South Central states living in the past on transgender document changes

States lag far behind current medical definitions regarding transgender persons going through transition.

by Rob Howard
Associate Editor

Kansas officials are attempting to prevent transgender persons from changing the gender on their birth certificate.

For years, the Kansas Department of Health and Environment (KDHE) allowed transgender persons to amend their gender on their birth certificate if they had medical certification that they had gender affirmation surgery.

Stephanie Mott, a Kansas transgender and LGBTQ activist, told The Gayly that, ““If you had gender affirmation surgery and a physician would testify to that, that you could have your birth certificate changed, but they haven’t followed that rule since 2012.”

The proposed change in the agency’s rules is particularly egregious because it effectively prevents trans people from getting a birth certificate that conforms to their gender identity, even if they have gone through gender affirmation surgery, a position that is at odds with both current medical policy, and most states’ rules.

Mott says the rule change, “Affects our safety.” Kansas will change name and gender on state Driver’s Licenses with name change court order or other documents showing the new name and gender, and a statement from a physician that the applicant has “Undergone the appropriate clinical treatment.” That is a much more modern approach to affirming the gender of a trans person.

GLAD (LGBT Legal Advocates & Defenders) notes that “most states require proof of sex reassignment surgery.” They point out that “This requirement reflects and outdated, medically inaccurate understanding of gender transition. Surgery is not a prerequisite to gender transition.”

Mott outlined the safety aspect for trans people. “When transgender people present documents that don’t match each other, or don’t match how the person presents, 28 percent experience harassment, 15 percent are turned away [from obtaining service] and 3 percent experience violence.”

Mott applied to the KDHE for a gender change on her birth certificate in December; the application was denied in January. Mott is suing the state to get the document changed to conform to the person she is.

Perhaps not surprisingly, the KDHE in January began the process of changing the rule that allowed birth document gender changes.

The current rule reads: “The items recording the registrant’s sex may be amended if the amendment is substantiated with the applicant’s affidavit, or a parent’s affidavit if the registrant is under the age of 18, that the sex was incorrectly recorded, or with a medical certificate substantiating that a physiological or anatomical change occurred.”

The proposed new rule reads: “The item recording the registrant’s sex may be amended if the amendment is substantiated with the registrant’s affidavit, or a parent’s affidavit if the registrant is under the age of 18, that the sex was incorrectly recorded and with medical records substantiating the registrant’s sex at the time of birth.” It deletes the option of certifying that gender affirmation surgery has taken place.

Kansas lags behind other states in The Gayly’s area in dealing with requests for gender change on birth certificates, even though those states lag far behind current medical definitions regarding transgender persons going through transition.

According to the National Center for Transgender Equality’s (NCTE) website, Arkansas and Missouri allow changes if the person’s gender “has been changed by surgical procedure.” Oklahoma and Texas don’t have specific procedures, but Oklahoma will “likely” change the birth certificate on receipt of a court order.

Texas rules allow Texas Vital Statistics to issue an amended birth certificate, but NCTE notes that, “Current case law and evidence indicates that Texas officials and judges are adverse to issuing the necessary court orders.”

The medical standard published by the World Professional Association for Transgender Health explains that there are a variety of options for gender transition. The options include:

  • A combination of surgery, hormones, social transition, psychotherapy, as well as other means.
  • Treatments are individualized
  • Health professionals recognize that “while many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these options and some need neither.”

Many progressive states have adopted that definition in their rules for changing birth gender for transgender persons. California requires, “a statement from a physician that you have ‘undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards.’"

Washington requires only, “a letter from a physician stating that the requestor has had appropriate clinical treatment for gender transition.”

In other words, California and Washington, and at least ten other states and Washington, D.C. have removed surgical requirements.

It’s a start. But Mott says, “I think the thing being missed here, that we really need to talk about, is that we know there is a direct correlation between validating a transgender person’s gender identify [and their mental health]. Any action by governments, organizations or individuals that invalidates a transgender person’s identity makes it more likely that they will attempt to end their own life.

“When we invalidate transgender youth, statistics show that up to 50 percent attempt suicide”

She concluded, “In schools with inclusive policies the negative outcomes are reduced, where they are exclusive, the negative outcomes increase.”

It appears that Kansas, Texas, Oklahoma, Arkansas and Missouri need a more enlightened approach to transgender persons and that they need to adopt current medical standards instead of requiring gender affirmation surgery.

For general procedures for name changes, driver’s license changes and birth certificate changes, the NCTE website,, is a great starting place.

The Gayly – May 12, 2016 @ 9:35 a.m.