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The Nuts and Bolts of Gender Change
Laws
SACRAO 2014
Kristin Drapela
Administrative Assistant II
University of Georgia
What do the terms mean?

Sex
-refers to a person’s biological status and is typically categorized as
male, female, or intersex (i.e., atypical combinations of features
that usually distinguish male from female). There are a number of
indicators of biological sex, including sex chromosomes, gonads,
internal reproductive organs, and external genitalia.

Gender
-refers to the attitudes, feelings, and behaviors that a given culture
associates with a person’s biological sex. Behavior that is
compatible with cultural expectations is referred to as gendernormative; behaviors that are viewed as incompatible with these
expectations constitute gender non-conformity.
What do the terms mean?

Sexual orientation
-refers to the sex of those to whom one is sexually and romantically
attracted. Categories of sexual orientation typically have included
attraction to members of one’s own sex (gay men or lesbians),
attraction to members of the other sex (heterosexuals), and
attraction to members of both sexes (bisexuals). While these
categories continue to be widely used, research has suggested that
sexual orientation does not always appear in such definable
categories and instead occurs on a continuum (e.g., Kinsey,
Pomeroy, Martin, & Gebhard, 1953; Klein, 1993;Klein, Sepekoff, &
Wolff, 1985; Shiveley & DeCecco,1977). In addition, some
research indicates that sexual orientation is fluid for some people;
this may be especially true for women (e.g.,Diamond, 2007;
Golden, 1987; Peplau & Garnets, 2000).
What do the terms mean?

Gender identity
-refers to “one’s sense of oneself as male, female, or transgender”
(American Psychological Association, 2006). When one’s gender
identity and biological sex are not congruent, the individual may
identify as transsexual or as another transgender category
(cf.Gainor, 2000).

Gender expression
-refers to the “...way in which a person acts to communicate gender
within a given culture; for example, in terms of clothing,
communication patterns and interests. A person’s gender
expression may or may not be consistent with socially prescribed
gender roles, and may or may not reflect his or her gender
identity” (American Psychological Association, 2008, p. 28).
What do the terms mean?

Transvestite
-refers to individuals who regularly or occasionally wear the clothing
socially assigned to a gender not their own, but are usually
comfortable with their anatomy and do not wish to change it (i.e.
they are not transsexuals). Cross-dresser is the preferred term for
men who enjoy or prefer women's clothing and social roles.
Contrary to popular belief, the overwhelming majority of male
cross-dressers identify as straight and often are married. Very few
women call themselves cross-dressers.
What do the terms mean?

Transsexual
-refers to a person who experiences a mismatch of the sex they were
born as and the sex they identify as. A transsexual sometimes
undergoes medical treatment to change his/her physical sex to
match his/her sex identity through hormone treatments and/or
surgically. Not all transsexuals can have or desire surgery.

Transition
-refers to a complicated, multi-step process that can take years as
transgender people align their anatomy with their sex identity
and/or their gender expression with their gender identity.
What do the terms mean?

Transgender
-refers to people whose psychological self ("gender identity")
differs from the social expectations for the physical sex they were
born with. For example, a female with a masculine gender
identity or who identifies as a man. An umbrella term for
transsexuals, cross-dressers (transvestites), transgenderists,
gender queers, and people who identify as neither female nor
male and/or as neither a man or as a woman. Transgender is not a
sexual orientation;transgender people may have any sexual
orientation. It is important to acknowledge that while some people
may fit under this definition of transgender, they may not identify
as such.
What do the terms mean?
Gender Dysphoria
According to the Diagnostic and Statistical Manual of Mental Health
Disorders, Gender Dysphoria is a condition where the gender at birth is
contrary to the one identified with.
For a person to be diagnosed with gender dysphoria, there must be a
marked difference between the individual’s expressed/experienced
gender and the gender others would assign him or her, and it must
continue for at least six months. This condition causes clinically
significant distress or impairment in social, occupational, or other
important areas of functioning.
Gender Dysphoria
Aetna's Clinical Policy Bulletin on Sexual Reassignment Surgery:
Aetna considers sex reassignment surgery medically necessary when all of the
following criteria are met:
Requirements for mastectomy for female-to-male patients: Single letter of
referral from a qualified mental health professional (see appendix); and
persistent, well-documented gender identity disorder (see appendix); and
capacity to make a fully informed decision and to consent for treatment; and
age of majority (18 years of age or older); and if significant medical or
mental health concerns are present, they must be reasonably well controlled.
Note that a trial of hormone therapy is not a pre-requisite to qualifying for a
mastectomy.
Gender Dysphoria
Requirements for genital reconstructive surgery (i.e., vaginectomy,
urethroplasty, metoidioplasty, phalloplasty, scrotoplasty, and placement of a
testicular prosthesis and erectile prosthesis in female to male; penectomy,
vaginoplasty, labiaplasty, and clitoroplasty in male to female): Two referral
letters from qualified mental health professionals, one in a purely evaluative
role (see appendix); and persistent, well-documented gender identity disorder
(see appendix); and capacity to make a fully informed decision and to
consent for treatment; and age of majority (age 18 years and older); and if
significant medical or mental health concerns are present, they must be
reasonably well controlled; and twelve months of continuous hormone
therapy as appropriate to the member’s gender goals (unless the member has
a medical contraindication or is otherwise unable or unwilling to take
hormones); and twelve months of living in a gender role that is congruent
with their gender identity (real life experience).
Gender Dysphoria
Requirements for gonadectomy (hysterectomy and oophorectomy in female-tomale and orchiectomy in male-to-female): Two referral letters from qualified
mental health professionals, one in a purely evaluative role (see appendix);
and persistent, well-documented gender identity disorder (see appendix); and
capacity to make a fully informed decision and to consent for treatment; and
age of majority (18 years or older); and if significant medical or mental
health concerns are present, they must be reasonably well controlled; and
twelve months of continuous hormone therapy as appropriate to the member's
gender goals (unless the member has a medical contraindication or is
otherwise unable or unwilling to take hormones).
Issues related to Higher Education
Registrar and Admissions Offices

Name Changes

Gender Changes

Discrimination
Name Changes
Changing a name is fairly straight-forward. Most judges will grant a name
change as long as they are convinced that the petitioner is not trying to
defraud anyone and as long as all paperwork and requirements have been
met.
For example, in Fulton County GA the steps are as follows: Fill out Petition to
Change Name, Verification Form, and Notice of Petition to Change Name.
Get Verification Form notarized. Publish the Notice of Petition to Change
Name once a week for four weeks in the Fulton County Daily Report. Go
before a judge in person and obtain the Final Decree. File the Final Decree
and get a certified copy.
Once a name change has been granted then the name can legally be changed on
Social Security cards, Passports, Driver's Licenses and Birth Certificates.
Gender Changes
Gender changes are not nearly as straight-forward as name changes and vary
from agency to agency and state to state.
Social Security Agency-requires a letter specifying “clinic or medical records or
other combination of documents showing the sex change surgery has been
completed”. This is enforced erratically. Changes have been made for
generally worded statements like, “ has undergone all necessary treatment to
be considered female”.
Passports- requires a letter from physician certifying that petitioner has
undergone “ appropriate clinical treatment”, although the formal rule is
concluded genital surgery.
Gender Changes
Birth Certificates-requires a court ordered name change and proof of surgical
treatment. Washington and Vermont allow change of gender for appropriate
clinical treatment (surgery not required). California and Virginia allow
surgery other than genital surgery as proof of gender change. Idaho, Ohio and
Tennessee will not allow gender to be changed on birth certificates. Alabama
will only issue amended birth certificates showing name and gender changes.
To confuse matters more, New York state requires that the applicant has
undergone either penectomy or hysterectomy and mastectomy; while New
York City requires that the applicant has undergone either a vaginoplasty or
phallosplasty.
Gender Changes
Driver's License-vary from state to state.
Hawaii, Iowa, Massachusetts, New Jersey, Texas, and Virginia require an
amended birth certificate. Arkansas, Georgia, Illinois, Indiana, Iowa,
Mississippi, New Jersey, Ohio, Pennsylvania, South Carolina, Texas, Utah,
West Virginia, and Wisconsin require a court order. California, Connecticut,
Delaware, District of Columbia, Illinois, Indiana, Maryland, Minnesota,
Montana, Nebraska, New York, Oregon, Vermont, Washington, and
Wisconsin require a doctor's letter, but not surgery. The other thirty five
states require a doctor's letter showing surgery.
Gender Changes
Driver's License cont.For example in the state of Georgia, from the Georgia Department of Driver
Services:


Gender updates requires applicant to submit a court order or physician's
letter certifying gender change.
The letter or court order shall state the person's name, date of birth, date of
gender reassignment operation and other identifying information.
Discrimination
In a 2012 decision, the U. S. Equal Employment Opportunity Commission
found that “discrimination against a transgender individual because that
person is transgender is...discrimination 'based on... sex', and ...violates Title
VII.”
Previously, in Holloway v. Arthur Anderson & Co. the Supreme Court held the
view that gender identity discrimination is different from sex discrimination.
In Ulane v. Eastern Airlines the Supreme Court found that Title VII's use of
the term sex referred to anatomical gender and not those with Gender
Dysphoria. In Price Waterhouse v. Hopkins the court found that Title VII
covers discrimination based on the ideas of what is appropriate for genders,
and “acknowledged that enforcing a specific sex-gender match may be
discrimination.” In Smith v. City of Salem, the Sixth Circuit Court of
Appeals found that sex discrimination is present when an employer
discriminated for not adhering to cultural norms in gender expression.
Discrimination
In October 2009, President Barack Obama signed into law, the federal hate
crimes act, the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention
Act. The wording of the law includes both OFFENSES INVOLVING
ACTUAL OR PERCEIVED RACE, COLOR, RELIGION, OR NATIONAL
ORIGIN and OFFENSES INVOLVING ACTUAL OR PERCEIVED
RELIGION, NATIONAL ORIGIN, GENDER, SEXUAL ORIENTATION,
GENDER IDENTITY, OR DISABILITY and gives the Justice Department
the power to investigate and prosecute bias-motivated violence.
Discrimination
In Iowa, Maryland, New Jersey, New Mexico, North Carolina, Rhode Island,
Vermont, and the District of Columbia, the non-discrimination statutes
explicitly include “gender identity” as a protected characteristic.
In Colorado, Illinois, Minnesota, Maine, Oregon, Washington the nondiscrimination laws prohibit discrimination based on sexual orientation, and
include gender identity or expression within the statutory definition of sexual
orientation.
California offers protection to transgender people by including gender identity
or expression within the statutory definition of sex for purposes of its
discrimination laws. Hawaii similarly prohibits discrimination based on
“sex,including gender identity or expression.”
In June, 2013 Delaware Legislature passed the Gender Identity
Nondiscrimination Act.
Discrimination
Discrimination
Federal Protections
All government employees are protected by the U.S. Constitution
against irrational discrimination based on sexual orientation or
gender identity. In addition, some measure of protection already
exists under Title VII based on gender, which has been held to
include gender identity and expression.
The U.S. Equal Employment Opportunity Commission (EEOC)
and several courts have interpreted Title VII to protect transgender
employees, and the EEOC has interpreted Title VII to cover sexual
orientation discrimination. The Supreme Court has held that the
EEOC's interpretations of Title VII are entitled to "great
deference."
State
Alabama
Birth Certificate Discrimination
Amendment
Protection
yes
no
Hate Crimes
Laws
yes*
Arkansas
yes
some
yes*
Florida
yes
no
yes
Georgia
yes
no
no
Kentucky
yes
some
yes
Louisiana
yes
some
yes
Mississippi
yes
no
yes*
North Carolina
yes
no
yes*
Oklahoma
yes
no
yes*
South Carolina
yes
no
no
Tennessee
no
some
yes
Texas
yes
no
yes
Virginia
yes
some
yes*
Some indicates
executive orders
that protect public
employees
* hate crimes laws
do not include
sexual orientation
or gender identity
Based on 2006
data from Human
Rights Campaign
Resources
National Center for Transgender Equality
Transequality.org
Transgender Law & Policy Institute
Transgenderlaw.org
American Civil Liberties Union
Aclu.org/translaw
Lambda Legal
Lambdalegal.org
References
Abigail W. Lloyd, Defining the Human: Are Transgender People Strangers to the Law?, 20
Berkeley J. Gender L. & Just. 150 (2005).
Kristine Holt, Comments: Reevaluating Holloway: Title VII, Equal Protection, and the
Evolution of a Transgender Jurisprudence, 70 Temp. L. Rev. 283 (1997).
Katherine Womack, Comment: Please Check One-Male or Female? : Confronting Gender
Identity Discrimination in Collegiate Residential Life?, 44 U. Rich. L. Rev. 1365 (2010).
Dean Spade, Documenting Gender, 50 Hastings L. J. 731 (2008).
John M. Ohle, Constructing the Trannie: Transgender People and the Law, 8 J. Gender Race
& Just. 237 (2004-2005).
ACLU, Know Your Rights-Transgender People and the Law, April 24, 2013,
www.aclu.org.
APA, The Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients,
Feb 18, 2011, www.apa.org.
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