Japan High Court: Gender Change Without Surgery Now Possible

The Hiroshima High Court ruled in July 2024 that a transgender man can change his legal gender without undergoing sterilisation surgery. The decision marks a turning point in Japanese law. For decades, transgender people had to be sterilised to be legally recognised in their gender. The Supreme Court had already called this requirement unconstitutional in October 2023.

What the court decided

The case involved a transgender man in his fifties. He wanted his legal gender changed from female to male. Under Japanese law from 2003, this required surgery to remove reproductive organs. The man refused this operation. He took his case to court.

The Hiroshima High Court ruled in his favour. The judges said the sterilisation rule violates the right to bodily integrity. This right is protected by Article 13 of the Japanese Constitution. The court ordered that his legal gender be changed without surgery.

The 2003 law explained

Japan's Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder dates from 2003. The law lists five requirements for a legal gender change:

• The person must be 18 or older
• The person must not be currently married
• The person must not have minor children
• The person must have no working reproductive organs
• The person must have genitals that resemble the desired gender

The fourth requirement effectively forced sterilisation. The fifth requirement often meant surgery as well. Both rules are now under legal pressure.

How the Supreme Court paved the way

In October 2023, Japan's Supreme Court ruled the sterilisation requirement unconstitutional. All fifteen judges agreed. They called the rule a serious restriction on bodily freedom. The court sent the case back to the Hiroshima High Court. That court then had to decide on the fifth requirement about genital appearance.

The High Court chose not to enforce that rule either in this case. The judges said strict application would also violate constitutional rights. This sets a precedent for other transgender people in Japan.

What changes for transgender people in Japan

The ruling does not automatically change the 2003 law. Parliament must still amend the text. But courts can now follow the Hiroshima ruling in similar cases. Lawyers expect more transgender people to apply for legal gender change without surgery.

According to the Ministry of Justice, around 12,000 people have legally changed their gender in Japan since 2004. Many had surgery they did not want. Human rights groups have campaigned against the rule for years. The World Health Organization called sterilisation requirements a violation of human rights in 2014.

International context

Japan was one of the last industrialised democracies with a sterilisation requirement. Most European countries dropped this rule years ago. Sweden was the first in 2013. Germany followed in 2011 after a Constitutional Court ruling. The Netherlands removed the requirement in 2014.

The European Court of Human Rights ruled in 2017 (case A.P., Garçon and Nicot v. France) that forced sterilisation for legal gender change violates Article 8 of the European Convention on Human Rights. That article protects private and family life.

In Asia, the picture is mixed. Taiwan still requires surgery. South Korea does as well in practice. India allows self-identification since a 2014 Supreme Court ruling. Japan now joins the group of countries moving away from medical requirements.

Reactions from both sides

LGBTQ+ organisations welcomed the ruling. Lawyer Kazuyuki Minami, who represented the plaintiff, called it a historic decision. He said Japanese law must now catch up with the courts. Activist group J-ALL urged parliament to revise the 2003 act quickly.

Conservative politicians reacted more cautiously. Some members of the ruling Liberal Democratic Party warned against quick changes. They pointed to concerns about women-only spaces and sports. Prime Minister Fumio Kishida said the government would study the ruling carefully. No bill has yet been proposed.

Religious groups and some women's organisations also expressed concerns. They want clear rules about access to single-sex facilities. The debate echoes discussions in the United Kingdom and the United States.

Same-sex marriage still pending

Japan remains the only G7 country without legal recognition of same-sex couples. Several lower courts have ruled the ban unconstitutional. The Supreme Court is expected to rule on this question in the coming years. More background can be found in our article on the Japan Supreme Court same-sex marriage case.

The transgender ruling shows that Japanese courts are willing to act on LGBTQ+ rights. But change through parliament remains slow. For a wider overview, see our piece on countries where LGBTQ+ rights are changing fast in 2026.

What happens next

The Ministry of Justice has started reviewing the 2003 law. A government panel is expected to propose changes in 2025. Possible options include:

1. Removing the sterilisation and genital appearance requirements entirely
2. Replacing medical rules with a self-identification model
3. Keeping a medical assessment but without surgery

Most legal experts expect option three. Full self-identification, as in Ireland or Argentina, is seen as politically unlikely in Japan for now.

For transgender people already in court proceedings, the Hiroshima ruling offers a direct path. They can refer to the precedent. Family courts across Japan are expected to follow the higher courts. The first applications without surgery are already being filed.