes have been the subject of many studies by geneticists, sociologists and psychologists in Iran. One such study found that because sex-change operations are relatively cheap in Iran, would-be immigrants choose to have procedures early, before they leave the country. But the problem is that  procedures in Iran tend to be done at a substandard level.

Iranian transsexuals have to contend with long processes of getting permits from sexologists, psychiatrists, the judiciary and other governmental authorities.  The process of getting a new identity and other necessary papers, as well as low quality hormones made in Iran, is also slow. The Medical Welfare Organization pays part of the sex change cost, although just a minimal part compared to the total fee.

 

Pressure on Homosexuals

There are many issues to having a sex change in Iran. The biggest problem of all, however, is that many gay people in the country are forced or advised into getting a sex change when they do not need one. Homosexuality in the Islamic Republic is illegal and deemed to be “deviant” behavior, which frequently means that when a gay person admits to being a homosexual to a psychologist, psychiatrist or family member, they are pressured into getting a sex change.

To have a sex change in Iran, a person needs approval from an array of different bodies, which includes psychologists, sexologists and a judicial court. Following this, if they are successful, the Legal Medicine Organization refers them to a hormone therapist and plastic surgeon to begin the multi-step surgery.

The first step is hormone therapy. Doctors recommend at least one year of hormone therapy to rein in existing sexual hormones and to inject hormones of the opposite sex.

Hormone therapy has two goals. Aside from preparing a person for surgery, it also aims to familiarize the individual with his or her selected gender and see how they feel in society as that gender because surgery is non-reversible; it is final thereafter. Patients are given a year to make a final decision.

However even before hormone therapy begins, transsexuals have to have three months of sexual counseling to make sure they are entirely sure of their decision.

During the initial stages of hormone therapy, the body continues to produce the same hormones it always has done because that person’s ovaries or testicles are still intact and continue to function normally. However this process causes damage to a person’s fertility. This means that if an individual changes their mind before therapy is finished and they want to have a baby from their own egg or sperm, they have to decide beforehand and freeze them.

Transsexual men going through a sex change are initially injected with five micrograms of Estradiol per kilogram of body weight per day. This is gradually increased until it reaches two milligrams for every kilo.

Testosterone is the hormone used for women wanting a sex change. Beginning with 25 milligrams per square meter of the women’s body surface, it is later increased to 100 milligrams per square meter of the body.

The final stage of the process is the removal of breasts, ovaries, the womb or the testicles depending on the patient. For female transsexuals, this final stage involves giving them a male organ that is both functionally and visually adequate.

 

The Two Methods

In Iran and other countries, there are two possible ways to achieve this end. The first is Metoidioplasty, which is when male hormones gradually enlarge the clitoris to four or five centimeters and then surgery lowers the clitoris to where a penis would be. Although the clitoris will keep sexual sensitivity alive, penetration becomes either difficult or impossible, which is why it is usually recommended to transsexuals of a low weight.

The second way is through phalloplasty, which is a simpler, faster and cheaper and is when a surgeon creates the new sexual organ from other tissues in the patient’s body. The shortcoming of this process is that sexual sensitivity is reduced, although in certain cases, pumps are placed below the belly or penis to change this. These, however, need replacing every few years.

For male-to-female sex changes, hormones are used to grow breasts or prosthetic ones are worn. Then the penis and testicles are removed and a vagina is built in its place. Currently, ovary or womb transplants are not possible. Voices changes or hair growth happen during hormone therapy.

The two best-known Iranian surgeons in this field are Professor Bahram Mir Jalali and Dr. Sudabeh Oskoei, a woman. According to Dr. Oskoei, who was speaking at a seminar about the experiences of Iranian transsexuals, the Medical Welfare Organization pays about $1700 dollars for a sex-change operation but the whole process can cost anything from as much as ten times that or $40,000.

Nevertheless this is a relatively cheap process compared to most countries and so it is commonplace for transsexuals from developing countries and Eastern Europe to go to Iran for a sex change. However the surgery is of a much lower quality than in other places such as Germany or Thailand. Hormones made in Iran are also of a much lower standard and can cause numerous physical complications, much the same way that low-quality plastic surgery can. Although it is good that in a country that fails to recognize homosexuality, sex changes are permitted practice but it is evident that the industry still needs a lot of work. Greater understanding of the issue on the part of the authorities would be a good starting point. 

 

Mahdis Pouya, Citizen Journalist

 

Related articles:

Forced Sex Changes Must Stop Now

Iranian LGBT Fight for Their Future in Turkey

Podcast: Gay in Iran

 

To read more stories like this, sign up to our weekly email.