Japan High Court Allows Gender Change Without Surgery

Japan's Hiroshima High Court ruled in July 2024 that transgender people can change their legal gender without undergoing sterilisation surgery. The ruling marks a major shift in one of the strictest gender recognition systems in the developed world. In 2025, more courts followed the same line.

What the court decided

The case involved Gen Suzuki, a transgender man who wanted to change his legal gender. Under Japanese law, he first had to meet five conditions. One of them was the so-called sterilisation requirement. This rule forced people to have surgery that removed their reproductive organs.

The Hiroshima High Court ruled that this surgery rule violates Article 13 of the Japanese Constitution. That article protects the right to personal dignity and self-determination. The court said the state cannot force a person to undergo surgery just to be legally recognised.

The court also looked at a second rule. That rule requires the person's body to look like the gender they want to register. The judges ruled that this rule must be interpreted in a less strict way. Hormone therapy alone can be enough.

How the law worked before

Japan's Gender Identity Disorder Special Cases Act dates from 2003. The law lists five conditions for a legal gender change:

• The person must be 18 years or older.
• The person must not be currently married.
• The person must not have minor children.
• The person must not have functioning reproductive organs.
• The person's body must resemble the genitals of the other gender.

For more than twenty years, the fourth and fifth conditions meant surgery in practice. Human rights groups called the law one of the harshest in the OECD. The World Health Organisation removed gender identity disorder from its list of mental illnesses in 2019. International bodies have repeatedly criticised Japan's approach.

The road to this ruling

The Japanese Supreme Court already ruled in October 2023 that the sterilisation requirement was unconstitutional. That was a landmark decision. But the Supreme Court sent the case about the appearance requirement back to the lower courts. The Hiroshima High Court was the first to give a clear answer on that point.

Before 2023, the Supreme Court had upheld the law twice, in 2019 and in earlier rulings. Public opinion in Japan has shifted in recent years. Polls by the Asahi Shimbun show growing support for transgender rights, especially among younger people.

What it means in practice

People who want to change their legal gender no longer need to undergo sterilisation surgery. Hormone therapy and a medical diagnosis can be enough. The legal gender appears on the family register, known as the koseki. This document is central in Japanese life. It affects marriage, inheritance, pensions and many official forms.

The four other conditions of the 2003 law still stand for now. That includes the rules about being unmarried and not having minor children. Lawyers expect new court cases on those points too.

The Japanese parliament, the Diet, has not yet changed the actual text of the law. Legal experts say lawmakers will need to update the statute to match the court rulings. Without a new law, lower courts may rule differently in similar cases.

Reactions from both sides

LGBTQ+ groups in Japan welcomed the ruling. The group Lawyers for LGBT and Allies Network (LLAN) said the decision protects bodily integrity. They called on the Diet to rewrite the law.

Conservative politicians, mostly from the ruling Liberal Democratic Party, reacted with caution. Some warned that quick changes could cause confusion in areas like sports, public bathing houses and women's shelters. Prime Minister Shigeru Ishiba said the government will study the ruling carefully.

Women's rights groups in Japan are divided. Some support the ruling. Others share concerns raised by gender-critical groups in the United Kingdom and the United States. They want clear rules for single-sex spaces.

How Japan compares internationally

Many European countries dropped the sterilisation requirement years ago. The European Court of Human Rights ruled in 2017 (case A.P., Garçon and Nicot v. France) that forced sterilisation violates the European Convention on Human Rights. Germany, France and the Netherlands changed their laws before or after that ruling.

You can read more about recent legal shifts in our overview of countries where LGBTQ+ rights are changing fast in 2026. Japan's neighbour Taiwan was the first place in Asia to allow same-sex marriage, in 2019. The Japan Supreme Court is also expected to rule on the country's same-sex marriage ban. See our explainer on the Japan Supreme Court same-sex marriage case.

What happens next

The Japanese government now faces pressure to update the 2003 law. Without a new statute, transgender people must still go to court to change their legal gender. That is a long and expensive process. Activists hope for a simpler administrative procedure, similar to systems in Argentina, Ireland or Malta.

The other three conditions of the law are likely to be challenged in court soon. Cases on the rule about minor children are already pending. Family law in Japan is built around the koseki, so changes will need careful drafting.

For now, the ruling sets a clear direction. Japan is slowly moving away from medical conditions for legal gender recognition. How fast the rest of the system follows depends on the Diet and on future court rulings. For broader context on European parallels, see our piece on LGBTQ+ rights wins in Europe in 2026.