On 19 September, the Sapporo Family Court found that the requirement to have “genitalia matching the target sex” as a requirement to legally change sex in Japan is unconstitutional and therefore invalid, according to an exclusive published in the Asahi Shinbun on 23 September. ([1])
According to Asahi, the case involved a transgender man in his 30s seeking to change his legal sex in his family registry, but was unable to fulfill the so-called “surgical requirements” outlined in the law due to a combination of personal medical issues and prohibitive costs.
The new Sapporo case is said to be the first time in Japanese legal history that this portion of the law has been successfully challenged on constitutional grounds.
An Obsolete Law on its Last Legs
Of the five requirements outlined by Japan’s Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder, two can potentially involve surgical interventions: one for permanent sterilization, which has already been struck down as unconstitutional by the country’s Supreme Court in 2023 ([2]), and another requiring having “genitalia matching the target sex”. To meet the former requirement, a person would have needed to undergo surgical removal of the gonads in most cases, but this is now moot in light of the Supreme Court decision.
For the other requirement, there has been a split between trans men and women as to how the courts view the need for surgery. In the case of trans women, generally some form of genital surgery has been needed. However, trans men can often meet the requirement via the effects of testosterone HRT alone.
This remaining surgical requirement had also come under scrutiny during the aforementioned landmark Supreme Court case, but no decision was rendered and the case was instead remanded to a lower court for reexamination. The Hiroshima High Court eventually found that the plaintiff, a trans woman, had sufficiently feminine genitalia without surgery to proceed with legal changes, leaving the question of constitutionality mostly unanswered (we discuss this briefly here).
While reform efforts were under way as it was becoming clear the Supreme Court was about to render their verdict, these were sidelined as the LDP began to lose its grip on parliament. It is unclear whether reform will become a legislative priority in the upcoming session, or the law simply left as-is to be slowly but surely rendered more and more irrelevant by the courts.
Costs a Factor in Trans Care
One thing laid bare by the case, on top of the fact that not all trans people want or are able to receive medical interventions, is that costs for medical transition remain an issue.
Since Japan’s Society of Psychiatry and Neurology conducts evaluations for diagnosing individuals with gender dysphoria under their guidelines, these diagnostic sessions with a psychiatrist are generally covered by insurance, as they are considered to be approved treatment for a condition. However, pharmacological and surgical interventions are a more complicated matter.
Insurance in Japan still does not cover the cost of HRT for the purpose of transition. Japan’s Health Ministry has stated in a document from 2018 that HRT “has no approved use in the treatment of Gender Identity Disorder (sic)” ([3]). It has, however, recently begun to cover costs for surgeries, but only if someone has not been receiving HRT.
The reason why someone receiving HRT is not eligible for surgeries is somewhat complicated, but lies in the fact that HRT for the purposes of transition is considered unapproved treatment, and Japanese health insurance will not cover treatments for either unapproved use or treatments done in conjunction with unapproved ones ([4]). While nominally this is to prevent the use of unapproved, potentially harmful, or unnecessarily overpriced treatments, the knock on result for trans people is that vanishingly few have received insurance coverage for surgeries. As of 2022, a total of 7 out of 198 surgeries performed domestically receiving coverage since coverage began in 2018 ([5]).
Still a Long Way from Self ID
While it might seem that Japan is moving towards self-ID for the purposes of legal sex change, the reality is that the country is as yet far from it. Even without the two surgical requirements, the law itself is still seen by some as being pathologizing in both its naming and requirement of psychiatric diagnosis on top of being discriminatory. More precisely, it reflects the Japanese government’s continued stance on same-sex marriage as well as seeming to reflect some kind of erroneous notion that LGBTQ+ people don’t have families.
As we have discussed here before in connection with marriage equality (most recent article here), Japanese law does not allow for legal change of sex unless an individual is unmarried ([6]). This is, nominally, to prevent a back door to same sex marriage, despite the fact that Japanese law has several loopholes to other “traditional” stances such as forcing married couples to use the same surname. (One backdoor? Marry a non-citizen. Then you both keep your surname unless you apply to legally change it.)
Legal change of sex also requires a person have “no children who are minors”, a small upgrade from the original version of the requirement that said a person could have no children at all. Although at least one trans woman has found something of a workaround here, too, these requirements both remain. Again, this is despite the fact that trans people, just like so many other members of the larger LGBTQ+ community, have families to whom they are out to and live in communities where they are visible. As activists have pointed out with regards to marriage equality, these requirements do not reflect the lived reality of LGBTQ+ people and are based much more in misunderstanding and assumption than they are in actual people’s lives.
Advocates continue to press for change. Meanwhile, Japanese legal experts are writing opinions and analysis in support of broad reforms to the law in order to protect the rights of trans Japanese citizens ([7]). Whether change will come about via legislation or the courts is still unknown, but as with most things regarding LGBTQ+ rights in Japan, it will likely come in fits and bursts, with long periods of glacially slow progress in between. After all, it took over two decades for the courts to put the scalpel to the law’s surgical requirements for legal transition.
As all this is happening, ascending parties in the country have been seemingly aligning themselves with powers outside of Japan, powers that also promote a very clear anti-trans and anti-LGBTQ+ agenda alongside nationalist messages. While some members of these parties have voiced similar notions to their overseas counterparts ([8]), it remains to be seen what types of legislation they may push for. With a new parliamentary session on the horizon, it remains to be seen what direction things will take, although as our readers are well aware, they could take a terrible direction indeed.
[1] 上保晃平「性別変更の外観要件は「違憲」 性同一性障害特例法めぐり札幌家裁」Asahi Shinbun, 23 September 2025[2] Himari Semans, “Japan’s Supreme Court Strikes Down Law Requiring Sterilization for Gender Change“, Unseen Japan, 25 October 2023
[3] For details (Japanese), see: https://gid.jp/article/article2018113001/
[4] For an explanation (Japanese), see: 上昌広「なぜ国は混合診療を認めないのか？」imidas, 27 September 2013
[5] 「性別適合手術の保険適用は３％ ホルモン治療前提で広がらず」Sankei Shinbunm 24 September 2022 [6] “Married couples still excluded under Japan’s transgender law” The Mainichi, 19 August 2025 [7] Since 2023, numerous analyses have been written about the afore-mentioned Supreme Court case in legal journals in Japan, analyzing both the decision and broader issues underlying both it and laws concerning sex designation more broadly. [8] Kristina Rin Fujikake “Sanseitō Rep Likens Being Transgender to a “Contagious” Disease” Unseen Japan, 16 September 2025Photo: Sapporo, Japan, by LABOS17, CC0, via Wikimedia Commons
