Japan has come under fire from the Human Rights Watch over a national policy that demands the sterilization of transgender people.

HRW released an 84-page report this week criticizing the legal criteria for applying for a legal change of gender. The law states that at least two doctors must diagnose a patient with gender identity disorder. Patients must also have no children, be single and over the age of 20. In a perplexing addendum, however, the law also demands that patients cannot have functioning genitals.

HRW has slammed the requirement for sterilization to receive legal recognition for gender transition. Kanae Doi, director of HRW, Japan said in a statement “Japan should uphold the rights of transgender people and stop forcing them to undergo surgery to be legally recognized.”

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The new report also provides a number of testimonials from transgender Japanese individuals. “It is humiliating,” one transgender man reported. “The surgery requirement itself feels wrong. It feels a lot like a surgery to maintain order. Why do we have to put a scalpel through our healthy bodies just for the sake of the country’s order?”

Though lawsuits have attempted to amend or overturn the law, Japan’s Supreme Court recently upheld the legal requirement for sterilization. That policy runs contrary to both international law and international guidelines for best medical practices.

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