Yep! If you can read Japanese, the details are here.

It’s partly Japan being way behind the rest of the world as usual, and partly due to a case in the 60s where a surgeon was prosecuted for performing sex reassignment on a sex worker. This violated Japan’s eugenics law (fortunately repealed since then) against sterilization. (The same law required forced sterilization of disabled people, resulting in a court case which still pops up in the news from time to time). So the doctors got a bit jumpy and wrote guidelines to give themselves some legal protection.

Basically, a strict interpretation means you have to get a psychiatrist to rule out any other possible explanation before you’re allowed to transition (that includes hormones, not just SRS). Up until last year, RLE was a requirement. Fortunately most specialist gender clinics here are a bit more relaxed and tend to follow WPATH, so getting started is quite easy. But to get approval for surgery you still need the mental health people involved, and despite having lived as a woman for over a year at that point (with documented proof!) they weren’t convinced and wanted to start the observation period from scratch. They were kind enough (!) to cut the period down to six months, though, so I had to go into Tokyo once a month for a 30-second appointment so they could check I was still being girly enough. No, seriously: they explained at the beginning that it would be a problem if I turned up to the appointment appearing masc. At the same time I had a series of written and oral interrogations into just why I thought I wanted to be a woman, my sexual history, etc etc. At every stage they openly expressed doubt as to the truth of what I was saying. It was humiliating and exhausting, but it’s done now.