A Human Rights Watch report has criticized the procedure for legally changing gender in Japan harmful and out-of date because it still requires sterilization. The 84-page publication, released on March 19, is based on interviews with 48 transgender Japanese, commented by lawyers, academics and healthcare specialists. “[The procedure of changing legal gender in Japan] rests on an outdated and pejorative notion that a transgender identity is a mental health condition, and requires transgender people who want legal recognition to undergo lengthy, expensive, invasive, and irreversible medical procedures,” the paper reads. “Japan should uphold the rights of transgender people and stop forcing them to undergo surgery to be legally recognized,” said Kanae Doi, Japan director at Human Rights Watch, demanding to reconsider the view of being transgender as an illness, a mental disorder. In January, Japan’s panel of four justices ruled unanimously to reject an appeal filed by Takakito Usui, a trans man who wants to change the gender on his official documents, Australian outlet SBS News reported.