Illness-Care and Validation-Dependency in the Diagnostic Model for Trans Healthcare: Ambivalent Epistemic Consequences in Japan's Evolving Medical Framework.

Abstract

This study examines the functions and ambivalences of the diagnostic model for trans healthcare in Japan. Drawing on interviews with 18 trans healthcare seekers, it explores how diagnosis operates not only as a medical requirement but as a socially embedded practice shaping access to care and self-understanding. Although often used expediently to obtain treatment, diagnosis also serves as a site of exploration or endorsement. This study identifies an additional layer of ambivalence-rooted in the structural imbalance of explanatory authority-beyond existing accounts of strategic navigation. Diagnosis may offer reflection and confirmation of identity and needs, but it also risks producing epistemic injustice by undermining individuals' authority to define their own experiences. The resulting ambiguity of validation-dependency, alongside the illness-care conundrum, creates an epistemic contradiction: the same diagnostic process that grants access and affirmation may also constrain self-determination. This study contributes to the trans health scholarship by foregrounding the interpretive work of trans healthcare seekers and critically analysing diagnosis as a practice of both regulation and care.