Identity has as much to do with socialization as it does with the circumstances surrounding one's birth. But since gender is considered an absolute, it has become the test of a society's willingness to allow its members to identify themselves. Except for hermaphrodites, humans are either male or female, but the traits associated with masculinity and femininity are shaped by society.
In 1998, the Saitama Medical University began offering diagnosis of and treatment for gender-identity disorders (GID). The treatment included sex-change surgery, which had previously been unavailable in Japan, but also counseling and hormone therapy. Since then about 20 individuals have undergone operations.
The two-pronged approach of counseling and medical treatment demonstrates an understanding that people who suffer from GID can be affected as much by social pressure as they are by physical discomfort. Many people who go through counseling decide not to have the surgery. In other words, the plumbing isn't always the problem. Sometimes, it's what's above the neck, not below the waist, that counts.