Birth Certificate

Birth certificate laws govern the process by which a state changes (or refuses to change) a gender marker on a person’s birth certificate. Many transgender people choose to revise the gender marker on their identity documents so that it matches the gender they live every day. Accurate and consistent gender markers on identity documents helps transgender people gain access to public spaces and resources, as well as dramatically reducing the risk they will face violence, discrimination, or harassment. For more information, see here.
State allows residents to mark M, F, or X on their birth certificates
State allows residents to mark M, F, or X on their birth certificates
(16 states + 1 territory + D.C.)
State updates birth certificates using an administrative process and does not require provider documentation
(15 states)
State updates birth certificates using an administrative process and requires provider documentation of "appropriate treatment"
(10 states + 2 territories + D.C.)
State has unclear process and/or unclear medical requirements left to the discretion of individual judges (see citations for more information)
(5 states + 2 territories)
State updates birth certificates using an administrative process but requires proof of surgery
(3 states + 1 territory)
State updates birth certificates but requires both a court order and proof of surgery
(7 states)
State does not allow for amending the gender marker on the birth certificate
(10 states)
State bans the use of an X option on birth certificates
State bans the use of an X option on birth certificates
(3 states)
Citations & More Information

*NOTES (and click the “Citations & More Information” button below the map legend for more information on every state):
—North Dakota‘s 2023 law bans all gender marker changes on birth certificates with a narrow exception for individuals who have had genital surgery. This is a stricter, more explicit surgical requirement than in many other states. See the “Citations & More Information” for further detail. 
—Puerto Rico‘s 2025 court ruling allowing “X” options on birth certificates may not be immediately implemented or available, pending the state’s birth certificate registry update.

See also MAP’s 2022 report The ID Divide: How Barriers to ID Impact Different Communities and Affect Everyone, detailing the ways that barriers to obtaining an accurate ID significantly impact people’s ability to move through their daily lives and how these obstacles harm specific communities, as well as our related Fact Sheet: Identity Documents & Transgender and Nonbinary Communities (2022).

 

Recommended citation for this set of maps:
Movement Advancement Project. 2026. “Equality Maps: Identity Document Laws and Policies.” https://mapresearch.org/equality-map/identity-document-laws-and-policies/. Data as of June 12, 2026.

Recommended citation for this specific map:

Movement Advancement Project. 2026. “Equality Maps: Gender Markers on Birth Certificates.” https://mapresearch.org/equality-map/identity-document-laws-and-policies/#birth-certificate. Data as of June 12, 2026.

Percent of Transgender Population Covered by Laws

*Note: These percentages reflect estimates of the transgender population (ages 18+) living in the 50 states and the District of Columbia. Estimates of transgender people in the U.S. territories are not available, and so cannot be reflected here. Population estimates are from The Williams Institute.

40%
40% of transgender people (ages 18+) live in states that allow residents to mark M, F, or X on their birth certificates
36%
36% of transgender people (ages 18+) live in states that update birth certificates using an administrative process and do not require provider provider documentation
21%
21% of transgender people (ages 18+) live in states that update birth certificates using an administrative process and require provider documentation of "appropriate treatment"
9%
9% of transgender people (ages 18+) live in states that have unclear processes and/or unclear medical requirements left to the discretion of individual judges
10%
10% of transgender people (ages 18+) live in states that update birth certificates but require both a court order and proof of surgery
19%
19% of transgender people (ages 18+) live in states that do not allow for amending the gender marker on the birth certificate
5%
5% of transgender people (ages 18+) live in states that update birth certificates using an administrative process but require proof of surgery