LONDON (Thomson Reuters Foundation) – When Arshkan, a young Iranian man, told a psychiatrist he was homosexual he was astonished to get a letter telling him to start hormone therapy in preparation for a sex change.
Sara, a student in Tehran, was similarly advised to change sex after confiding to a psychologist that she preferred girls to boys.
Rights campaigners say Iranian doctors routinely pressure lesbians and gays to undergo sex change operations including sterilisation.
While homosexuality is considered a sin in Iran, transsexuality is viewed as a legitimate health problem which can be cured through surgery, according to a report by Justice For Iran (JFI) and 6Rang, an Iranian lesbian and transgender network.
“Most healthcare professionals in Iran believe homosexuality is a form of mental illness,” said the report’s author and 6Rang founder Shadi Amin. “Lesbians and gays are often told they have gender identity disorder.”
Transsexuality was legalised after revolutionary leader Ayatollah Khomeini issued a religious edict in 1985 authorising sex change operations.
Today, Iran carries out among the highest number of sex changes in the world and is the only country which imposes the death penalty for homosexual behaviour while permitting sex changes, Amin said.
There are no official statistics for sex change operations, but the report says applications made to the Legal Medicine Organisation of Iran (LMOI) have soared in recent years.
There were 1,366 applications between 2006 and 2010, but campaigners say anecdotal evidence from doctors suggests the number of operations is far higher.
A leading LMOI psychiatrist is quoted in the report as linking the high number of applicants to Iran’s rejection of homosexual lifestyles.
A prominent surgeon is also quoted as saying in 2005 that he had performed at least eight times as many sex change operations as he would have done if practising in Europe - a fact he attributed to the ban on homosexuality.
Iran is one of a handful of countries where certain homosexual acts are punishable by death. The penalty for lesbian sexual acts is flogging, but anyone convicted a fourth time faces execution.
Rights campaigner Amin said Iran was a “highly gendered society” where the law defines a true man as one who is attracted to women and a true woman as one who is attracted to men.
People perceived as lesbian or gay risk discrimination, arbitrary arrest, torture and violence from their communities and families.
Amin said the lack of information on sexuality combined with the demonisation of homosexuality and criminalisation of homosexual acts pushed lesbians and gays into having psychiatric, hormonal or surgical treatment.
While some doctors advise people to change their gender, others try to switch patients’ sexual orientation using nausea-inducing psychoactive medications or electroshock treatment, the report says.
“I think psychiatrists in Iran … want to either electroshock you into being straight or remove your testicles. This is a very prevalent attitude,” one gay man comments.
Amin believes that homophobia is often so internalised in Iran that some people prefer to identify themselves as transgender rather than admit they are lesbian or gay.
The rights campaigner, who has lived in Germany since the 1980s, believes she would also have opted for a sex change if she were growing up in Iran now, even though she has never felt male.
“When I was young I thought there was something wrong with me. I thought it wasn’t normal that I loved women and wanted to be like a boy so I thought I should change myself,” she said.
“I’m really glad that at that time there was not this discourse around sex change operations. If I was that young girl today, I’m sure I would have decided to have sex reassignment.”
Amin said Iran’s official acceptance of transsexuality “doesn’t make it a paradise for transsexuals”.
She said transgender people could not obtain legal recognition of their preferred gender unless they underwent sex reassignment, including forced sterilisation.
The report - which includes shocking testimonies from people who have undergone harmful therapies and surgery - says operations are often carried out in “a reckless and substandard fashion” with little or no aftercare.
“The doctors who do this are not specialists for transsexuals. Any surgeon or gynaecologist can do it,” Amin said.
She said transgender people she interviewed had been left with serious problems including severe back pain, chest pain, debilitating infections, loss of sexual sensation and incontinence.
The report will be launched at a gay pride event on Thursday in Istanbul in Turkey, where many Iranian gays and lesbians have sought refuge.
It calls on Iran to abolish the death penalty, repeal laws criminalising homosexual conduct and outlaw forced sterilisation and sex reassignment surgery without informed consent.