Reconsidering “Blue Boy Trial”: Sex Reassignment Surgery in Postwar Japan and the “Gatekeeper Model”

The 1965∼69 “Blue Boy Trial,” in which a doctor was found guilty of breaching Article 28 of the Eugenic Protection Law after he was indicted on charge of having performed sex reassignment surgery (SRS) on three “blue boys”(trans woman entertainer or prostitute), has been known to have brought a “dark age” to SRS in Japan. However, the court did state that SRS could be considered a legitimate treatment if operated with careful procedures. This court decision was made based on the documents obtained by the defendant from the United States. These documents reflected the movement toward the expansion of transgender healthcare of US in the 1960s. This movement was led by endocrinologist Harry Benjamin and large hospitals such as Johns Hopkins Hospital that sought to systematically approach SRS. The gender identity clinics in those large medical institutions adopted a so-called “gatekeeper model,” a step-by-step procedure in which they carefully chose candidates and treated them based on the narrow definition of “transsexual.” This model was also employed by university-based medical institutions in Japan by 1990s when these hospitals launched SRS. Therefore we need to reconsider “Blue Boy Trial” in the context of bringing to Japan the “gatekeeper model” of SRS that had been originated from the United States in the 1960s. However, this “gatekeeper model” with particular emphasis on the step-by-step approach and the “real-life test” significantly limited transgenders’ access to the surgical procedure, and compelled them to find other clinics that were independent of “gatekeepers.”