Majority who register gender change go abroad for the operation

http://mdn.mainichi.jp/mdnnews/news/20090801p2a00m0na006000c.html
8/26/09

Less than 20 percent of those who changed their gender in family registration records are believed to have undergone gender reassignment surgery in Japan, a survey by the Japanese Society of Psychiatry and Neurology (JSPN) has found.

A shortage of medical institutions that conduct such surgery and the high cost due to an absence of insurance coverage are apparently behind the large number of patients undergoing operations abroad.