“ You really don’t need to move off-planet - this particular weirdness is largely confined to the US and Western Europe.”
You think so?
Here are some excerpts from Wikipedia page about Iran, for example.
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As Article 20 in Clause 14 states, a person who has sex reassignment surgery can legally change their name and gender on the birth certification upon the order of court.
Since the mid-1980s, the Iranian government has legalized the practice of sex reassignment surgery (under medical approval) and the modification of pertinent legal documents to reflect the reassigned gender. In 1983, Khomeini passed a fatwa allowing gender reassignment operations as a cure for “diagnosed transsexuals”, allowing for the basis of this practice becoming legal.[48][49]
Transgender identity is recognized through a sex reassignment surgery. Sex reassignment surgeries are partially financially supported by the state. Some homosexual individuals in Iran have been pressured to undergo sex reassignment surgery in order to avoid legal and social persecution.[12] Iran carries out more sex reassignment surgeries than any other country in the world after Thailand.