In 2015, at the age of 24, Kanata Kimoto had the uterus and ovaries he was born with removed at a Thai hospital.

Back then, the Osaka Prefecture native didn’t even question his move, despite the huge cost and potential health risks involved. Sterilization is one of several conditions that all transgender individuals are required to meet if they want to have their gender changed on official papers in Japan. Living with a gender that didn’t match his identity was unbearable for Kimoto.

“It was a choice between undergoing surgery so I could change my gender, and dying,” Kimoto, 31, recalled. “Even if the surgery failed and if I died as a result, I didn’t care. I was that desperate.”