All I can say is, once the new card arrived, I saw a much happier child and more confident child, once he felt that he was legally recognized as a male,” Alice says, speaking about the day her son, now sixteen, got his revised birth certificate in the mail last June. (Alice’s name has been changed to protect her family’s privacy.)
Though Alice’s son wasn’t born in North Carolinaher family moved here from the Northeast more than a decade agothe state where he was born, like North Carolina, requires people to undergo surgery before they can revise the sex on their birth certificate. In her son’s case, any irreversible sex affirmation operation would fulfill the requirement, which meant a mastectomy would suffice.
“All of this [was] out of pocket medically, as it is considered cosmetic surgery,” Alice says. “This was hard on us financially, but we did it for the mental and physical stability of our child.” Ultimately, altering the birth certificate cost the family $8,300.
People born in North Carolina face similar hurdles. According to state statute, individuals have to receive “sex reassignment surgery” in order to change the sex on their North Carolina birth certificate. But there are many types of sex reassignment (better described as “sex affirmative”) surgery: mastectomies, hysterectomies, and phalloplasties for trans men; facial feminization surgeries, breast augmentations, and vaginoplasties for trans women. The language isn’t clear as to which surgery the law actually refers to.
When I asked Chris Brook, the legal director of the ACLU of North Carolina, about this, he told it was safe to assume, especially given House Bill 2, that the state is referring to surgery of the genitalia. For proof that the surgery has been performed, North Carolina requires a notarized letter from the doctor who performed the surgery or from “a physician licensed to practice medicine who has examined the individual and can certify that the person has undergone sex reassignment surgery.”
“You can change your gender marker in North Carolina. It’s a very onerous process to do so,” Brook told me.
As a North Carolinian born in New York, updating my birth certificate to reflect my proper sex is comparatively easy. No surgery is required, though I would have to submit a notarized affidavit from a licensed physician explaining that I had “undergone appropriate clinical treatment for a person diagnosed with gender dysphoria.” It takes about three months to get the updated birth certificate.
I would more than fulfill New York’s requirementsand North Carolina’s, too, had I been born here. The total cost of the surgeries I’ve undergone (facial feminization and vaginoplasty) comes to more than $50,000; for the vaginoplasty, I had to obtain two letters from therapists: one to attest that I’d thought through my decision, the other to ensure that I didn’t have any mental health issues.
Because I pass so well, howeversomething I’m grateful forI’m in no hurry to update my birth certificate. Instead, the document I’m determined to update is my driver’s license. My current one still lists my sex as male, an embarrassment I’m forced to face every time I show it to someone.
• • •
[page]
There’s a medical condition that is characterized by extreme discomfort with the primary and secondary sex characteristics of one’s body. The current name for this condition is gender dysphoria. That term also refers to a psychological condition brought on by an acute dissonance derived from the cultural and social associations of the male and female sex. A preponderance of research into the cause of gender dysphoria points to a disorder of sex development. While researchers have yet to narrow down the specific mechanisms at work, a neuroanatomical cause seems to be responsible. (On occasion, gender dysphoria pushes someone into a nonbinary statein other words, a condition in which people don’t view themselves as either the male or female sex.)
There’s no cure for gender dysphoria, but there are a number of ways to treat the symptoms. This is known as transitioning: medical measures and social steps taken to lessen the dysphoria and bring the body more closely in alignment with the mind. These steps include hormone replacement therapy, laser hair removal, going full-time (i.e., presenting publicly as your transitioned sex), and the surgeries mentioned above. Some reach a point in their transition where they’re comfortable enough that they don’t need to get every possible thing done, especially considering the cost and intensive nature of the surgeries. Others may have concurrent medical conditions that prevent them from taking some, most, or maybe even all of the medical steps needed.
Understanding transitioningand how states handle the processis crucial to understanding why House Bill 2, whatever its intent, is bad public policy. The law mandates that bathrooms in North Carolina schools and government buildings be used by those who have the corresponding sex on their birth certificate. But states have different standards for updating birth certificates, some easier than others.
There are three broad groups of states when it comes to these laws. The first and most common are states like North Carolina, where the applicant must undergo a sex affirmation surgery. States in the second-largest group have laws comparable to New York’s: a requirement to submit a notarized letter from a practicing physician stating that the applicant has undergone appropriate clinical treatment. The third and final group is the smallest, and states belonging to this group don’t allow any alteration of a birth certificate under any circumstances. These states, according to Lambda Legal, include Tennessee, Idaho, Ohio, and Kansas.
“I’m willing to wager a number [of transgender people in North Carolina] were born in Tennessee,” Brook explains. “So they, pursuant to HB 2, are stuck in the wrong restroom for life.”
• • •
[page]
Laws like North Carolina’s might be more reasonable if surgeries were more affordable and were something everyone received at the same point in their transition. The reality is far more complicated. Everybody’s transition is different, not everything happens quickly, and no step is automatic. Even if you get vaginoplasty, for example, your birth certificate isn’t automatically updatedand HB 2 doesn’t address what bathroom you’re supposed to use between getting the surgery and obtaining a revised birth certificate.
For those born in North Carolina, once you’ve had genital surgery and obtained a notarized doctor’s letter proving you’ve undergone the surgery, you’ll need to fill out a form called a Request to Amend a Record. You’ll need a photocopy of a valid form of identification and $24, which covers a search fee. Mail all of that to North Carolina’s Vital Records (1903 Mail Service Center, Raleigh, NC 27699-1900).
The Vital Records department will then evaluate your request and, if it meets the requirements outlined by General Statute 130A-118, you’ll be contacted in writing and have to pay up to $15 to actually amend the birth certificate. Once the state has this final fee, your birth certificate will be changed. About six weeks later, you’ll receive your new birth certificate in the mail.
(North Carolina’s Department of Health and Human Services did not respond to the INDY‘s request for the number of revisions for birth certificates involving sex designations within the past five years.)
As for Alice and her son, they’re relieved they were able to update his birth certificate before House Bill 2: “[We] feel fortunate that we were able to do this last year in June, because we do not know how many more obstacles we would have run into with [HB 2],” she says. “I am not sure if HB 2 would have made it harder to change things, but I am just relieved we didn’t have to find out.”
This article appeared in print with the headline “How to Change Your N.C. Birth Certificate”
