Editors' Note: Guest blogger Jen Pula, MD is a psychiatrist and member of the LGBT Committee of the Group for Advancement of Psychiatry
Two transgender citizens, Sam Berkely and Joann Prinzivalli, are suing New York City's Department of Health and Mental Hygiene. Why? Ms. Prinzivalli felt humiliated when she went to the DMV to apply for a new license and a clerk kept calling her "sir" because her legal birth certificate listed her as "male." Mr. Berkely, whose birth certificate says "female," applied for new health insurance and endured a disapproving, shaming gaze from the company's employee.
Why are they suing New York City over these incidents? Because its 40-year old health code requires individuals to have genital surgery before changing their legal gender on their birth certificates. Yet today, many people like Prinzivalli and Berkely transition without undergoing genital surgery, and an absence of legal documentation can create situations that are often embarrassing, discriminatory and possibly even dangerous.
Calling a trans woman "sir" in public may expose her to potential harassment and possibly even violence. Possible denial of health insurance for being trans is discriminatory. When a trans person transitions to a new gender, they need new legal documents that accurately reflect their lived gender.
Policies regulating the change of gender on legal documents vary by state, locality, and country. Many states continue to stipulate a requirement of surgery, though most, including New Jersey allow for non-genital surgery (eg.-chest surgery in female-to-male transition). Washington State does not require proof of surgery and neither does the federal government to anyone born abroad to US parents. The ACLU has recently filed suit against the state of Illinois for requiring genital surgery. The UK, Spain, Uruguay, Hungary, and Finland require no surgery. German courts have struck down as unconstitutional a law that required genital surgery to obtain corrected birth certificates.
New York City's requirement for genital surgery is misguided and behind the times. Today, transgender people have a myriad of medical and social options available to transition. Some will avail themselves of hormones and surgery. Some will choose to have genital surgery. However, genital surgery is not always available, is not always affordable, is not always medically indicated, is not always desired, and it is not always effective. In New York City, only 5% of trans men and 20% of trans women undergo genital surgery.
Clinical experience has shown that one can undergo a successful gender transition without genital surgery and many people comfortably take this route. Being able to change legal documents is a vital step in completing a successful transition. According to the "Standards of Care" issued by the World Professional Association for Transgender Health (WPATH), "genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes." Furthermore, WPATH cautions that the "delay of document changes may have a deleterious impact on a patient's social integration and personal safety."
Across the country, reform is needed so that requirements are consistent with the medical definition of gender transition, which does not require genital surgery. New York City's Department of Health and Mental Hygiene needs to revise its policy so that transgender citizens can safely and productively move on. Their lives depend upon it.