But the screening is the only restriction in Iran's relatively lax system. In most countries where sex-change operations are performed, doctors urge their patients to live for some time in the guise of their preferred gender before taking any drastic measures.
But in Iran, there's no waiting period. After passing the psychological screening, the patients are hustled into treatment. After all, in the interim they are considered gay, and therefore outlaws.
"By the time they come to me, they've made up their minds," Mir-Djalali says. "They've already worn makeup and women's dresses. They don't need to try."
The 25 years since the revolution have been an era of turmoil and liberation for Iran's transgender community. Despite the tolerance contained in Khomeini's fatwas, many suffered bitterly when he came to power, caught in revolutionary purges meant to turn Iran into a pure Islamic republic.
"Twenty years ago, we were living in secret and with fear," says Maryam Khatoon Molkara, 54, one of the elder stateswomen of the transgender movement. "I wanted to become a woman and also do something for the others."
Today Molkara lives in a second-floor walk-up in a dingy part of Tehran, where she receives her visitors in a cramped sitting room with pink walls and baffling layers of mirrors. There are books of religion and poetry and paintings of Ali -- cousin of the prophet Muhammad and a revered figure among Shiites -- and his trusty sword, Zulfiqar.
In the chaotic early days of the revolution, Molkara was taunted and harassed by overzealous mobs. So many transgendered people were rounded up by the regime that a special jail wing was built for them. Molkara grew depressed. "I wanted to die," she says, waves of perfume wafting from her muumuu.
Instead, she appealed to the government, working her way up the chain of clerics until she spoke with Khomeini's brother. It was he who took her to see Khomeini himself. That same day, Molkara won the right to live as a woman. On Khomeini's orders, the clerics gave her a chador and registered her as a woman in the government directories.
"It was like heaven," she remembers dreamily. "I was born again."
But it was only the beginning of Molkara's fight. She recently teamed up with sympathetic Iranian officials -- including the head of the Special Court of Clergy and the vice president for women's affairs -- to form an organization devoted to transgender rights. At her prodding, a government-linked Islamic charity named after Khomeini recently agreed to provide loans to pay for the surgeries.
Still, Molkara is not satisfied. She doesn't like the government-issue identity card that spells out her former life as a man. She doesn't like the hard-liners who've threatened her. One official even sneered that she'd tricked Khomeini, she says. In short, she is hoping to push transgenders even further into the Iranian mainstream.
"Nobody ever asks why a dog is a dog," she says. "And yet they always have to explain that I was once a man."
