In this article, I show that the figure of the ‘trans’ person, or historically, the ‘third gender’ (Herdt 1994), is not a new phenomenon in Egypt, nor it is an import from ‘the West’ as some Islamic authorities and Egyptian media suggest, as demonstrated historically by the figure of the khawal, an effeminate young male dancer1 prominent in the late eighteenth and early nineteenth centuries.
Recently, medical advances have made it possible for individuals to undergo sex change surgery. In this matter, I analyse the fatwā2 of the Sunnī Islamic authority of al-Azhar in Cairo with regard to sex change surgery issued in 1988. This fatwā was initially related to Sally Mursi's case.
In 2017, another Egyptian trans woman, the trans activist Malak al-Kashif, struggled for her rights, and beyond herself, for the rights of all trans people in Egypt. That same year, in 2017, the first Egyptian trans association – Transat – was founded.
This article concludes by contrasting Egypt's Sunnī position on ‘sex-reassignment’ surgery with the Shīʿī stance in Iran. While the two may appear diametrically opposed, I argue they are underpinned by the same logic: the prohibition of homosexuality.
From Khawals to Trans: The Sex Change Surgery Issue
As Joseph A. Boone (2014) observed, Egypt was home to the khawals3 (plural khawalat) until the late eighteenth and early nineteenth centuries. Khawals (see Figure 1) were effeminate young male dancers who performed in public celebrations with castanets. Their hands were painted with henna, their long hair was braided, their facial hair was plucked, and their faces adorned with makeup – especially kohl. They cross-dressed and had the mannerisms of women dancers (ghawazee), as noted by Judith Lynne Hanna (1988). When not performing, they often veiled their faces – not out of shame, but to enhance their femininity. Khawals performed at various functions, such as weddings, circumcisions feasts, and other festivities. They were viewed as sexually available; their male audiences found their ambiguity seductive.
Khawal from Egypt (postcard, public domain)
Citation: Anthropology of the Middle East 20, 1; 10.3167/ame.2025.200108
Recently, advances in medical science have enabled people to access hormone therapy and surgery to align their physical bodies with their gender identities (Fortier 2022a). In Egypt in response to the case of a student of al-Azhar who had undergone sex change surgery in the 1980s, a fatwā was issued in 1988 by the Sunnī muftī (the highest government-appointed religious authority) of al-Azhar in Cairo, at-Tantawi (1928–2010).
[…] the rulings derived from these and other noble hadiths on treatment grant permission to perform an operation changing a man into a woman, or vice versa, as long as a reliable doctor concludes that there are innate causes in the body itself, indicating a buried (matmura) female nature, or a covered (maghmura) male nature, because the operation will disclose these buried or covered organs, thereby curing a corporal disease which cannot be treated, except by this operation (Skovgaard-Petersen 1997: 318; Alipour 2017a: 95; Tolino 2017: 235; Noralla 2023a: 13).
Consequently, ‘sexual-reassignment surgery’ understood as uncovering an already existing nature – some would label it intersex – is legal, where surgery due to one's personal desire to change their sex is considered illegal.4
The context of this fatwā in Egypt helps to explain the muftī’s opinion, as it concerned a medical student at al-Azhar University, originally named Sayyid, who later became known as Sally. Egyptian doctors decided to perform surgery after diagnosing her with ‘psychological hermaphroditism’ (al-khunūtha an-nafsiyya).
This concept appears to be related to the classical Islamic notion of physical hermaphroditism, but here it is applied not to the anatomical body, but to the psyche. The closest Western equivalent is the psychiatric category of ‘gender dysphoria’, a term developed by the psychiatrist Fisk in 1970 (Fortier 2014b: 275).
Following Sally Mursi's surgery, al-Azhar, along with the Egyptian Medical Syndicate, submitted a petition in 1988 to the Public Prosecutor's Office, calling for a criminal investigation into the doctors (Noralla 2023a: 24). However, in 1991, the court ruled that the medical team had not violated any professional obligations by performing the surgery, given the diagnosis of psychological hermaphroditism. But the muftī argued that the suffering experienced by a trans person could be treated psychologically, rather than through surgery, which he deemed a violation of the body's integrity (Dupret 2001).
From Anal Examination to Homosexuality
In addition, al-Azhar accused the doctors of having performed this surgery so that Sally Mursi could maintain a legally sanctioned homosexual relationship under the cover of a gender transition. As a result, medical examiners from the Public Prosecutor's Office subjected her to an anal examination, intended to ‘prove’ that she had not engaged in anal intercourse. This procedure involved the insertion of a finger into the anus to determine whether the anal muscles had been subjected to penetration.
Such examinations are also conducted by Egyptian police on individuals suspected of homosexuality to ‘prove’ their ‘crime of sodomy’, even though there is no law specifically criminalizing homosexuality in Egypt. These procedures are inefficient and constitute a form of sexual violence. They have been widely condemned by human rights organizations as lacking forensic validity and as violating international standards against torture.
In October 2017, the World Medical Association called for a global ban on the practice. Human Rights Watch stated that forced anal examinations ‘involv[ing] doctors or other medical personnel forcibly inserting their fingers, and sometimes other objects, into a person's anus to attempt to determine whether that person has engaged in anal intercourse’ have ‘no scientific basis, violat[ing] medical ethics, and constitut[ing] cruel, degrading, and inhuman treatment that can rise to the level of torture.’5
In Muslim societies, homosexuality between men is often defined specifically in reference to anal intercourse. For instance, the term khawal in Egyptian Arabic refers to the passive sexual role in anal sex. Similarly, the Arabic word for sodomy, liwāṭ, and its derivative lūṭī (sodomite), both derive from the name of Lūṭ (Lot) (Bosworth, Lewis, and Pellat 1986) – referring to the biblical and Qur’ānic story in which the people of Lot, or of Sodom and Gomorrah, were destroyed by God, presumably for engaging in this practice, deemed an abomination (fāḥisha).
The Qur’ān (Sura VII, verses 78–81) states: ‘And Lot, when he said to his people…: “See, you approach men lustfully instead of women; no, you are a people that do exceed (musrif)”’ (Arberry 1980: 181). While some scholars, such as the American historian of religion Scott Kugle (2010), argue that the Qur’ān does not explicitly refer to homosexuality, this interpretation remains marginal among both the public and religious authorities in much of the Muslim world.
From Sally Mursi's Battle to Be Recognized as a Woman to Al-Azhar's Refusal
To return to the case of Sally Mursi: in 1989, she obtained legal recognition of her gender identity from the Administrative Court. Despite this ruling, the Faculty of Medicine at al-Azhar University, which is gender-segregated, refused to re-admit her either to the male section or to transfer her to the female section.
Sally Mursi waged a lengthy legal battle in Egypt's national Administrative Court to gain admission to the women's section of al-Azhar's medical faculty – a battle she ultimately won (Noralla 2023a: 25–26). Nonetheless, al-Azhar University continued to refuse her admission. She then threatened to file complaints against the university before the African Commission on Human Rights and the International Court of Justice in The Hague. It was only after a ruling of the Administrative Court that al-Azhar's decision was revoked and Sally Mursi was allowed to take her final exams at any university.
Doctors are strictly prohibited from performing sex change operations. Sex correction is only permissible after receiving approval from the review committee in the Syndicate. Surgeries will only be conducted after two years of psychiatric evaluation and hormonal treatment and after conducting a complete examination of hormones and the chromosomal map of the applicant (Noralla 2024).
Because the terms ‘trans’ and ‘intersex’ are not clearly distinguished in the new Code of Ethics, as they were not clearly pronounced in Tantawi fatwā, some trans individuals mistakenly believed they could access sex change procedures free of charge in public hospitals, such as Cairo University Hospital.
However, this belief is misplaced. The ambiguity of terms like ‘sex correction surgery’ serves to exclude trans people: only intersex individuals are eligible for treatment under this policy. Intersex conditions are framed as biological anomalies that can be “corrected” surgically, whereas trans identities are framed as psychological disorders to be addressed through therapy – not through surgical intervention.
Applicants are required to undergo hormonal and chromosomal assessments, as well as a minimum of two years of psychiatric counseling, after which they must obtain a report from a psychiatrist. The committee responsible for approving such procedures includes two psychiatrists, an endocrinologist, an andrologist, a geneticist, a medical chairperson, and a representative of the al-Azhar Board (Noralla 2023a: 18). Between 2014 and 2017, the committee approved 87 cases for ‘physical’ reasons, but zero cases for ‘gender identity disorder’, confirming that this system applies only to intersex individuals, not to trans people.
In subsequent cases, judicial verdicts have aligned with Tantawi's fatwā. For example, in 2016, a trans man who had undergone hormone treatment and sex change surgery requested legal recognition of his gender identity (Noralla 2023b). The Cairo Administrative Court rejected the request, after subjecting him to a series of forensic tests, including a chromosomal analysis – what Noralla (ibid.) calls ‘the chromosome trap’. The applicant was found to have XX chromosomes, and his hormonal profile matched that of a ‘biological woman’.
The court emphasized that, in the absence of a legal framework addressing gender identity, it would defer to Islamic jurisprudence (ibid.). Because Tantawi's fatwā permits surgical intervention only in cases of intersex diagnosis, the court denied the application.
In 2013, members of the ‘sex correction’ committee of the Egyptian Medical Syndicate attempted to challenge the influence of the al-Azhar representative by approving applications not only for intersex patients but also for trans individuals diagnosed with ‘gender identity disorder’ (Noralla 2023b). This incident underscores the enduring conflict between medical professionals and religious authorities, a tension that has persisted from Sally Mursi's case in the 1980s to the present.
An illustrative example is Ḥanan aṭ-Ṭawīl (1966–2004), Egypt's first openly trans actress to portray female characters in film. She did not undergo surgery in Cairo, but abroad, reflecting the stigmatization of transsexuality within Egypt. During her lifetime, she could not publicly affirm her trans identity, which was only revealed posthumously in tabloid media. Since then, however, she has been reclaimed by Egypt's trans movement as an icon.
From the Trans Actress Ḥanan aṭ-Ṭawīl to the Trans Activist Malak al-Kashif
The trans icon Ḥanan aṭ-Ṭawīl has inspired Malak al-Kashif, a trans woman and an LGBTQI+ rights activist. Malak al-Kashif was born in Abha in Saudi Arabia in 1999 and moved to Egypt with her family in 2007 (Hemdan 2024). Her family rejected her, as she appeared ‘effeminate’: ‘They used to say I behaved in a soft and feminine way, and my traits were unsuitable for a man’ (ibid.).
But according to Malak al-Kashif, her family's reaction was less violent than the reaction of the Egyptian society itself: ‘The family contented themselves with rejecting and excluding me to keep me lonely and to “man up”; however, society hurled various forms of violence at me’ (ibid.). For example, she mentions that she refused sometimes to go to school out of fear of being beaten by other students (ibid.).
The Transat Foundation also saved me. I don't know how I would have lived after prison if they hadn't given me the opportunity to join their team. It was a lifeline for me in the most difficult times.7
Transat is the first trans rights organization created in 2017 in Egypt by a trans woman, Maha Mohamed.8 It offers an online platform for trans people in the MENA to share their own narrative.
Malak al-Kashif as a trans activist is well known not only in Egypt, but also internationally. In 2022, Malak al-Kashif released a video talking about her experience as part of the United Nations video campaign Diversity in Adversity, which focuses on LGBTQI+ activists around the world, and she already talked about her situation in Egypt in an international video online in 2020 in Africanews.9 She received in 2022 the ‘Courage Award’ for the LGBTQI+ community from ‘Queer Allies Caucus of Sexual and Gender Minorities’ for her trans activism in Egypt (Hemdan 2024).
Malak al-Kashif came to the public fore in 2017, when local media outlets reported on her transition, which she had documented on her personal Facebook – the most popular social media platform in Egypt and the only one that hosts such trans spaces (Noralla 2024). She shared on Facebook the challenges and violence she was subjected to.
Malak al-Kashif's activism extends beyond advocating for the trans community. She was arrested in 2019 after she called for protests following a fatal train crash resulting from what she saw as government negligence. Malak al-Kashif underwent a medical exam at the Boulaq General hospital on her second day in prison. She was subjected to the anal examination described before and faced verbal and physical harassment from the policeman accompanying her, who called her ‘prettier than my wife’.10
She was imprisoned in a men's prison for four months. Malak al-Kashif's arrest was widely discussed on social media and hundreds of people have used the Arabic hashtag ‘in solidarity with Malak al-Kashif’. Amnesty International11 pressured authorities to isolate her from male prisoners, which could put her at risk. She has been held in solitary confinement.
From the first day, I didn't submit to prison rules. I forced them not to shave my hair,12 the only evidence of my identity. The prison administration wrote on my cell: Abdul Rahman Mohammed – a transgender, also known as Malak al-Kashif. I felt proud, and I liked the idea of putting both names officially together (Hemdan 2024).
The authorities which I was in contact with insisted on treating me as a boy, but I told the public prosecutor that I refuse any other name, and that I rejected being labelled as sexually transitioning and that I am a Transgender person. After that, I was addressed as a female even in prison, which was a men's prison at the end of the day. The official prosecution records even used the word ‘Transgender’. This was the thing that made me feel that I can do anything in life (Arafat 2020).
After her release in 2019, Malak al-Kashif, in collaboration with the Egyptian Commission for Rights and Freedoms (ECRF), filed a lawsuit against the Minister of Interior demanding special places for holding trans people in prisons and police stations. It was rejected (Hemdan 2024).
Malak al-Kashif spent more than two years under psychiatric review at the Hussein University Hospital in Cairo for her transition. In 2017, a psychiatrist diagnosed her with ‘gender dysphoria’ in an official report. She applied to the doctors’ committee to begin the official procedures for sex change surgery, and five months later, she was able to submit her medical file to the committee. But the al-Azhar representative's boycott of the committee meetings to approve sex surgery for Malak al-Kashif and dozens of others like her meant that no transsexual surgeries have been approved for five years, as I reported before.
Despite the interdiction, there is a network of doctors and private clinics where trans people know to access medical care and sex change surgeries, but surgical and hormonal treatment are very expensive and many trans people lack sufficient financial resources (Noralla 2023b).
In 2019, at age 19, Malak al-Kashif decided to undergo the sex change surgery in a private hospital in Egypt. After the procedure, Malak al-Kashif posted a picture of herself online, writing that she had ‘completed’ her sex change surgery. She wrote: ‘Today is the day I defeated society, from this day on, there's only Malak’.
Then, she was flooded with thousands of messages. Some congratulated her; many insulted her. The comments ranged from ‘pray to God to heal you’ or ‘you have lost in this life and the afterlife’13 to ‘if you were my son, I would have set you on fire’ (Arafat 2020).
Today, Malak al-Kashif still carries an ID which classifies her as ‘male’, in her own words: ‘under a name that is not mine and a photo that does not represent me’.14 By 2019, Malak al-Kashif had been petitioning to change her gender identity on her official ID but has not obtained it so far.
From Sunnī Egypt to Shīʿī Iran: The Fear of Homosexuality
Today we are seeing an obsession with unwarranted sex change, which not only goes against basic human nature but is unanimously rejected by all divine religions. These are despicable attempts to alter Allah's creations and give in to desires under the false pretence of freedom (Noralla 2023a: 30).
The gender binarity remains fundamental for al-Azhar authority, and the suspicion of homosexuality behind transsexuality remains important, hence why all Sunnī muftīs forbid transsexual operations. But, paradoxically, I show that it is this very reason, the fear of homosexuality, that informs Shīʿī religious authorities decision to allow sex change surgery, as a way to change homosexuality into heterosexuality.
If Sunnī Islam forbids transsexual surgery, it is licit in Shīʿī Islam. In 1976, Iran's medical council limited surgery to intersex cases (Najmabadi 2014: 49), as is the case in Egypt today. But this situation was changed by Ayatollah Khomeini's fatwā after the Iranian revolution in 1979 (Saeidzadeh 2016: 251; 2020; 2025, in this volume). In this country, transsexual surgery was allowed in 1982 by a fatwā of the supreme guide of Iran, Ayatollah Khomeini (1902–1989), at the instigation of a trans woman.
It seems that the sex-reassignment surgery for Male-to-Female is not forbidden (ḥarām) [in Islam] and vice versa, and it is also not forbidden for a khuntha (hermaphrodite/intersex) undergoing it to be attached to one of the sexes [female or male]; and [if one asks] is a woman/man obliged to undergo the sex-reassignment surgery if the woman finds in herself [sensual] desires similar to men's desires or some evidence of masculinity in herself – or a man finds in himself [sensual] desires similar to the opposite sex or some evidence of femininity in himself? It seems that [in such a case] if a person really [physically] belongs to a [determined] sex, a sex-reassignment surgery is not an obligatory (wājib), but the person is still eligible to change her/his sex into the opposite gender (Alipour 2017a: 96; 2017b: 170).
At the beginning of 1984, Iranian judicial and medical institutions started to regulate the process of sex change under the supervision of Iran's judicial power (Saeidzadeh 2016: 251). Obeying a rigorous medico-psychiatric protocol which ends in the legal change of gender identity ensures the transsexual surgery is taken care of by the government (ibid.: 254). But, after having obtained a medical certificate, it is possible to live as a transgender person without necessarily going for surgery, as Afsaneh Najmabadi (2014: 175) wrote: ‘Legal and religious authorities know fully well that many certified trans persons do very little, beyond living transgender lives, once they obtain their certification; at most they may take hormones’.
At first glance, this medical and judicial reform seems a recognition of transsexuals, but at a second glance it appears as an avenue for normalization (Jafari 2014: 33; Sadzadieh 2025, in this volume) and heterosexualization. In a country where homosexuality is illegal, the legality of transsexuality pushes certain effeminate gays and lesbians to become trans (Bahreini 2008).
Transsexual men are more accepted than transsexual women, given that to become a man is considered upward social mobility due to the superiority of men in society. Even after transsexual surgery, trans women are perceived as homosexuals and are called by a pejorative term which refers to sodomy (kunis in Persian) (Azadi 2025, in this volume). It shows that the suspicion of homosexuality/sodomy behind transsexuality remains a constant.
If Iran permits sex change operation as a way to transform homosexuality into heterosexuality, inversely, this operation is forbidden in Egypt, as transsexuality is seen as a way to legitimize homosexuality. But behind the interdiction or the allowance, the two countries, Egypt and Iran, share the same aim: the ban of non-reproductive homosexuality, a practice interpreted as forbidden by the Qur’ān, the sacred text followed both by Sunnī and Shīʿī Islam.
Notes
About masculinity in Egypt, see for example Jacob (2011), Fortier (2012a, 2012b, 2013), Inhorn (2012), Naguib (2015), Kreil (2016), and Abdelazim (2021).
About the concept of fatwā in Islam, see Fortier (2010).
I use in this article the plural khawals, a hybrid plural formed from the original word (khawalat) + English-language plural ending.
This explains why imams may refuse to organize a funeral ceremony and conduct prayers for a deceased trans person, and some of them may consent to do so only if the prayers are gendered in the same way as the sex assigned to the deceased at birth, as reported Asli Zengin (2019) in Turkey. Zengin states that this situation is different for an intersex person who could benefit from an Islamic funeral: ‘Neither women nor men practice the full washing ritual for intersex people. Instead, the washer wraps their hand with a piece of cloth and performs a cleaning ritual of the face and arms only, using purified sand or dust. In cases of an intersex person an imam might try to learn how the person identified in their lifetime. In case this information is impossible to acquire, the imam could act according to the testimonies of those who knew the deceased in life’. This shows that discrimination against trans people continues after their death, as their body is in itself a transgression. In 2016 in Pakistan, a fatwā obliged imams to perform Islamic funerals for trans people known as hijras, khusras, or khwāja sirās: ‘Muslims should perform the funeral prayers for deceased hijras and khwajasaras, just as these prayers are to be performed for ordinary Muslims’, see ‘Fighting Transphobia: Analyzing the Pakistani Fatwa on Transgender Marriage’, by Ali Altiaf Man, 8 August 2016, Contending Modernities, https://contendingmodernities.nd.edu/global-currents/fighting-transphobia-analyzing-the-pakistani-fatwa-on-transgender-marriage/.
‘Global Medical Body Condemns Forced Anal Exams. Doctors Worldwide Should Halt Abusive “Homosexuality Tests”’, Human Rights Watch, 17 October 2017, https://www.hrw.org/news/2017/10/17/global-medical-body-condemns-forced-anal-exams.
‘Diversity in Adversity: Malak Al-Kashif, Egypt’, UN Human rights, 18 May 2022, https://www.youtube.com/watch?v=qh7-SjGmXX4.
‘Minorités. Transat, la plateforme arabe qui ose dire non à la transphobie’, Courrier International, 18 February 2022, https://www.courrierinternational.com/article/minorites-transat-la-plateforme-arabe-qui-ose-dire-non-la-transphobie.
‘The sad tale of Egyptian trans activist’, Africanews, 27 March 2020, https://www.africanews.com/2020/03/27/the-sad-tale-of-egyptian-trans-activist/.
‘Tortured and mocked: Lawyers call for release of transgender Egyptian woman’, by Shahenda Naguib, Middle East Eye, 13 March 2019, https://www.middleeasteye.net/news/tortured-and-mocked-lawyers-call-release-transgender-egyptian-woman.
‘Egypt: Transgender woman held in all-male prison: Malak al-Kashef’, Amnesty International, 9 April 2019, https://www.amnesty.org/en/documents/mde12/0168/2019/en/.
The hair is as an immediately perceptible element that manifests the bodily difference between the sexes (Fortier 2022b).
On the importance of the afterlife in Islam, see Fortier (2005).
Ibid.
‘A fatwa for freedom’, by Tait Robert, The Guardian, 27 July 2005, http://www.theguardian.com/world/2005/jul/27/gayrights.iran. For a critical analysis of this expression, see Fortier (2014 and 2022c).
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