1999 World Congress of Sexology GENDER IDENTITY DISORDER IN JAPAN: A CLINICAL SURVEY OF 194 OUTPATIENTS 　 Katsuki Harima and Teruo Abe Tokyo Family Court1 and Abe Mental Clinic Tokyo, Japan INTRODUCTION 　Medical treatment as well as even discussion of gender identity disorder (GID) have long been practically a taboo in Japan. For this reason some patients with GID have got sex reassignment surgery (SRS) in other countries, while others have received hormonal therapy and/or SRS underground at home. This situation, however, is now changing. In 1998 Dr.Harashina performed the first SRS in Japan that was legally admitted. Patients who visit a doctor are increasing in number. MATERIALS AND METHOD 　We report on our study of the data of 194 out-patients who visited Abe Mental Clinic and were diagnosed as having GID according to DSM-IV. 79 patients are FTM (female to male)and 115 patients are MTF(male to female). RESULTS 1. Age 　Age distribution of FTM peaks in 3rd decade and that of MTF in 4th decade. These results correspond with those in other countries. The youngest patient is a 16 year old MTF and the oldest one is a 78 MTF. 2. Motivation for their visit 　139 patients wanted for psychotherapy. Some only for psychotherapy, others for psychotherapy as a step to go on to hormonal treatment or SRS. 52 patients wanted for medical information. Some patients come to ask what the GID is and others ask if there are any good peer support groups. 3 patients needed a medical certificate for change of their registered name or other reasons. 3. Social status 　44 patients work as a part timer.　Some patients do so because they don't want to wear a typical gender role uniform or because they don't want to tell their boss their registered sex. 17 patients are unemployed. Some were fired because of GID. 6 patients receive welfare aids. 4. Education 　Some patients didn't go on to high school, because they did not want to wear a school uniform or a swimming suit or because they wanted to avoid being teased by classmates and teachers. 5. School refusal 　The average rate of school refusal in Japan is below 2%. Therefore 35% is significantly higher. There are some reasons for this. The biggest reason is teasing. Another reason is the uniform. They did not want to wear a school uniform, a swimming suit, or a gymnastic wear. 6. Divorce of their parents 　About 10% parents of Japanese children get divorced. Therefore 20 % is higher than the average. The relation between their parents divorce and GID is yet to be known. 　　　　　　 7. Partner 　Yes means the patients have or had a partner. No means the patients have never had a partner. A partner is hard to get for MTF. 8. Sexual orientation 　FTM patients tend to be attracted to female. MTF patients have various sexual orientations. These results correspond with those in other countries. 9. Hormonal therapy. 　Some patients have already begun to be on hormonal therapy without a psychiatrist's permission. Some patients have got hormonal therapy without a medical check-up or informed consent on the risk of side effects. 10. Surgery 　Some patients had already got surgical therapy. 23 FTM patients underwent mastectomy. Now they can enjoy hot summer with or without a T shirt. 4 MTF patients reduced Adams' apple to get a female neck line. 12 MTF patients removed their testes to reduce their androgen level. 29 MTF patients got electrolysis to remove their facial hair permanently. 11. Change of registered name 　19 FTM patients changed their first name from typical female name to typical male or non sexual related name. 17 MTF patients did the opposite. Today a growing number of patients are changing their registered name. This is mainly because nowadays they can easily change their first name when diagnosed as having GID. Presently they can change their first name, but not change their registered sex in Japan. CONCLUSION 　Our results show many GID patients have many problems: educational, social, economical and psychological and patients who want medical help are increasing in number. It is concluded that both social and medical support system should be established to improve the QOL of GID patients. SUBJECTS FTM MTF Total 79 115 194 1984~1996:4 1997~1999:190 RESULTS 1. Age 　 FTM MTF Total ~19 2 5 7 20~29 55 38 93 30~39 19 55 74 40~49 2 15 17 50~ 1 2 3 2. Motivation for their visit 　 FTM MTF Total Psychotherapy 61 78 139 Medical information 17 35 52 Medical certificate 1 2 3 3. Social status 　 FTM MTF Total Full-time job 36 75 111 Part-time job 22 22 44 Student 13 9 22 Unemployed 8 9 17 4. Education 　 FTM MTF Total University 36 58 87 Vocational school 10 12 22 High school 33 39 72 Junior high school: 7 6 13 5. School refusal 　 FTM MTF Total Yes 25(32%) 43(37%) 68(35%) No 54(68%) 72(63%) 126(65%) 6. Divorce of their parents 　 FTM MTF Total Yes 21(26%) 17(15%) 38(20%) No 58(74%) 98(85%) 156(80%) 7. Sexual partner 　 FTM MTF Total Yes 58(73%) 40(35%) 98(51%) No 21(27%) 75(65%) 96(49%) 8. Sexual orientation 　 FTM MTF to male 2 53 to female 71 31 to both 6 30 to neither 0 1 9. Hormonal therapy 　 FTM MTF Total Yes 51(65%) 77(68%) 128(66%) No 28(35%) 38(32%) 66(34%) 10. Surgery 　 FTM MTF Mastectomy 23 　 Thyroid cartilage shave 4 　 Orchiectomy 12 　 Orchiectomy 7 　 Electrolysis 29 　 11. Change of registered name 　 FTM MTF Total Yes 19(24%) 17(15%) 36(19%) No 60(76%) 98(85%) 158(81%)