In a landmark recommendation, the American Medical Association (AMA), the country's largest association of physicians, released in a June report that they are advocating for the removal of 'male' and 'female' sex as a legal designation from the public portion of birth certificates.

"Gender is a social construct that describes the way persons self-identify or express themselves. A person's gender identity may not always be exclusively male or female and may not always correspond with their sex assigned at birth," reports the AMA.


The AMA's LGBTQ advisory committee pushed for the change, which marks a major step forward in gender equity, and advocates for the removal of a major bureaucratic hoop that the transgender community often needs to jump through to fully participate in society.

Though birth certificates contain highly personal information, they're still a document of public record, required for everything from enrolling in schools, participating in sports, obtaining a driver's license or a passport, to getting married or adopting a child.

Per the AMA's recommendation, the sex designation would remain on the birth certificate as part of the private record—not the public facing one—to be used only for medical, public health and statistical purposes.

"Assigning sex using a binary variable and placing it on the public portion of the birth certificate perpetuates a view that it is immutable and fails to recognize the medical spectrum of gender identity," writes the LGBTQ advisory committee. "Participation by the medical profession and the government in assigning sex is often used as evidence supporting this binary view. Imposing such a categorization system risks stifling self expression and self-identification and contributes to marginalization and minoritization."

Birth certificates have long held potential for discrimination

Historically, birth certificates have been used to promote racial hierarchies and discrimination.

"For that reason, the race of an individual's parents is no longer listed on the public portion of birth certificates. However, sex designation is still included on the public portion of the birth certificate, despite the potential for discrimination," writes the AMA.

This change is intended not only to protect the privacy of individuals, but also to prevent future discrimination by avoiding the disclosure of a person's sensitive personal information.

Having a gender identity that doesn't match the assigned sex on your birth certificate can result in possible confusion, discrimination, harassment or even the potential for violence whenever the birth certificate is requested, notes the AMA.

"We unfortunately still live in a world where it is unsafe in many cases for one's gender to vary from the sex assigned at birth," Jeremy Toler, a delegate from GLMA: Health Professionals Advancing LGBTQ Equality, said to WebMD.

More work is needed

While this is a significant win for the LGBTQIA+ community, this is still just a recommendation, albeit one with great weight behind it.

Today, 49 states and Washington, DC allow people to amend their sex designation on their birth certificate—though the process highly varies by state, ranging from simply requiring the signature of a medical provider to as drastic as requiring proof of surgery. Ten states currently allow a gender-neutral designation on the birth certificate, usually marked as an "X."

Tennessee remains the only state that does not allow an amendment of the sex designation on birth certificates.

The AMA's LGBTQ advisory committee admits that this change "will not address all aspects of the inequities transgender and intersex people face, but such an effort would represent a valuable first step." It's a powerful move.