Japan’s Supreme Court unanimously ruled this week in favor of upholding an archaic law that forces all transgender people to become sterilized prior to transitioning, Japan Today reports.

As of 2003, trans people in Japan must "permanently lack" functioning reproductive glands before they can be officially recognized and documented with correct gender markers. Law 111 also requires that anyone seeking to transition must be single, have no children under 20, and undergo a psychiatric evaluation.

The ruling on the two-year trial, brought by trans man Takakito Usui, is “a blow for the recognition of transgender people in Japan,” said Suki Chung of Amnesty International in a statement. “It is a missed opportunity to address the discrimination transgender people face.”

Despite the court declaring Law 111 constitutional, judges released opinions stating that the mandate was invasive and should be regularly reviewed. Presiding judge Mamoru Miura said that “doubts are undeniably emerging,” suggesting that change may be imminent.

“It is unthinkable in this day and time that the law requires a sex-change operation to change gender,” said Tomoyasu Oyama, Usui’s lawyer. “When the law was established 15 years ago, LGBT people had to make a bitter decision and swallow the conditions to pave a narrow way for official change of gender. With this decision, I hope lawmakers will change the law to support the wishes of the LGBT community.”

Law 111 has been widely condemned by human rights organizations around the world, including the UN, which considers “sterilization surgeries as a prerequisite to enjoy legal recognition of their preferred gender” a human rights violation.

Human Rights Watch (HRW) issued a report in 2017 as part of the UN’s 16 Days of Activism Against Gender-Based Violence campaign, urging Japan to end the forced sterilization of trans people in order to obtain legal recognition.

Government officials in Japan have defended Law 111, citing a need for “objectivity and certainty” in determining whether someone is actually transgender and deserving of applicable legal verification.

The Japanese government has taken positive steps toward improving LGBTQ rights in the country, including multiple municipalities legally recognizing same-sex unions. The city of Iruma also elected Tomoya Hosoda, a trans man, to its city council.

HRW calls Japan's continued policy of forced sterilization “contrary to [its] reputation as a champion of LGBT rights.”