A transgender doctor has opened a clinic in Nagoya specializing in counseling and hormone therapy for transgender people.

While people diagnosed with gender dysphoria in Japan are receiving more social support, such as getting health insurance coverage for gender reassignment surgery, the more widely adopted hormone therapy remains uncovered by health insurance.

Hime Muto, 41, formerly a pediatrician, began accepting transgender people last fall at Hisaya Clinic, which she runs in central Nagoya, believing it is necessary to provide proper diagnosis and adequate therapy.

Muto offers support for people with various conditions to help solve each of their issues, drawing on her own experience of being assigned as male at birth but identifying as being female.

The causes of gender dysphoria are unknown. For those who wish to reduce a sense of discomfort with the sex they have been assigned, there are various kinds of medical care available to bring their bodies more in line with their gender identity and make their lives easier.

A dozen or so people visit Muto’s clinic each week, many of them feeling uncomfortable with being seen as a man and wishing to live as a woman like Muto.

One such person, an Aichi Prefecture resident in her 30s, said she wants to be identified as female and has visited some psychiatrists but was told she couldn’t be treated because she was attracted to women.

She said she was at a loss over how to identify herself, thinking that if she is mentally female, she should be attracted to men.

She learned about Muto’s clinic on the internet, and visited for the first time in June. She said she was asked to talk about her childhood memories. “I thought my genitalia would disappear when I grew up,” she said. She preferred playing house with girls and was wondering why her mother kept asking her why she didn’t play with boys.

She always kept her hair long, and was bullied by boys when she was young because she behaved more like a girl. She wanted to wear a skirt but could only wear one over pants, hoping others would interpret it as a fashion choice.

After the first counseling session, which lasted more than half an hour, Muto diagnosed her as transgender, saying that many transgender people who identify themselves as women tend to be attracted to men but that there are some who are attracted to women.

Muto said the person’s discomfort with her assigned sex in her childhood was the key in diagnosing her as transgender, adding that transgender people tend to behave differently from others when they are divided by gender in places like kindergartens.

“Some transgender people become aware of their gender identity after they grow up, but when they look back to their childhood, they realize that they had actually been acting according to their identity,” Muto said.

Now the patient is undergoing hormone therapy, and although it will take some more time for the therapy to produce changes in her body, she said her mental stress is largely relieved. Now she tries to eat more to build up enough physical strength to do well with the therapy. She used to wear a hat pulled down over her eyes when she went out, but now she leaves her house with the brim of her hat raised.

The Japanese Society of Psychiatry and Neurology first created a guideline for diagnosing and treating gender dysphoria in 1997. The nation’s first gender reassignment surgery was conducted the following year, and the availability of treatments including hormone therapy has gradually improved since then.

Muto, however, expressed concern that in many cases, hormone treatments are conducted too readily on patients’ request.

“Treatments should be conducted after careful consideration,” Muto says. “I don’t prescribe (hormones) unless a patient is really determined (to change his or her physical sex).”

Muto said that people should be aware that hormone therapy has some irreversible effects, such as becoming sterile, as well as other side effects including nausea and risks of thrombosis.

Muto sometimes even advises people who visit the clinic while undergoing hormone therapy at other hospitals to stop the treatment, suspecting that they have been given the medication without being properly diagnosed as transgender.

“Since the treatment is not covered by health insurance, it is not checked by authorities and problems tend to be overlooked,” Muto said. “I hope (in the future) it will be covered by health insurance to ensure safety.”

This section features topics and issues from the Chubu region covered by the Chunichi Shimbun. The original article was published on Aug. 28.