The first sex reassignment surgery (SRS) performed officially in Japan - for a female-to-male (FtM) person in 1998 and for a male-to-female (MtF) person in 1999 - are reported. For the FtM, two-stage conversion was applied. In the first operation, salpingo-oophorectomy, hysterectomy, colpectomy, metoidioplasty, and mastectomy were performed. A free flap phalloplasty with the deltoid flap is planned as the second stage. For the MtF, one-stage neovaginoplasty was performed by penile skin inversion technique with sensate pedicled neoclitoplasty.