People diagnosed with gender dysphoria in Japan are getting more support from social security, including the ability to have the names they usually go by printed on their health insurance cards and to get coverage for gender reassignment surgery under certain conditions.
But even as greater consideration is shown toward transgender individuals, problems still loom for them in old age, including pension payouts that might be altered by transitioning and potential problems receiving appropriate nursing care.
Last year, the Health, Labor and Welfare Ministry notified prefectures that people with gender dysphoria can have the names they go by printed on their health insurance cards if they submit a medical certificate issued by a doctor and other documents.
Since April, transgender individuals have been covered by insurance for sex reassignment surgery as long as they are not receiving hormone treatment, among other conditions, lowering medical costs.
Transgender man Aki Nishino, 32, officially changed his name after feeling distress when called by his former female name during hospital consultations.
“It was harsh when people would just say, ‘You’re a woman’ to my face or look at me in a bizarre way,” Nishino said.
He filed for the name change in court, taking a unisex Japanese name instead.
“There are people who are unable to change their names because of the wishes of their family or other reasons. I welcome being able to use a new name since it increases my options,” Nishino said.
Takamasa Nakayama, who works in Tokyo, said people were always suspicious that he was using someone else’s insurance card before he had sex reassignment surgery and changed his family registry. Nakayama also welcomes the added support from social security.
“There are cases where health conditions worsen because people want to avoid the hassle of going to a hospital. This will be helpful for such people,” Nakayama, 45, said.
But despite the improvements, there are still reasons for concern when addressing the social security net for transgender people as they age.
For example, the earnings-related component of employee pensions is paid out later for men than for women, putting those born female at birth at a disadvantage if they have gender reassignment surgery before they reach retirement.
Receipt of survivors’ pensions also differs by sex.
“If you turn 60 and it is after your pension payouts have been decided, there wouldn’t be any influence from a sex assignment, but people have to be mindful of changes in the conditions even though they might have paid the same insurance premiums all this time,” said Koji Nakajima, a licensed social insurance consultant.
Another difficulty is posed by nursing care for transgender seniors, which requires the use of separate rooms and the bathing of residents by gender.
Transgender people worry their wishes will not be respected if they become senile or other illnesses prevent them expressing themselves anymore.
“It’s necessary to have the flexibility to respond to individual wishes at these facilities. One way is leaving a notarized document with one’s wishes,” Kazuyuki Minami, a lawyer and legal expert knowledgeable about the challenges facing sexual minorities, said.
Minata Hara, representative director for a national sexual minority support network, suggested establishing a nongender-based social security network.
“Today’s social security system is based on sex. What we hope for is a structure that guarantees on an individual basis, not between the sexes,” Hara said.