LGBTQ+ in Japan — Interview with Dr. Singh Ikebukuro
This interview is part of an ongoing Women in Science Japan (WISJ) project highlighting LGBTQ+ experiences in Japan, particularly those within STEM and medicine. Thank you to our interviewees, interpreters, Labianna Joroe, Kat Joplin, and the WISJ team for making this project possible.
This interview was published with the interviewee’s consent and edited for length and clarity. Also, this article includes discussion of self-harm and suicide. Reader discretion is advised.
I was fortunate to speak with Dr. Singh Ikebukuro (he/him), 池袋真先生, an obstetrician and gynecologist at Women’s Medical Clinic LUNA. He is certified by the Japanese Society of Gender Identity Disorder (GID 性同一性障害学会), making him one of the fewer than 40 doctors in Japan with that distinction.
Women’s Medical Clinic LUNA offers a wide range of services to support women, transgender people, and other LGBTQ+ people in Japan. In speaking with Dr. Singh, my goal was to portray the challenges transgender people face in Japan, as well as their options to live a healthy, safe, and authentic life despite such challenges.
Transgender and the law in Japan
“Transgender” is an inclusive term for anyone whose sex assigned to them at birth does not conform to their lived or perceived gender. Transgender people may choose to use hormone therapy, surgery, aesthetic treatments, and other services to align their physical attributes with their perceived gender.
Prior to speaking with Dr. Singh, I sought to better understand the legal rights of transgender people in Japan. In July 2004, the Act on Special Cases in Handling Gender Status for Persons with Gender Identity Disorder (性同一性障害者の性別の取扱いの特例に関する法律) went into effect.
As of 2020, more than 10,000 people have applied for a legal change of gender. However, the true number of people who identify as transgender in Japan is unclear due to the social, legal, and medical ramifications of transitioning.
To legally change one’s gender in Japan, the applicant must comply with five requirements:
- Be at least 20 years old,
- Be unmarried,
- Have no children under the age of 20,
- Permanently lack functioning gonads, and
- Have a physical form that is “endowed with genitalia that closely resemble the physical form of an alternative gender.”
It is also possible to change one’s legal gender through the family court system beginning at age 18, with the additional requirement that you must have been diagnosed with gender identity disorder by at least two doctors.
In simple terms, to legally change your gender, you must undergo sterilization, and in many cases forego marriage and a family until you have transitioned. It’s worth noting that gay marriage is not legal in Japan, and therefore not an option for many transgender people who haven’t legally transitioned.
Organizations including the United Nations, World Health Organization, and Human Rights Watch have called for Japan to abolish these harmful requirements that are rooted in the outdated idea that transgender people suffer from the mental illness referred to as “gender identity disorder.” The Diagnostic and Statistical Manual of Mental Disorders, or DSM, was revised in 2012 to change the diagnostic term “Gender Identity Disorder” with “Gender Dysphoria,” a change made to recognize that identifying as transgender is not a mental illness.
“The number of transgender people who undergo the required surgery for legally transitioning in Japan despite not wanting to is very large.”
There are substantial and often irreversible sacrifices that must be made to legally change one’s gender in Japan. Yet, As Dr. Singhpointed out, “the number of transgender people who undergo the required surgery for legally transitioning in Japan despite not wanting to is very large.” Sterilization stands in the way of marrying their partner and otherwise living life with a legal gender that matches their identity.
Transgender children and adolescents in Japan
Transgender adolescents also face a number of challenges, particularly in the classroom. For example, as a transgender student, your gender identity may not match the uniform that your school requires you to wear based on the sex you were assigned at birth. “The teachers’ rules can be so severe and so strict,” says Dr. Singh. “It can have a really bad impact [on transgender students].” Dr. Singh notes that a large percentage of transgender students avoid attending school; the consequence of missing out on their education often makes it hard for them to apply to university or to find jobs upon graduation. “All children have the right to attend school. I am saddened that some students are not attending school because of gender dysphoria.”
“All children have the right to attend school. I am saddened that some students are not attending school because of gender dysphoria.”
Due to the numerous social, economic, and cultural challenges of being transgender in Japan, a disproportionately large number of trans children and adults contemplate ending their life. Nearly 70 percent of people diagnosed with gender identity disorder in Japan report thoughts of suicide.
Living without a way to explain your gender and sexuality could lead to social isolation, depression, and in some cases, suicide. Prior to the internet and social media, it was harder for transgender adolescents and adults to learn about their gender. There is some hope, however. “Now, because younger kids are able to access the internet to get information,” Dr. Singh points out, “they’re more able to learn about their gender identity.” In fact, Women’s Medical Clinic LUNA works with patients as young as 8 years old.
“Much of the support that we offer the family has to do with their kids’ ability to survive in the school environment,” says Dr. Singh. This includes administrative tasks, such as completing paperwork to have permission to use a different restroom at school, as well as connecting patients with additional healthcare providers. “In order to use secondary sexual characteristics supplements, the patient must first visit a psychiatrist for two years,” according to Dr. Singh. After two years has passed, “if a transgender boy wants to stop menstruation, I can help.”
Dr. Singh is a vocal advocate for transgender children’s well-being outside of the clinic, too. In May 2022, Dr. Singh participated in a free screening and discussion of the documentary “Little Girl,” which follows 7-year-old Sasha, who has always known she was a little girl, even though she was assigned male at birth. “The response was totally positive,” Dr. Singh said of the event in Tokyo. “Because I do not want other children to go through similar hardships, I hope to be a part of more free events like this.”
Accessing transgender-friendly healthcare in Japan
Women’s Medical Clinic LUNA provides many services for not only transgender patients, but also the LGBTQ+ community. There are unique health challenges associated with being transgender that warrant visiting a clinic specialized in LGBTQ+ care. Getting care at a specialized clinic is much more likely to yield stigma-free, respectful care from empathetic doctors.
Women’s Medical Clinic LUNA’s staff includes obstetrician and gynecologists such as Dr. Singh, urologists, dermatologists, and plastic surgeons. Their services include hormone therapy, medical check-ups, cervical cancer screenings, breast cancer screenings, prostate cancer screenings, and even hair removal. I was a bit surprised by the hair removal service in particular, but I soon realized I took for granted how gendered such services are. “In Japan, hair removal [salons] are only for girls or only for boys,” Dr. Singh explained. “All kinds of medical care are very gendered, which is why we also offer cosmetic services such as hair removal and permanent makeup.”
There are as few as eight hospitals in Japan that are accredited by the Japan Society for Gender Identity Disorder for treating transgender patients. The lack of options available is a reflection on the medical school system in Japan, according to Dr. Singh. “There is a lag with the instruction [on LGBTQ+ issues],” he says. “Only about 20% to 30% of instructors have sufficient knowledge of LGBTQ+ issues.”
When Dr. Singh was a medical school student, he and his colleagues sought to provide hope and resources for the LGBTQ+ community in Japan. This group of friends eventually evolved into ReBit (認定NPO法人ReBit), a non-profit organization whose vision is “a society where all children, including LGBT children, can become adults as they are.” More than 600 people have participated in ReBit’s programs since its founding 10 years ago.
To address the lack of understanding of LGBTQ+ issues among healthcare professionals, Dr. Singh co-authored a book titled “LGBTQ Course for Medical Professionals’’ (医療者のためのLGBTQ講座), which provides comprehensive information on LGBTQ+ health issues in Japanese.
The future of trans rights and healthcare in Japan
There were several major setbacks for the LGBTQ+ community in Japan already in 2022:
- In June, the Osaka District Court ruled that it was not against the Constitution to ban same-sex marriage, despite the 2021 ruling from the Sapporo District Court that it was unconstitutional.
- In July, members of the LGBTQ+ community protested outside of the headquarters of the Liberal Democratic Party (LDP), the ruling political party in Japan, after a booklet was circulated during a party meeting stating that “homosexuality is a mental disease or addiction.”
- In August, the Tokyo High Court ruled that a child born to a trans woman after her transition could not be legally recognized as her child.
“Any substantial change to transgender rights in Japan will probably take decades, maybe tens of decades,” Dr. Singh remarked. “[Same-sex marriage] at a bare minimum would be great.” There are other, perhaps less obvious, changes to the legal and political system in Japan that Dr. Singh is hoping for. “It’s really important to implement better laws surrounding sperm and egg donations,” as such fertility services are quite often accessed in an unregulated, under-the-table manner.
Dr. Singh’s message to the trans community is to seek medical care early and often. “The most important thing I want to relay to the transgender community is that LUNA Clinic is available for anything that they might need,” he said. Dr. Singh emphasized the importance of getting tested if they are worried about having contracted an STI as early as possible, for instance. His clinic is open to foreigners, too: he will “gladly use Google Translate” to help trans patients get the care they need despite language barriers.
“LUNA Clinic is available for anything that [the trans community] might need.”
“Recently, transgender people from various countries have been coming to our office. Some of them don’t speak Japanese or English, but we communicate well with them and provide medical care for them,” says Dr. Singh. “I believe that everyone has the right to receive medical care, no matter what sexuality, what nationality, or race they are. For this reason, I will continue to provide medical care at the LUNA Clinic.”
You can learn more about LUNA clinic here: https://www.luna-clinic.jp/transgender/
