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Purpose – This study examines the consequences of sudden influx of medicalized discourse of gender in Japan by introduction of gender identity disorder (GID) in the late 1990s where transgender identities and the LGBT activism have had a different history and meanings from Western societies.

Methodology – I use discourse analysis of autobiographies of people with GID in Japan and the limited studies concerning the history of GID and transgender in Japan.

Findings – The introduction of GID to Japanese society contributed to increased social awareness of transsexual individuals. However, it also resulted in transsexual fundamentalism, which has excluded individuals who do not meet certain rigid medical and social identity criteria. This development reinforces the conventional binary gender norms instead of problematizing them. Furthermore, a legislation strictly based on the diagnosis has produced two groups: transsexual individuals with GID diagnosis who will be legally and socially recognized as legitimate, and those who are not GID and thus undeserving of such recognitions.

Social implications – Diagnosis cannot exist without criteria, therefore it is impossible for GID to function as an inclusive identity category. Therefore, we must seek a system to provide medical services that do not necessitate diagnosis. It is also crucial to nurture the social environment where people can freely choose gender identities and expressions that go beyond conventional binary gender system and to keep insisting on plurality and fluidity of gender so that people do not have to rush for a narrow window of recognition.

Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.

Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.

Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.

Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.

Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.

Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.