A transgender woman looks at her reply letter from the health ministry concerning the use of a different name on her national health insurance card, in the city of Kyoto. (Mainichi)

KYOTO -- A transgender woman here -- who is officially classed as a man on her family registry -- has been allowed to use her female name on her health insurance card, the Mainichi Shimbun has learned.

According to a support group that is involved in gender dysphoria issues, it is extremely rare for someone in Japan to be allowed to use an alias on a document that is as formal as a health insurance card. Speaking on the matter, the woman -- who is in her 50s and who runs a company here -- said, "This is huge progress -- because it will enable people such as myself to lead a stress-free social life."

After being diagnosed with gender identity disorder (GID) in 2012, the proprietor later underwent gender reassignment surgery in spring 2014. She received hormone treatment, and lived her life as a woman. She has children -- so she has decided not to change the name on her family registry, in order to avoid any impact on the daily lives of her children.

However, her situation occasionally presents an element of confusion in public. For example, when she visits a medical institution for a consultation, she is often called by her male name, and then is told that she is "not allowed to use someone else's health insurance card." In addition, for medical checkups, she has been shown to the men's changing room, and not the women's room. The recurrence of incidents such as these makes her life psychologically stressful.

In August 2015, the proprietor consulted with the relevant national health insurance association in Kyoto about whether it would be possible to start using her female name on her health insurance card. The association referred her inquiry to the Ministry of Health, Labor and Welfare -- to which it replied, "We respect the association's judgment concerning the use of names, and we have no objections." Encouraged by the health ministry's positive response, the lady started using her female name on her health insurance card from August 2016 onward.

Regarding the issue of gender on health insurance cards of people with gender dysphoria, the health ministry has judged that it would be acceptable to display the family registry gender on the back of the card, so long as it states "refer to back of the card" on the front.

However, concerning full names on health insurance cards, there are no stipulations as such -- and the woman had been using her male name on her health insurance card, based on the nationwide census. As for the use of her female name on her card, the health ministry stated, "We replied to the national health insurance association in the way that we did, having considered methods of supporting patients with GID."

Changing one's full name is possible upon gaining permission from the family court. However, as we have seen with the Kyoto proprietor's case, it is thought that there are many people with gender dysphoria who are using aliases, and not making official name changes (on the family registry for example) due to personal or family-related reasons.