Iran has long performed more transgender surgeries than any other nation, largely by forcing gay people to undergo the procedures. But is the theocratic regime now using its expertise in the field of gender-affirming care to increase tourism?

Iran’s government just announced a goal of attracting more medical tourism, according to the Tehran Times, and is seeking the equivalent of $8 billion in annual revenue from it.

Related: Iran Offers Acceptance for Transgender People but Death to Gays

While the nation touts expertise in stem cell therapy and organ transplants, The New York Times reports the nation has also stepped up marketing to transgender people seeking cheap care. The newspaper reported that transition surgeries that cost $45,000 in the U.S. and $30,000 in Thailand can be obtained for $12,000 or less in Iran.

The newspaper spoke to a transgender man from Orange County, California, who said he was as attracted by the level of expertise as by cost.

But while Iran’s medical community performs a significant number of gender-affirming surgeries, that’s not a sign of tolerance. Homosexuality remains punishable by death in the nation. But the country, while still classifying gender dysphoria as a mental disorder, subsidizes gender-affirming surgeries for people who identify as transgender.

Many reports have found other gay and bisexual Iranians choosing gender surgeries rather than submit to execution. That is consistent with a directive issued by Ayatollah Ruhollah Khomeini in the 1980s that transgender people can gain legal recognition in Iran, but only if they undergo gender-affirming surgery.

Related: LGBTQ+ Iranians Are Suffering and Dying While the World Yawns

The situation has some transgender advocates questioning the sincerity of Iran’s promotion of its expertise in gender surgery as it pursues tourism revenue.

“The goal of these medical tours is probably to portray Iran as a paradise for trans people, which it isn’t,” Saman Arastu, a transgender Iranian man who underwent surgeries there, told the Times. “In my opinion, these are nothing but a show. The situation for trans people is dire.”