It is inevitable that it will affect the medical field as well.

The decision handed down by the Grand Bench of the Supreme Court on October 25 is causing ripples. The provisions of the Gender Identity Disorder Special Cases Act, which effectively required people with gender identity disorder (gender nonconformity) to undergo surgery to eliminate their reproductive functions in order to change their gender on their family register, have been judged to be unconstitutional. Ta. In response to this, the government will amend the special law and related laws, but this will inevitably have an impact on the medical field that has been involved in diagnosing gender identity disorder and performing gender change surgeries. Additionally, there are deep-rooted concerns that the Supreme Court's decision will cause social chaos, and public opinion is actually divided.

　Currently, the special law requires the following five requirements when changing the gender on the family register. ① Be 18 years of age or older (adult); ② Not currently married; ③ have no minor children; ④ have no gonads or permanently lack their function (sterile condition); ⑤ Have genital appearance similar to the changed gender (appearance requirement).

　This time, the Supreme Court ruled ``unconstitutional'' as ④. In effect, surgery is required to permanently eliminate reproductive function, which interferes with the ``freedom not to have one's body invaded against one's will'' as guaranteed by Article 13 of the Constitution. Similarly, there was a debate as to whether point 5, which often requires surgery, violates the Constitution, but the Supreme Court did not rule on this point and sent the case back to the High Court. There is a possibility that it will be considered unconstitutional in the future if it is examined by the High Court.

　In the first place, why were such strict requirements such as requiring surgery created? This was to prevent social confusion in which children would be born with the reproductive function of the sex they had before their gender change. If reproductive function is maintained, it will be possible for a registered male to give birth to a child, and society will become chaotic. When the special law was enacted in 2003, this requirement was based on this idea. However, the Supreme Court ruled in this case that although there are already cases in which a parent changes gender after a child becomes an adult, resulting in a ``female father'' and ``male mother,'' there is no confusion in the parent-child relationship. Judging. He also pointed out that many people who feel strongly uncomfortable with their gender at birth are reluctant to have children in that gender.

　However, the issue of the sterility requirement of the Gender Identity Disorder Special Cases Law was considered by the Supreme Court four years ago, and at that time it was deemed constitutional. ``The Supreme Court changed its decision this time, paying attention to advances in medical knowledge and social changes domestically and internationally regarding sexual minorities,'' said a judicial reporter for a national newspaper.

　What does it mean that medical knowledge has advanced?

　``At the time the special law was enacted, the goal of treatment for gender identity disorder was considered to be sterile surgery.However, as many patients were treated, treatment guidelines changed, and now sterile surgery is It has become an option. Some people desire it, but many people no longer feel uncomfortable with their physical gender due to changes in their masculinity or femininity, such as their voices and beards, due to hormone therapy, etc. )

High-risk sterile surgery is fraught with challenges

　Sterilization surgery has a major impact on the body. If the ovaries are removed, the hormonal balance will be disrupted, often leading to poor health conditions such as menopausal symptoms. Once the ovaries and testicles are removed, they cannot be replaced. Many patients receive hormone therapy before surgery, but public insurance does not cover hormone therapy. As a result, sterile surgery becomes a mixed treatment and is not covered by insurance, resulting in a large financial burden. Furthermore, although the Supreme Court did not rule this time, surgeries that require appearance are also highly invasive. In particular, when transitioning from male to female, surgery such as removal of the penis is required, which is a heavy burden. There is also a risk of after-effects such as urinary disorders.

　Since the special law was enacted, more than 10,000 people have changed their gender on their family register. With the recent Supreme Court decision relaxing some of the requirements, it is expected that the number of people changing their gender will increase, but it is unclear whether the medical field will be able to respond to such a situation.

　``The five requirements are the focus of attention, but in order to change your gender, you first need to be diagnosed by two (or more) doctors.Although this is a field that primarily deals with psychiatrists, it is possible to deal with gender non-conformity. There aren't that many specialized doctors.'' (ibid.) Even if surgery is no longer necessary, doctors are still needed to appropriately respond to patients who complain of gender dysphoria.

　In the future, if appearance requirements are no longer required, the hurdles for changing gender will be much lower, but there is no guarantee that there will not be cases where people change their gender, but feel uncomfortable with the new gender, and change their gender again. do not have. ``Of course, there is nothing illegal about changing your gender multiple times, but if the number of such cases increases, the reliability of medical examinations will be shaken, as will whether doctors have diagnosed the situation correctly.'' Securing them will also become important,'' the reporter mentioned above pointed out.

　``Gender'' can sometimes become a debate that divides public opinion. Many have pointed out that the Supreme Court's recent decision, which stated that ``society's understanding has advanced,'' has inadvertently exposed this fact. ``This is the 12th time since the end of the war that the Supreme Court has ruled a legal provision unconstitutional, which is extremely rare, so it is definitely big news.However, even if you look at the major newspapers, the tone of the reporting is quite different.'' same).

　For example, the Asahi Shimbun (Tokyo edition) has pages 2, 12 (editorials), and 28 (Summary of Supreme Court decisions) in addition to the front page, as well as a social section that covers the parties involved and issues. It has expanded to a large extent. On the other hand, the Yomiuri Shimbun (the same newspaper) similarly published the front page, editorials, and summaries of the decisions, but the way they communicated the social aspects was largely restrained. Comparing the headlines, Asahi viewed the decision favorably, saying, ``A path to expand to one's own sexuality,'' ``Concerns about intensifying discrimination, 'eliminate prejudice,'''' ``I want to live a happy life in body and mind,'' and the welcome was emotional. I told him. On the other hand, in Yomiuri, there were articles that included both sides of the issue, such as ``Expert says: ``Parent-child legal system shakes,'' ``One step forward to eliminate disadvantage,'' and ``There are concerns about social chaos.'' What was even more distinctive was the Sankei Shimbun, which included voices from a group of female volunteers who opposed the special law that made gender change possible, as well as voices from those who had actually experienced gender change and who opposed removing the requirement for surgery. It also reported critically on the Supreme Court's decision.

　Another reporter for a national newspaper said, ``In Japan's online public opinion, there are a lot of voices that are critical of the Supreme Court's decision.'' A typical example of this is the claim that ``registered women with male genitalia enter the women's baths and women's restrooms.'' Regarding this, the Ministry of Health, Labor and Welfare has notified that men and women are separated in public baths based on physical characteristics, so ``Even if the court decides to remove the appearance requirement in the future, this will not change.'' (The reporter mentioned above) ). However, if the number of such "women" is to increase in the future, it will be necessary to discuss whether the "Ministry of Health, Labor and Welfare notification" is sufficient as the basis for rules, or whether legislation needs to be put in place.

The disappearance of genderless toilets is evidence of a sense of rejection.

Also, regarding transgender people who have changed their gender from male to female, so-called activists overseas often take surprising and radical actions and become a problem. Such cases have become widespread in Japan, and women have a deep-rooted sense of rejection towards women with male physical characteristics.

　``The new gender-neutral toilets built at Tokyu Kabukicho Tower in Kabukicho, Shinjuku were also abolished after just four months.The Supreme Court stated in this decision that the social situation had changed, but there were people who felt uncomfortable with gender. It is one thing to understand that there is a certain number of people with this gender and that one can change gender, but it is another thing to understand that a woman with physical male characteristics will be able to use a female space.'' same).

　A Tokyo woman who opposed Kabukicho's gender-neutral toilets said, ``I don't understand or appreciate that the Supreme Court opened the door to people who were unable to undergo surgery due to age or chronic illness, and therefore were unable to change their gender.'' "The requirements for potentially life-threatening surgery are too harsh in exchange for being treated as the correct gender." On the other hand, she says, ``I want people to understand that there are many women who feel fear or rejection when a woman with a male body enters a women's space.'' This issue is likely to continue to divide public opinion.