BACKGROUND: Individuals with gender dysphoria are exposed to greater health risks and are increasingly seeking medical care. In pursuit of gender equity and improved healthcare outcomes, this study aimed to explore the lived experiences of individuals with gender dysphoria in Iran, where the 'traditional' gender binary constitutes an integral aspect of Islamic social ethics. METHODS: We employed a qualitative approach using a phenomenological hermeneutic framework. Fourteen individuals with gender dysphoria were recruited to participate using purposive sampling. Face-to-face and semi-structured interviews were used to collect data, which was subsequently analysed using the seven-stages of Critical Hermeneutic Analysis. RESULTS: Our findings revealed how people living with gender dysphoria experienced a lack of social and cultural support and distressing psychological experiences. Theme (1) lacking social and cultural support included the following sub-themes; rejection by family and society; lack of legal support and being victims of cultural taboos. Theme (2) distressing psychological experiences included the following sub-themes; disgust in relation to sexual characteristics and gender conformity, fear, and anxiety about disclosing one's authentic gender. In this study, a constitutive pattern emerged of "being in a different world". Participants experienced being beaten, abused, suicidal ideation and death threats. CONCLUSIONS: This research was carried out in a unique cultural and religious context in which government jurisprudence is implemented. In Iran, individuals with gender dysphoria require social, familial support along with legal and medical frameworks which enable access to gender affirming care. The experience of gender dysphoria is deeply influenced by cultural factors. Thus, cultural and educational interventions are required in Iran to change both attitudes and perceptions. These may include endorsement of change by law and policy makers through public and television appearances.