TOKYO (AP) — Japan’s Supreme Court will rule Wednesday whether a law forcing transgender people to have their reproductive organs removed in order to officially change their gender is constitutional.

Currently, transgender people who want to have their biologically assigned gender changed on family registries and other official documents must be diagnosed as having Gender Identity Disorder and undergo an operation to remove their gonads.

International rights and medical groups have criticized the 2003 law as inhumane and outdated.

On Wednesday, the top court’s 15-judge Grand Bench will decide if the much-criticized surgical requirement is constitutional. The case was filed by a plaintiff whose request for a gender change in her family registry — to female from her biologically assigned male — was turned down by lower courts.

The plaintiff, who is only identified as a resident in western Japan, originally filed the request in 2000, saying the surgery requirement forces a huge burden economically and physically and that it violates the constitution’s equal rights protections.

Rights groups and the LGBTQ+ community in Japan have been hopeful for a change in the law after a local family court, in an unprecedented ruling earlier this month, accepted a transgender male’s request for a gender change without the compulsory surgery, saying the rule is unconstitutional.

The special law that took effect in 2004 states that people who wish to register a gender change must have their original reproductive organs, including testes or ovaries, removed and have a body that “appears to have parts that resemble the genital organs” of the new gender they want to register with.

More than 10,000 Japanese have had their genders officially changed since then, according to court documents from the Oct. 11 ruling that accepted Gen Suzuki’s request for a gender change without the required surgery.

Surgery to remove reproductive organs is not required in more than 40 of about 50 European and central Asian countries that have laws allowing people to change their gender on official documents, the Shizuoka ruling said. The practice of changing one’s gender in such a way has become mainstream in many places around the world, it noted.

Japan has a growing awareness of sexual diversity, but it is changing slowly and the country remains the only Group of Seven member that does not allow same-sex marriage or legal protections, including an effective anti-discrimination law. In a country where pressure for conformity is strong and productivity is stressed by the conservative government, many LGBTQ+ people hide their sexuality due to fear of prejudice at work, school or in the community.

Hundreds of municipalities now issue partnership certificates for same-sex couples to ease hurdles in renting apartments and other areas, but they are not legally binding.

In 2019, the Supreme Court in another case filed by a transgender male seeking a gender registration change without the required sexual organ removal and sterilization surgery found the ongoing law constitutional.

In that ruling, the top court said the law was constitutional because it was meant to reduce confusion in families and society, though it acknowledged that it restricts freedom and could become out of step with changing social values and should be reviewed later.