That process is “regressive and harmful,” a new report from Human Rights Watch argues. And, the authors write, it needs to change to make changing one’s gender under the law an administrative, and not medical, act.

To be clear, some transgender people do want to undergo medical procedures. But not all do.

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“I’m happy like this,” one 18 year old trans man who has not had surgery is quoted as saying in the report. “But I think I might have to do more operations and fully transition before applying for a job because that’s what people expect of me ... I’m happy, but the future feels horrible already.”

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“I can’t understand why the government is asking for such high conditions. I do want to change my legal gender, but surgery has such a high risk, so I don’t know yet,” a 27 year old transgender woman is quoted as saying.

Rather than leaving that decision up to the individual, the 2003 Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder says that transgender people cannot change the gender on their paperwork without also having surgery -- and getting a diagnosis for a disorder, which, as of May 2019, won’t be recognized by the World Health Organization.

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Back when the law was passed, the World Health Organization did recognize ‘gender dysphoria’ in its classification of mental and behavioral disorders. But last June, the WHO updated its International Classification of Diseases to reclassify ‘gender dysphoria’ to ‘gender incongruance,’ which it does not classify as a mental disorder. WHO member states will adopt the updated International Classification of Diseases this May.

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“The diagnosis of gender identity disorder will no longer exist on planet Earth,” Kyle Knight, a researcher at Human Rights Watch and co-author of the report, told The Washington Post.

“This law is gonna have to be changed -- it’s incoherent once the diagnosis no longer exists,” Knight said. “We wanted to give them a road map for changing it.”

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The report’s origins are back in 2015, when Human Rights Watch was working on a report on LGBTQ bullying in schools -- Japan was reviewing its national bullying prevention policy, and Human Rights Watch saw an opportunity. In the course of working on that report, the researchers interviewed transgender and gender non-conforming teenagers.

“They were afraid of growing up largely because they knew that in order to become legally recognized … they would have to undergo a number of medical procedures that scared them,” Knight said. “That sticks with you.”

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Knight and his co-author, Kanae Doi, recommend that Japan’s Ministry of Justice amend the law to bring it into accordance with international standards (that is, not require surgery or sterilization), stop necessarily excluding transgender people under the age of 20 to change their legal gender, and stop requiring people to be single in order to change their legal gender. They also call on the Ministry of Health to work with the Ministry of Justice to launch a new process of legal gender recognition “based on an administrative act of self-declaration of gender identity.”

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“I think it’s gonna take a little bit of courage on behalf of the Ministry of Justice and the Ministry of Health,” Knight told The Post. He pointed to a Japanese Supreme Court decision from earlier this year that upholds the 2003 law as constitutional at present, but that wrote, "“It cannot be denied that [this law] impinges on freedom from invasion of bodily [integrity].” Two of the four judges wrote a concurring opinion that stressed, "The suffering that [transgender people] face in terms of gender is also of concern to society that is supposed to embrace diversity in gender identity.”

“I think signals that Japan is absolutely ready to change, that the government has political will,” Knight said, adding, “In some ways that Supreme Court judgement just made it really clear it has to be the government.”