i mean... its technically true that they have only improved. iran, iirc, has the third most transgender surgeries, behind USA and Thailand. of course, if you are gay or perceived as gay, its fucking awful there. real acceptance of transgender people, despite the legal status, is not very good because sometimes it is perceived as being gay.

ive had the pleasure of talking with a trans woman in iran that actually had an accepting traditionalist family. basic thing is that her family was so fervent in their shia beliefs that if khomeini said it was fine, it is fine. but of course this also resulted in her family arranging her a marriage with a man, who himself was a traditionalist war veteran and infertile due to a war (so it resolved an issue for both of them). she also is lucky enough to pass. despite this traditional upbringing, support, having a 'beard', and passing, she was harassed many times on border crossings, by bureaucrats, by police before her surgery and gender marker changes, and her spouse was accused of being gay. these things can all be fixed by having the right documentation, but its certainly not good to be harassed all the time with what is essentially a death threat / a threat of severe harm (accused of being gay).

plus side is she described the trans healthcare as absurdly affordable for most city dwellers and the surgeons were very kind. she said she felt like she got a good result from the surgery.

i have actually discussed in detail iran's decision on why this is OK. their decision actually goes back to something i say a lot here, that in the bible and abrahamic religions, the term 'eunuch' refers to a wide umbrella of people that includes transgender people (in fact it even goes beyond this, the british referred to the hijra in india as eunuchs from the 1700s to the 1900s, and we know for a fact that hijra see themselves as transgender or a different gender). iran is one of the few areas of the world that actually recognizes this history for what it is and codified it into law. the bible, and other abrahamic texts, expressly say to assist and help eunuchs with their troubles and to accept them.