A federal judge in Arizona has ruled that transgender people are no longer required to get gender-affirming surgeries in order to update their birth certificates to align with their gender identity. The Arizona Department of Health Services has 120 days to comply with the ruling.

“We are grateful that the Court ruled in Plaintiffs’ favor and found that this outdated requirement violated Plaintiffs’ constitutional rights,” said Rachel Berg, a staff attorney for the National Center for LGBTQ Rights (NCLR), which filed the case on behalf of four trans youths. “We are thrilled that the Arizona Department of Health Services will be permanently enjoined from enforcing this irrational and overly burdensome requirement, and Plaintiffs will be able to amend their birth certificates to reflect who they are.”

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The ruling instructs the Arizona Department of Health Services to ignore the state’s law that requires proof of surgery to be able to amend gender markers on a birth certificate. A correction of one’s gender marker on the document still requires a doctor to attest that the patient is living as a different gender from the one assigned at birth.

The Arizona Attorney General’s Office represented the state health department. The office told the Arizona Daily Star that they are studying the ruling while deciding whether to launch an appeal on the matter.

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In August last year, the same federal judge, James Soto (who was appointed by former President Barack Obama), made a similar ruling recommending that the Department of Health Services reconsider the surgical requirement for amending a birth certificate.

Soto highlighted that the requirement risked forcing trans people into unnecessary surgeries in order to live authentically or risk outing themselves in potentially dangerous situations. After a failure to act from the Department of Health Services, this week’s ruling from Judge Soto takes the matter out of their hands.

Earlier this year, Arizona Republicans tried to pass legislation to ban gender marker changes on trans people’s birth certificates entirely. While that bill passed both the state’s House and Senate, it was vetoed by Democratic Gov. Katie Hobbs.

The governor upheld her promise to veto any anti-trans bills that made it to her desk, saying the legislature should “focus on real issues that matter and impact people’s everyday lives.”

If the Arizona ruling withstands an appeal, it’ll leave only 10 states that require proof of surgery for trans people to correct their birth certificate gender markers. However, several states still refuse to allow trans people to update their gender markers in any way.

The requirement for trans people to receive surgery to update their gender markers is discriminatory, can force people to have surgeries they don’t want, and can cause particular issues for minors who cannot access gender-affirming care.

As Soto noted in his 2024 ruling, “Not every transgender person needs surgery to complete a gender transition. Starting social transitioning and other recommended therapy may eliminate the need for any potential surgical intervention.”

These requirements can mean that minors, regardless of whether they wish to pursue gender-affirming surgeries later in life, are stuck for many years with documentation that includes an incorrect marker. That can lead to situations where a trans person is forced to out themselves, which — aside from being mentally damaging — can also put them at risk for physical harm, given the current climate towards trans people.

In a statement, NCLR noted, “For young people, their birth certificate impacts everything from school records to camp registration. ”

Finally, in most cases the surgeries required for a trans person to update their birth certificate in these states result in sterilization. That forces them to either give up on having biological kids one day, go through expensive processes to preserve their sperm or eggs, or requires them to put off updating their documents until after having children.

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