The conceptual framework is entirely different though. It’s regarded as a treatment for homosexuality at worst, or at best medical treatment of a birth defect.

Iran isn’t a hub for transgender surgery because they have the same idea about what transgender means as the US does, it’s more like they accept the idea that some men were supposed to be born as women and they concede it to be a medical issue that demands treatment.

My words aren’t explaining it the best, but I’m familiar with the mentality and the ideas that prop up that mentality.