Maryam Molkara (formerly Fereydoun), however, was religious, and apparently intended to encourage the clerics to issue a fatwa allowing sex reassignment. Khomeini did so, and Fereydoun became Maryam and continued to live in Iran as a woman until she passed away last year.

“Deep down, Farideh had always felt she’s a boy,” his mother said, “so I brought her to Tehran from our city [Shabestar, in western Azerbaijan] for evaluation." As Ettelaat informs us, Farideh successfully underwent surgery and treatment in Tehran and when interviewed, expressed enthusiasm for serving in the military .

In 1987, Ayatollah Ruhollah Khomeini’s fatwa gave the green light for sex-reassignment surgeries. While many consider the now-female Maryam Molkara the first Iranian transsexual to undergo sex-reassignment surgery in 1987, a 60-year-old issue of the Iranian Ettelaat newspaper cites an earlier case. The newspaper ran the story of a proud and happy girl-turned-boy Farhad (formerly Farideh) and his nurse in Tehran’s Pahlavi hospital.

The Iranian government goes so far as to subsidize the surgeries, paying up to half of the high expenses of both surgery and treatment. Iran says an average of 300 of these surgeries are performed in the country each year.

Another version of the story behind Khomeini’s fatwa is that he decided to issue it after meeting with a couple who were not sexually attracted to each other and could not have intercourse because one of them felt out of place.

Some believe that the ayatollah had made a decision about transsexuals years before the 1979 Islamic Revolution, while he was in exile in Iraq and after having read a letter from Molkara, requesting the cleric’s blessing to transform and become a woman.

Iran’s Health Ministry reports that 56% of transsexuals are males who would rather be female, and 44% are women who want to become men.

Tehran’s fashion of dealing with openly transsexual citizens willing to reassign their gender is yet another paradoxical aspect of the administration’s peculiar prescriptions for “curing” homosexuals.

While Iran does not acknowledge attraction to the same sex, it encourages individuals who, they believe, are confused sexually or from their perception, suffer from sexual disorders to seek out switching their gender. While valid and legal, this option is not as easy as it may sound.

Dr. Mehrdad Baghaei, an Iranian surgeon who specializes in sex-reassignment surgery in Tehran and has been active and well-known in this field over the past decade, told Al-Monitor that most of his patients are young. In a phone interview, he said, “Yet, from time to time, I see unusual cases. Just this morning, I operated on a 61-year-old man, married with grown kids, who wants to become a woman.”

Baghaei added that religious families have less trouble fathoming and accepting their loved ones as transsexuals, since they have faith in what they consider God’s will and would much rather see their family member undergo gender change than be gay.

The Islamic Republic of Iran basically has the same approach: If you stand on either side of the sexual spectrum, as expected, you’re accepted. It’s the "in-between" that makes the government uneasy.

The path to sex reassignment is by no means a short one, nor is it simple — not if aid from the government is desired or needed. An individual who feels the urge to switch genders must start the process by seeing an authorized psychiatrist. These psychiatrists are known and listed, most of them specializing in sexology.

Baghaei tells Al-Monitor, “Six psychiatrists need to examine the patient and talk with them, usually during multiple sessions, to confirm the necessity of gender change. Then, a commission of psychiatrists needs to sign off on the diagnosis of 'sexual disorder.' A forensic examiner of the Iranian Legal Medicine Organization is then required to see the patient and confirm the diagnosis, at which point the Legal Medicine Organization issues a permit validating the sex-reassignment surgery."

The Welfare Organization of Iran covers half of the total expenses of gender change, which includes surgeries, hormone therapy and psychological aftercare. There is usually a wait-list for this coverage. Most patients find waiting worth their while, since it rarely exceeds six months. Immediately after the sex-reassignment surgery, the government issues a new birth certificate for the transsexual citizen and the original one is discarded.

Sina (formerly Simin) is a 26-year-old transsexual receiving hormone therapy and counseling. Talking with Al-Monitor over the phone, he sounds like a teenager whose voice has not quite broken yet. He tells me he looks forward to having a really deep voice. Sina, who co-owns a fancy boutique in the center of Tehran, tells me he is ecstatic about having a girlfriend. He says, "I’m really proud of the decision I made. I’m much more comfortable now, too. Got rid of the hassle of wearing a headscarf. Now I can unbutton my shirt and show a bit of chest hair. It’s gradually getting hairier, so I’ll get to open the second button soon.”

But not everyone is as elated as Sina. Rouzbeh, 18, lives in northern Iran, by the Caspian Sea. He’s already gotten the slip of paper he’d always yearned for: the permit for living his dream of becoming Roudabeh. He’s at the gate, waiting to be let in — except the gate is locked. He told Al-Monitor that he sleeps with the permit under his pillow at night; it is his most invaluable piece of property, his passport to finally breaking free.

Rouzbeh is religious, and is having an extremely difficult time convincing his family that he really feels feminine. He tells me that he attempted suicide last month and prays day and night for God to take him away or grant his wish of becoming his true inner self: a woman, which is what, according to him, Islam supports.

But Rouzbeh’s parents have tried to “get him well” since he turned 13. They have taken him to top doctors both in their city and in Tehran. They have forced Rouzbeh to take male hormones. They just cannot wrap their heads around “him” longing to be “her.”

The challenge of being a transsexual Iranian citizen is not so much the transformation itself as it is surviving the storm of stigma which exists. One may have a different birth certificate, a different look, a different name, but most likely will be forced to find a different job, different mannerisms and a different skin: a much, much thicker one, one that can tolerate the taboo of being a transsexual Iranian.

Mehrnaz Samimi is an Iranian-American journalist. On Twitter: @mehrnazsamimi