.

The earliest identifiable recipient of Male to Female Sex Reassignment Surgery was 'Rudolf ("Dora R-'),[13], "He took the first step towards changing his sex in 1921, when he had himself castrated, As a result his sexual instinct was enfeebled, but the homosexual tendency, as well as his own feelings, remained the same. This step, however, was not sufficient for him, and he tried to obtain a still greater degree of femininity in his sexual parts. Finally, in 1930, the operation which he himself had attempted at the age of six was performed upon him, that is, the removal of his penis, and six months afterwards the transformation was completed by the grafting of an artificial vagina [sic]."

This was followed by Lili Elbe in Berlin, in 1930-1931. This was started with the removal of the male sex organs and was supervised by Dr. Magnus Hirschfeld. Lili went on to have four more subsequent operations that included an unsuccessful uterine transplant, the rejection of which resulted in death. An earlier known recipient of this was Magnus Hirschfeld's housekeeper,[14] but her identity is unclear at this time.

Filmmaker Tanaz Eshaghian discovered that the Iranian government's "solution" for homosexuality is to endorse, and fully pay for, sex reassignment surgery.[15] The leader of Iran's Islamic Revolution, Ayatollah Ruhollah Khomeini, issued a fatwa declaring sex reassignment surgery permissible for "diagnosed transsexuals."[15] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel transitioning is the only way to avoid further persecution, jail and/or execution.[15] The head of Iran's main transsexual organization, Maryam Khatoon Molkara—who convinced Khomeini to issue the fatwa on transsexuality—confirmed that some people who undergo operations are gay rather than transsexual.[16]

Thailand performs the most sex reassignment surgeries, followed by Iran.