The Japanese Supreme Court struck down a 2003 ruling that required the surgical removal of reproductive organs for a state-recognized gender change. This now allows Japanese transgender citizens to officially change their gender without the requirement of surgical procedures. There had been ongoing criticism from international rights and medical groups that the law was unconstitutional. In the original case filed in 2000, the plaintiff laments the financial and physical burden of the surgery requirement, as well as the violation of the constitution’s equal rights protections. Traditional paternalistic family values remain central to the Japanese government and it does not allow same-sex marriage or legal protections.