Respect Equality

Transgender people in North Carolina no longer required to provide proof of surgery to correct birth certificates

“The State of North Carolina now must recognize us for who we are.”
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Story at a glance


  • Transgender people born in North Carolina are now able to alter their gender marker on their birth certificates regardless of whether they have undergone gender-affirming surgery, a federal judge said Thursday.

  • The ruling stems from a Lambda Legal lawsuit filed last year alleging the state’s surgical requirement erected unnecessary and discriminatory barriers for transgender people wishing to correct their birth certificates.

  • Transgender people in most other states are not easily able to alter their gender identity on official state-issued documents.

Transgender people born in North Carolina are now able to alter their gender marker on their birth certificates regardless of whether they have undergone gender-affirming surgery, a federal judge said Thursday.

Under a consent judgment issued by U.S. District Court Judge Loretta C. Biggs, the North Carolina Department of Health and Human Services and other state government officials must provide corrected birth certificates to transgender applicants regardless of whether they have undergone gender-affirming surgery.

In seeking to change the gender marker on their birth certificates, transgender North Carolinans will still be required to provide “supporting documentary evidence” of their gender identity, including an accurate driver’s license or identification card, valid U.S. passport or certification from a physician or mental health professional stating the gender identity.

Thursday’s ruling stems from a lawsuit filed by Lambda Legal last year on behalf of three plaintiffs who were unable to obtain birth certificates reflecting their gender identity. 


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“The State of North Carolina now must recognize us for who we are,” Lillith Campos, a transgender woman born in North Carolina and one of the plaintiffs in the lawsuit, said Thursday in a statement released by her attorneys.

Campos called the state’s prior surgical requirement “outrageous” and “dehumanizing.”

“We should all agree that everyone deserves accurate and accessible identity documents that allow us to go through life and run errands with safety, dignity and respect,” she said.

Most mainstream research supports this. More than a third of transgender people in a nationwide survey released in 2015 said they had been harassed, assaulted or discriminated against when they presented an identity document with a name or gender marker inconsistent with their their perceived gender.

While there is no exact blueprint for gender-affirming care, not all transgender people want or need surgery. In 2015, only about a quarter of transgender and gender-nonconforming people reported undergoing procedures similar to those once required in North Carolina. 

Perhaps more importantly, more than half of transgender people who wanted gender-affirming surgery prior to 2015 said they were denied coverage for it by their health insurance company. About 25 percent who sought coverage for other gender-affirming medical care, like hormone therapy, were also denied.

A study published in April by researchers at the LGBTQ+ youth suicide prevention and crisis intervention group the Trevor Project determined that the risk of suicide among transgender youth is significantly lowered when the gender listed on their identification documents is consistent with their gender identity.

In a statement on Thursday, Omar Gonzalez-Pagan, counsel at Lambda Legal, commended the court’s decision, but acknowledged that more work needs to be done across the country, where transgender people in many states still face barriers to acquiring identity documents that match their gender identity.

“This lawsuit was just the latest step in our nationwide battle to break down barriers for transgender people to access accurate identity documents,” he said.