Gender Affirmation
Our gender affirmation services offer comprehensive and appropriate hormone therapy, supervised by our specialist*, addressing the growing concerns related to Gender Incongruence (GI), Gender Dysphoria (GD) and Gender Identity Disorder (GID).
* Dr. Singh IKEBUKURO, a gender affirmation specialist and certified physician of the GID Society
We offer generic Nebido, the long-acting male hormone injection at nearly half the price of its original.
Depending on the day of your appointment, consultation will be provided either face-to-face or online (via video calls in our examination room). In either case, patients need to visit our clinic.
Whether the consultation is conducted face-to-face or online, you can undergo hormone therapy and/or testing immediately after the consultation at the day of your visit.
April: 10th [Wed], 29th [Mon/holiday]
May: 3rd [Fri/holiday], 4th [Sat/holiday]
*Schedule in June onwards is to be announced.
The specialized doctor will provide consultation via video call. Note that a patient needs to come to our clinic. You can get a hormone therapy, various tests, etc. after that.
Mar: 11th [Mon], 18th [Mon], 20th [Wed/holiday], 25th [Mon], 29th [Fri]
Apr: 5th [Mon], 19th [Mon]
*Schedule in May onwards is to be announced.
The initial consultation fee is discounted for video consultations as follows (incl. tax).
| Patient | FTF consultation |
Video consultation |
|---|---|---|
| Uni students or younger |
1,500 JPY | 500 JPY |
| Others | 2,500 JPY | 1,500 JPY |
If you have any questions regarding the gender affirmation, contact us via our official LINE.
Please select the section to jump to.
About Gender Affirmation
The tests and treatments we can perform are as follows:
Our counseling and hormone therapy are not covered by Japanese national health insurance.
Counseling
For those with GD, we initially ask to your concerns, provide advice on what can be done and suggest what to begin with.
We offer consultations on GI/GID, hormone therapy, and potential surgeries (for surgeries, we will provide referrals).
We also provide advice for those wishing to undergo gender transition and support for preparations for a gender affirming surgery. Note that the procedures for gender change are carried out at the court.
While we offer consultations on treatment policies, we do not diagnose GI/GID.
Hormone Therapy
Treatment for individuals with GD or GID includes “hormone therapy” and “gender-related surgeries”.
We ensure safe hormone therapy while conducting thorough medical consultations and examinations.
If you are considering a mastectomy or gender-affirming surgery, we offer assistance in selecting the appropriate hospital and provide necessary referrals.
Those who have undergone a gender affirming surgery will become able to apply for a “change of gender in the family register” at the family court.
We offer hormone administration for FTM (Female to Male) to transition from female to male and MTF (Male to Female) to transition from male to female.
Administering hormones helps individuals get closer to their desired physical appearance, but it may also lead to changes from their original healthy state.
It is crucial to consult with a doctor in advance; self-administering hormones without medical guidance can be hazardous.
Regular Examinations
Starting hormone replacement therapy can increase the risk of various diseases such as liver dysfunction, kidney dysfunction, lipid metabolism disorders, diabetes, polycythemia, thrombosis and osteoporosis.
The following examinations may be eligible for coverage under the Japanese national health insurance.
We investigate liver and kidney functions, lipid metabolism disorders, uric acid levels, hormone levels, etc. Based on these results, hormone dosage will be adjusted as necessary.
Price: 3,000 JPY (incl. tax)
There is a risk of thrombosis as a complication associated with hormone therapy.
We provide not only blood tests but also comprehensive medical care whenever necessary. This includes lower limb ultrasound, cardiac echography and neck echography to evaluate the risk of cerebral infarction and myocardial infarction.
Price: 1,500 JPY (incl. tax)
Hormone Therapy
The options and side effects of male and female hormones replacement in relation to hormone therapy are summarized as follows.
Options for MTF Hormones
(MTF Hormone Therapy)
Medication Options:
Injection: Progynon Depot, etc.
Patch: Estrana Tape
Gel: Le Estrogel, Divigel
Oral medication
Main Side Effects:
Allergic reactions, recurrence of psychiatric disorders, hypercalcemia, sodium retention, fluid retention, gastrointestinal bleeding, abnormal bleeding, changes in menstrual blood volume, breast pain, breast engorgement, headache
Options for FTM Hormones
(FTM Hormone Therapy)
Medication Options:
Injection: Short-acting male hormone (Enarmon Depot 125mg, 250mg), Long-acting male hormone (Nebido generic)
Topical: Gromin
Major Side Effects:
Allergic reactions, liver function abnormalities, pigmentation, bone marrow fibrosis, aplastic anemia, renal anemia
Short-acting injections can elevate blood testosterone levels, sometimes surpassing physiological norms for several days, potentially leading to irritability and emotional instability.
Long-acting injectable Nebido, on the other hand, stabilizes blood testosterone levels for 3-5 months with a single injection, reducing irritability and emotional instability risks.
Nebido, produced by Germany’s Schering AG, is a medication utilized in hormone replacement therapy for treating male menopause and Gender Identity Disorder (GID).
Although not yet approved in Japan, Nebido is widely recognized and utilized in Europe and the United States, thanks to its proven safety profile.
While ‘Nebido’ is recognized as a safe and stable medication, its original cost of approximately 30,000 to 35,000 JPY per dose has been financially prohibitive for many patients.
Price: 18,000 JPY (incl. tax)
Product Name: Cernos injection
Manufacturer: Sun Pharma Japan Limited
– The price includes the cost of hormone level testing.
– Consultation fee is incurred in addition: 2,500 JPY (incl. tax) for initial visit, and 1,000 JPY (incl. tax) for following visits.
Furthermore, as of January 2024, we have introduced Nebido Generic oral medication (Cernos capsule).
Oral Medication
Price: 4,000 JPY (incl. tax) per 30 capsules
Product Name: Cernos Testosterone Undecanoate Soft Gelation Capsules
Manufacturer: Sun Pharma Japan Limited
Active Ingredient: testosterone undecanoate 40mg per capsule
– Consultation fee is incurred in addition: 2,500 JPY (incl. tax) for initial visit, and 1,000 JPY (incl. tax) for following visits.
The Nebido Generic oral medication (testosterone undecanoate oral medication) has been approved by the U.S. Food and Drug Administration (FDA) (reference ), and it has been academically reported to be effective in maintaining male hormone levels without increasing the risk of serious side effects (reference).
– Those who want a backup male hormone preparation for emergencies or when unable to administer injections due to work.
– Individuals desiring to undergo male hormone therapy without high-dosage administration (e.g., those seeking minor male characteristics or gradual masculinization).
– Those who prefer not to have regular injections or who want to focus on oral medication for hormone therapy.
– People living in rural areas or with geographical constraints that make regular injections difficult.
If you are interested or have any questions, please feel free to contact us via our official LINE account.
Required Examinations
During hormone therapy, there’s an increased risk of various diseases such as liver dysfunction, kidney dysfunction, lipid metabolism disorders, diabetes, polycythemia, thrombosis and osteoporosis.
Additionally, it’s essential to periodically measure hormone levels because excessive hormone replacement therapy could potentially lead to lethal complications.
We recommend blood testing and hormone measurement in starting and continuing hormone replacement therapy.
(3,000 JPY incl. tax)
Blood count, liver function, kidney function, electrolytes, uric acid, CK, TG, LDL, HDL, blood sugar, HbA1c
In addition to the above, the following hormone tests can be conducted.
Before oophorectomy: Estrogen, Testosterone (2,000 JPY incl. tax)
After oophorectomy: Testosterone (1,500 JPY incl. tax)
* Oophorectomy refers to the surgical removal of one or both ovaries.
In addition to the above, the following hormone tests can be conducted.
Before orchiectomy: Estrogen, Testosterone
After orchiectomy: Estrogen, (Testosterone)
* Orchiectomy refers to the surgical removal of one or both testicles.
* The level of prolactin will be measured annually.
The gender affirmation will primarily not be covered by Japanese national health insurance. However, depending on the patient’s underlying conditions, blood tests and other examinations may be covered by insurance.
For more details, please consult with our doctor.
Research and Free Testing
We conduct research on sexual health for transgender individuals undergoing hormone replacement therapy, aiming to provide holistic support for those experiencing GD/GI.
The study is anonymous and the test results will be sent via email.
For those agreeing to participate in the study, we offer free examinations for initial lifestyle disease hormone and STIs. (Hormone replacement therapy is available even if testing is not required.)
If you have already started hormone replacement therapy at our clinic and are interested, please inform your doctor.
Hormone Measurements: Testosterone, Estrogen (normally 2,000 JPY)
Lifestyle Disease Testing: Complete blood count, liver function, kidney function, electrolytes, uric acid, CK, TG, LDL, HDL, blood sugar, HbA1c (normally 3,000 JPY)
Sexually Transmitted Disease Testing: HIV, Hepatitis B, Syphilis, Gonorrhea (genital, pharyngeal, anal), Chlamydia (genital, pharyngeal, anal) (normally 24,000 JPY)
We continue to ensure accessibility and comfort for everyone by means of various measures to so that the medical content and personal information of all our patients, regardless of gender, remain confidential.
・All patients are called by number, not by name.
・Consultation rooms are soundproofed.
・Bills are confirmed on screen without being read aloud.
・Consultation rooms are not department-specific, preventing department identification.
Prices
The gender affirmation will primarily not be covered by Japanese national health insurance.
But, periodic examinations associated with hormone therapy may be covered by insurance, so please consult the doctor.
The price of medical care without insurance will be calculated based on the following pricing system.
[Total Price] = [Consultation Fee] + [Test Fee] + [Medication Fee]
Consultation Fee
The consultation fee varies depending on whether it’s your initial visit or a follow-up visit.
Irrespective of insurance coverage, a follow-up consultation fee applies for all subsequent visits.
Please refer to the top of this page to see whether your preferred consultation date falls on an face-to-face consultation day or an online consultation via video call.
Initial fee: 2,500 JPY (incl. tax)
Follow-up fee: 1,000 JPY (incl. tax)
Test Fee
The test fees are as follows:
| Type of Test | Price (JPY) (incl. tax) |
Test Results* |
|---|---|---|
| Hormone Therapy Blood Collection Package |
3,000 | In 2-3 days |
| Testosterone + Estrogen |
2,000 | In 4-5 days |
| Testosterone | 1,500 | In 4-5 days |
| Free Testosterone | 1,500 | In 4-5 days |
| Estrogen | 1,500 | In 4-5 days |
| D-dimer (Evaluation of Thrombosis Risk) |
1,500 | In 2-3 days |
*The calculation of result-reporting day begins when the collected samples arrive at the laboratory. If samples are collected in the evening, on weekends or on national holidays, the countdown begins from the next business day of the laboratory.
Treatment Price
The price for hormone therapy is as follows:
| Type | Formulation | Price (JPY) (incl. tax) |
|---|---|---|
| Short-Acting Male Hormone |
Enarmon Depot 125mg Testinon Depot 125mg |
2,500 |
| Enarmon Depot 250mg | 3,500 | |
| Long-Acting Male Hormone |
Nebido Generic (Cernos injection) |
18,000** |
| Nebido Generic (Cernos capsule) |
4,000* | |
| Male Hormone Cream |
Gromin | 4,100 |
| Short-acting Female Hormone |
Progynon Depot 10mg | 2,500 |
| Progynon Depot 20mg | 3,500 | |
| Female Hormone Gel |
Le Estrogel | 1 bottle : 4,300 2 bottles : 6,200 3 bottles : 8,100 |
| Anti-androgen medication |
Spironolactone | 50 mg: 3,000* 100 mg: 6,000* 150 mg: 9,000* 200 mg: 12,000* |
* Indicated price are per 30 doses.
** Includes the price for hormone measurement.
Consultation Flow
First-time visitors, as well as those who wish to have counseling or other consultations, are required to visit on the days when Dr. IKEBUKURO is available. Depending on the day of your appointment, consultation will be provided either face-to-face or online consultations via video calls. In either case, there are no difference in the treatments and/or examinations you can get.
The gender affirmation operates on our appointment-priority system just like our other departments. And, walk-ins may result in extended wait times, so we kindly ask you to make an appointment and fill out the questionnaire in advance.
Appointment
Please make an appointment from the “Gender Affirmation” section on our website or the button below.
Regardless of the “Designated Doctor” option, Dr. IKEBUKURO will conduct all the first consultations in the “Gender Affirmation” at least for now.
For gender affirmation, appointments can only be made on the schedule specifically designated for “Gender Affirmation (First Visit).”
But from the second time onwards, hormone treatments can be administered any time during our open hours. Please make your appointment from the “Gender Affirmation (Follow-up visit)” on the appointment website.
Filling Out the Questionnaire
After completing the appointment, please click on the link in the appointment confirmation email or the button below to fill out the questionnaire.
Visit On the Day
Please visit us at your appointed time. We will provide you with a number at the reception, and you will be called by that number for testing, billing, etc.
Doctor’s Interview & Consultation
The doctor will conduct a consultation based on the questionnaire, provide appropriate advice, conduct tests, and administer treatment as required.
| Date | Consultation type |
|---|---|
| FTF | Face-to-face consultation in examination room |
| Others | Online consultation via video call where a patient must be in the examination room of the clinic. |
Residents of Hokkaido, Tohoku and Kanto region can access the generic Nebido at our partnered Personal Health Clinic in Tokyo.
Obstetrics and Gynecology Specialist. Certified by Japanese Society of Gender Identity Disorder.
Handles transgender consultations at Yokohama Motomachi LUNA Clinic and gender consultations at the Personal Health Clinic.