Pahichan, (Kathmandu), November 10 -For homosexuals in Iran, life is really difficult. A recent report in BBC shows that homosexuals in this Islamic Republic, where homosexual acts are punishable by death, are pushed into having gender reassignment surgery – and to avoid it many flee the country.

Growing up in Iran, Donya kept her hair shaved or short, and wore caps instead of headscarves when she was young. According to her, she didn’t really understand herself for several years. Donya also had hormone treatment for gender reassignment surgery. But, later on, she got to know herself better and accepted that she was a lesbian and was happy with that.

But living in Iran as an openly gay man or woman is impossible. Donya, now 33, fled to Turkey with her son from a brief marriage, and then to Canada, where they were granted asylum.

Psychologists suggested gender reassignment to Soheil, a gay Iranian 21-year-old.

Then his family put him under immense pressure to go through with it. They told him that he need to either have his gender changed or they will kill him and will not let him live in that family.

The day before he was due to have the operation, he managed to escape with the help of some friends. They bought him a plane ticket and he flew to Turkey.

Marie, aged 37, is now staying in Kayseri after leaving Iran five months ago. She grew up as a boy, Iman, but was confused about her sexuality and was declared by an Iranian doctor to be 98% female.

Many, like Donya, Soheil and Marie, have fled. Usually they go to Turkey, where Iranians don’t need visas. From there they often apply for asylum in a third country in Europe or North America.

According to the BBC news report, it’s not official government policy to force gay men or women to undergo gender reassignment but the pressure can be intense. In the 1980’s the founder of the Islamic Republic, Ayatollah Khomeini, issued a fatwa allowing gender reassignment surgery – apparently after being moved by a meeting with a woman who said she was trapped in a man’s body.

Shabnam, a psychologist at a state-run clinic in Iran says some gay people now end up being pushed towards surgery. Doctors are told to tell gay men and women that they are “sick” and need treatment, she says. They usually refer them to clerics who tell them to strengthen their faith by saying their daily prayers properly.

But medical treatments are also offered. And because the authorities “do not know the difference between identity and sexuality”, as Shabnam puts it, doctors tell the patients they need to undergo gender reassignment.

Supporters of the government’s policy argue that transgender Iranians are given help to lead fulfilling lives, and have more freedom than in many other countries. But the concern is that gender reassignment surgery is being offered to people who are not transgender, but homosexual, and may lack the information to know the difference.

Some are fleeing to avoid gender reassignment surgery, but others have had treatment and find they still face prejudice. It is estimated 45% of those who have had surgery are not transgender but gay.

There is no reliable information on the number of gender reassignment operations carried out in Iran.

Khabaronline, a pro-government news agency, reports the numbers rising from 170 in 2006 to 370 in 2010. But one doctor from an Iranian hospital told the BBC that he alone carries out more than 200 such operations every year.