We study the complexity of approximating the permanent of a positive semidefinite matrix $A\in \mathbb{C}^{n\times n}$. 1. We design a new approximation algorithm for $\mathrm{per}(A)$ with approximation ratio $e^{(0.9999 + γ)n}$, exponentially improving upon the current best bound of $e^{(1+γ-o(1))n}$ [AGOS17,YP22]. Here, $γ\approx 0.577$ is Euler's constant. 2. We prove that it is NP-hard to approximate $\mathrm{per}(A)$ within a factor $e^{(γ-ε)n}$ for any $ε>0$. This is the first exponential hardness of approximation for this problem. Along the way, we prove optimal hardness of approximation results for the $\|\cdot\|_{2\to q}$ ``norm'' problem of a matrix for all $-1 < q < 2$.