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December 2017

Transgender Surgery—Not the Benchmark for Gender Marker Determination

Author Affiliations
  • 1School of Medicine and Health Sciences, The George Washington University, Washington, DC
  • 2Legal Services, Whitman-Walker Health, Washington, DC
JAMA Surg. 2017;152(12):1099-1100. doi:10.1001/jamasurg.2017.3432

North Carolina legislators recently partially repealed House Bill 2, the law requiring transgender individuals to use the public bathroom that corresponds with the sex (also referred to as gender marker) that is listed on their birth certificate. The logical short-term solution to this legislation for transgender people living in North Carolina might have been to change the gender marker that was listed on legal documents, a goal that most transgender people pursue during their gender transition. However, in North Carolina, as well as most other states, to change the gender marker on a birth certificate or a driver’s license, individuals must have undergone sexual reassignment surgery, an overly broad term that typically refers to “bottom surgeries” such as a vaginoplasty for transgender women (male to female), or a phalloplasty or metoidioplasty (a less complex procedure than phalloplasty that lengthens the clitoris to 4-5 cm) for transgender men (female to male).1 However, not every transgender individual wants, or is medically able, to undergo such invasive procedures. For those who are interested, these procedures are difficult to obtain because of the lack of surgeons who are trained to perform them, the related costs, and ongoing controversies regarding insurance coverage. Because of the challenges related to gender-affirming procedures, it is critical that the legal status of transgender people never be determined by surgical history.

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