www.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org
Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

Takashi Yamashita
Minister of Justice, Government of Japan
1-1-1 Kasumigaseki,Chiyoda-ku,Tokyo 100-8977,Japan
Takumi Nemoto
Minister of Health, Labour and Welfare, Government of Japan
1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo, 100-8916 JapanMay 28, 2019Your Excellencies:
The World Professional Association for Transgender Health (WPATH) is
the only international, interdisciplinary professional association
dedicated to the scientific study of gender dysphoria and the evidencebased best practices in transgender health. We are a non-profit
association with over 2200 members in the fields of medicine, mental
health, law and ethics, and scientific research. Formed in 1979 for the
purpose of bringing scientists and medical providers together toexchange knowledge about the field, we are the creators of theinternationally accepted Standards of Care for the Health of Transsexual,
Transgender, and Gender-nonconforming People, now in its 7th edition(SOC v7), and available in a Japanese translation 1 on our website:www.wpath.org. We have also advised governments around the world
with respect to transgender health and human and civil rights. Our
mission is to encourage education and research to ensure that thehighest possible standards of health, social services, and justice areavailable to transgender people around the world.
We, WPATH's leadership, write to encourage Japan to urgently amend
the “Gender Identity Disorder Special Cases Act” 2 as it contains some
harmful and unscientific elements, and is not in line with international
consensus on protecting and promoting the health of transgenderpeople.
In writing this letter, we use the term transgender as an adjective todescribe all those who identify in a gender other than the one thatmatches the sex they were assigned at birth. The term, used in thissimple way, includes persons who seek gender affirming medical services,
https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_Japanese.pdf
Act on Special Cases in Handling Gender Status for Persons with Gender Identity
Disorder, Act No. 111 of July 16, 2003. 性同一性障害者の性別の取扱いの特例に関する法律. http://www.japaneselawtranslation.go.jp/law/detail/?id=2542&vm=04&re=02

12

www.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org
Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

as well as those who do not. It includes persons who identify using labels
other than transgender, and who are described by others by way of otherterms (for example, by way of the term transsexual or gender-diverse). It
includes persons who identify as male or female, as well as those who
identify as both or neither, and who therefore find male and female
gender markers inadequate in describing who they are.
As you are aware, Japan’s law regulating legal recognition fortransgender people requires a diagnosis of “Gender Identity Disorder”(GID) before any transgender person can apply to secure legal
recognition of their appropriate gender. “GID” is defined in the law as:
A person, despite his/her biological sex being clear, who continually
maintains a psychological identity with an alternative gender, who holds
the intention to physically and socially conform to an alternative gender.
In addition to providing a certificate attesting to the fact that theindividual has been diagnosed with GID, an applicant to the court mustmeet the following qualifications:






Be 20-years-old or older;
Be presently unmarried;Not presently have any underage children;
Not have gonads or permanently lack functioning gonads; andHave a physical form that is “endowed with genitalia that closely
resemble the physical form of an alternative gender.”All of the above provisions require revision—most urgently, WPATH
encourages the government of Japan to eliminate the sterilization
requirement and update the diagnosis requirement in line with APA and
WHO standards. The GID Special Cases Act, while serving to acknowledge
the existence of a population and allowing for their legal recognition, is aformidable barrier for transgender people in Japan. The requirement of a
“GID” diagnosis is unscientific and is no longer in use in the medical ormental health care fields in either clinical or research settings. The
requirement of single marital status and not having minor children
amounts to discrimination; and the requirement of surgeries that sterilize
amounts to coerced sterilization—a widely-recognized human rights
violation, including in Japan.
As the world's peak professional organization concerned withtransgender health, WPATH is aware of the importance that genderrecognition can play in facilitating the health and wellbeing oftransgender people. We share here the official WPATH Identity
Recognition Statement.

www.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org
Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

WPATH Identity Recognition Statement:
The World Professional Association for Transgender Health (WPATH)
recognizes that, for optimal physical and mental health, persons must beable to freely express their gender identity, whether or not that identity
conforms to the expectations of others. WPATH further recognizes theright of all people to identity documents consistent with their gender
identity, including those documents which confer legal gender status.
Such documents are essential to the ability of all people to enjoy rights
and opportunities equal to those available to others; to accessaccommodation, education, employment, and health care; to travel; tonavigate everyday transactions; and to enjoy safety. Transgender people,
regardless of how they identify or appear, should enjoy the genderrecognition all persons expect and deserve. Medical and other barriers togender recognition for transgender individuals may harm physical andmental health.
WPATH opposes all medical requirements that act as barriers to thosewishing to change legal sex or gender markers on documents. These
include requirements for diagnosis, counseling or therapy, puberty
blockers, hormones, any form of surgery (including that which involves
sterilization), or any other requirements for any form of clinical treatment
or letters from doctors. WPATH argues that marital and parental status
should not be barriers to recognition of gender change, and opposes
requirements for persons to undergo periods living in their affirmed
gender, or for enforced waiting or 'cooling off' periods after applying for achange in documents. Further, court and judicial hearings can produce
psychological, as well as financial and logistical barriers to legal genderchange, and may also violate personal privacy rights or needs.
WPATH advocates that appropriate gender recognition should beavailable to transgender youth, including those who are under the age ofmajority, as well as to individuals who are incarcerated or
institutionalized. WPATH recognizes that there is a spectrum of gender
identities, and that choices of identity limited to Male or Female may beinadequate to reflect all gender identities. An option of X, NB (nonbinary), or Other (as examples) should be available for individuals who sochoose. WPATH urges governments to eliminate barriers to genderrecognition, and to institute transparent, affordable and otherwise
accessible administrative procedures affirming self-determination, whenwww.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org
Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

gender markers on identity documents are considered necessary. These
procedures should be based in law and protect privacy.
We are aware that in January 2019, the Supreme Court of Japan issued its
judgment in the case of Takakito Usui, a 43-year-old transgender man
who had brought a case to the court challenging the GID Special Cases
Act on the grounds that the requirement of surgery violated Japan’sconstitution. While the court upheld the GID Special Cases act asconstitutional at this time, the justices also stated that, “It cannot bedenied that [this law] impinges on freedom from invasion of bodily[integrity].”
Two of the justices in a concurring opinion wrote of the urgency of Usui’scase, and the need to reform Japan’s law: “The suffering that[transgender people] face in terms of gender is also of concern to societythat is supposed to embrace diversity in gender identity.” They concluded
that for transgender people, being “able to receive rulings of changes inrecognition of gender status…is an important, perhaps even urgent, legal
benefit.” 3
WPATH recognizes that, for optimal physical and mental health, persons
must be able to freely express their gender identity, whether or not that
identity conforms to the expectations of others.
WPATH further recognizes the right of all people to identity documents
consistent with their gender identity, including those documents which
confer legal gender status. Such documents are essential to the ability ofall people to enjoy rights and opportunities equal to those available toothers; to access accommodation, education, employment, and healthcare; to travel; to navigate everyday transactions; and to enjoy safety.
Transgender people, regardless of how they identify or appear, should
enjoy the gender recognition all persons expect and deserve.
Some transgender people want to undergo hormonal treatment, surgicalprocedures, or other medical interventions as part of their transition.
Others do not. Access to gender-affirming healthcare is important;
Heisei 30 nen (2018)(ku) No. 269 Tokubetsu-koukoku Appeal Case Against the
Koukoku Dismissal Decision Against the Decision to Dismiss the Application to Change
the Treatment of Sex, Heisei 31 nen (2019) Decision by the Second Petty Bench of theSupreme Court, http://www.courts.go.jp/app/files/hanrei_jp/274/088274_hanrei.pdf;
See Appendix 43

www.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org
Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

however mandatory use of medical services as part of the legal
recognition process is not recommended on the basis of science orhuman rights. The decision to undergo invasive medical or surgicalprocedures of any kind should remain with the individual in consultation
with their physician(s).
Medical and other barriers to gender recognition for transgenderindividuals may harm physical and mental health. WPATH opposes all
medical requirements that act as barriers to those wishing to change
legal sex or gender markers on documents. These include requirements
for diagnosis, counseling or therapy, puberty blockers, hormones, any
form of surgery (including that which involves sterilization), or any otherrequirements for any form of clinical treatment or letters from doctors.
People experience their lives under many different circumstances andmay lack the means or the opportunity to overcome these barriers, yettheir gender identity is an innate characteristic that they deserve to haverecognized.
Although WPATH acknowledges that age restrictions are subject to local
jurisdiction, we wish to point out that many countries do allow
individuals younger than age 20 to transition and to receive identity
documents that support their gender identity. Also, most countries thatdo acknowledge transgender individuals also do not restrict marriage orenforce divorce, nor do they demand that any children of a transgenderperson must reach the age of majority before a transgender parent may
be legally recognized. Clinical and practical experience has shown that
requirements such as these imposed by Japan’s current law do not serve
to protect parties who may be in relationship with a transgender person,
but instead interfere with the rights of all parties to enjoy the support oftheir family members. Further, the physical form of an individual’s
genitalia in no way describes or defines the individual’s gender. Variationin human bodies, whether congenital, accidental, or deliberately
achieved should not limit any individual’s integrity with respect to theirgender identity or their humanity.
Japan has taken some important steps in recent years to respect therights and protect the health of sexual and gender minorities, including
by the Tokyo Metropolitan Government passing a non-discrimination law

www.wpath.org
wpath@wpath.org
phone: 1+(847) 752-5328
fax: 1+(224) 633-2166
1061 E Main Street Ste 300
East Dundee, IL 60118
STAFF
Executive Director
Sue O’Sullivan
sue@wpath.org
Executive Director of Global
Education & Development
Donna Kelly
donna@wpath.org
Associate Director
Blaine Vella
blaine@wpath.org

with protections for gender identity.4 The 2020 Olympic Games in Tokyo
will be an important moment for the government of Japan todemonstrate to the world that it respects the rights of all people, and
WPATH encourages urgent reform of the GID Special Cases act in order todo so. These are complex components of human experience, and we urgeYour Excellencies to consider them with due diligence.
Please contact us if we may be of assistance in the process of reforming
this law.
Sincerely and respectfully,

Vin Tangpricha, MD
President
on behalf of the WPATH Board of Directors

Educational Program Coordinator
Taylor O’Sullivan
taylor@wpath.org
EXECUTIVE COMMITTEE
President
Vin Tangpricha, MD, PhD
President-Elect
Walter Pierre Bouman, MD, PhD
Secretary
Randi Ettner, PhD
Treasurer
Baudewijntje Kreukels, PhD
Past-President
Gail Knudson, MD, MEd, FRCPCBOARD OF DIRECTORS
Tamara Adrian, JD
Marci Bowers, MD
Tone Maria Hansen, MSN
Ren Massey, PhD
Asa Radix, MD, MPH
Loren Schechter, MD
Jaimie Veale, PhD
Ex-Officio
Lin Fraser, EdD
Student Representative
Luke Allen, MA
EPATH Representative
Griet De Cuypere, MD
USPATH Representative
Joshua D. Safer, MD

Human Rights Watch, “Tokyo: New Law Bars LGBT Discrimination,” October 5, 2018,https://www.hrw.org/news/2018/10/05/tokyo-new-law-bars-lgbt-discrimination.

4