I love questions!

There's a national health insurance and pension system in Japan that everyone is required to join (it's a bit more complicated than that, but never mind). The fees are based on your previous year's income.

Most clinics and hospitals accept this insurance, and for most people it covers 70% of the cost of healthcare (more in certain cases). Prices are set by the government as a condition of participating. There's a maximum out-of-pocket limit too, so you're covered if you have a long hospital stay or whatever.

However, only approved treatments can be used under this scheme, and cosmetic, experimental, and off-label treatments aren't covered. Some clinics specializing in these don't bother joining the system and set their own prices.

You can get private insurance as well, of course, but there's not much point.

Ooh, lucky! I guess you went to a better clinic than me then :)

(I only found out afterwards that mine was a bit notorious for being stuck in the past)

Yep! If you can read Japanese, the details are here.

It's partly Japan being way behind the rest of the world as usual, and partly due to a case in the 60s where a surgeon was prosecuted for performing sex reassignment on a sex worker. This violated Japan's eugenics law (fortunately repealed since then) against sterilization. (The same law required forced sterilization of disabled people, resulting in a court case which still pops up in the news from time to time). So the doctors got a bit jumpy and wrote guidelines to give themselves some legal protection.

Basically, a strict interpretation means you have to get a psychiatrist to rule out any other possible explanation before you're allowed to transition (that includes hormones, not just SRS). Up until last year, RLE was a requirement. Fortunately most specialist gender clinics here are a bit more relaxed and tend to follow WPATH, so getting started is quite easy. But to get approval for surgery you still need the mental health people involved, and despite having lived as a woman for over a year at that point (with documented proof!) they weren't convinced and wanted to start the observation period from scratch. They were kind enough (!) to cut the period down to six months, though, so I had to go into Tokyo once a month for a 30-second appointment so they could check I was still being girly enough. No, seriously: they explained at the beginning that it would be a problem if I turned up to the appointment appearing masc. At the same time I had a series of written and oral interrogations into just why I thought I wanted to be a woman, my sexual history, etc etc. At every stage they openly expressed doubt as to the truth of what I was saying. It was humiliating and exhausting, but it's done now.

Thanks! It's not that long, and you pretty much guessed it :)

So, surprisingly, SRS is covered by the national health insurance (at certified hospitals) as a treatment for GID. But of course, it's not that easy, and in order to book the surgery you need approval from a "gender committee", which is an excruciating combination of waiting, and dancing to the tune of gatekeeper psychiatrists (so, what do you think of when you masturbate?)

Anyway, one of the conditions to even start the approval process is a year of hormone therapy. And, guess what? Cross-gender hormone therapy is not covered by insurance. I can get as much testosterone as I want, though! The law says that you're not allowed to mix approved and unapproved treatments for the same condition, and so -- tada! -- you have to pay full price for surgery. I can't think of any way you could ever use insurance for it, unless there was some pre-existing medical reason you couldn't take HRT and you somehow managed to convince the committee that you still wanted to go ahead.

DIY was just at the beginning, because I had to wait several months to get my initial diagnosis, and even then the first clinic I went to only offered weekly E.V. injections, so I was crashing out by day 6 or so every week. Fortunately I'm on patches now.

I'd have thought Korea might well be cheaper than here, although I haven't checked. There are just so few places offering it and they're always fully booked so they just keep on raising the price.