The BBC did a feature on people in Iran pushed into being transgender as an acceptable alternative to being not straight.

Growing up in Iran, Donya kept her hair shaved or short, and wore caps instead of headscarves. She went to a doctor for help to stop her period.

“I was so young and I didn’t really understand myself,” she says. “I thought if I could stop getting my periods, I would be more masculine.”

If police officers asked for her ID and noticed she was a girl, she says, they would reproach her: “Why are you like this? Go and change your gender.”

So she did.

For seven years Donya had hormone treatment. Her voice became deeper, and she grew facial hair. But when doctors proposed surgery, she spoke to friends who had been through it and experienced “lots of problems”. She began to question whether it was right for her.

“I didn’t have easy access to the internet – lots of websites are blocked. I started to research with the help of some friends who were in Sweden and Norway,” she says.

“I got to know myself better… I accepted that I was a lesbian and I 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.

But what if you want to stay in Iran and be gay rather than transgender? Stupid question.

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 – not her real name – who is 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.

I’m not convinced that many people have a good handle on the difference between identity and sexuality. There seems to be a lot of confusion about that, and not just in Iran.

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.

But there are people who worry about that here, too – that little boys who like to wear skirts or play with dolls or both are being told they’re trans as opposed to just being allowed to dress and play however they want.

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.

That’s desperately sad.