Japan’s supreme court has upheld a law that effectively requires transgender people to be sterilized before their gender can be changed on official documents.

The court acknowledged “doubts” were emerging over whether the rule reflects changing social values, but said the law was constitutional.

The decision, issued Wednesday but published on Thursday, upholds a law that requires any individual wishing to change their documents have “no reproductive glands or reproductive glands that have permanently lost function,” referring to testes or ovaries.

It also requires the person to have “a body which appears to have parts that resemble the genital organs of those of the opposite gender.”

The appeal was filed by Takakito Usui, a transgender man who wants to change official documents that identify him as female.

The panel of four justices ruled unanimously to throw out Usui’s appeal, declaring the law constitutional.

They said the measure was intended to prevent “problems” in parent-child relations that could lead to societal “confusion” and “abrupt changes” in society.

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