Dr. Jillian T. Weiss

The Significance of the New State Department "Gender Change" Policy

Filed By Dr. Jillian T. Weiss | June 10, 2010 1:00 PM | comments

Filed in: The Movement, Transgender & Intersex
Tags: Hillary Rodham Clinton, passport requirements, passports, State Department

UPDATE: Here is a link to the new policy. See comments for discussion.

The U.S. Department of State has announced new policy guidelines regarding gender change in passports and Consular Reports of Birth Abroad.passport.jpg

The previous policy, which was never made publicly available, required a surgeon's affidavit documenting specific sex reassignment surgery procedures used (and often non-US affidavits were not accepted), and restricted change in the sex marker on passports to those who had "sex reassignment surgery." I got a copy of the previous policy after a FOIA request during my own passport woes. There are different kinds of surgery that might be considered in aid of "sex reassignment," but the policy didn't specify. Passport issuance often depended on the interpretation of the particular official who reviewed the application.

The new policy is not yet publicly available, but the press release says that it will require certification from an attending medical physician that the applicant has undergone "appropriate clinical treatment for gender transition."

This will be sufficient to reflect the new gender on a passport and "Consular Reports of Birth Abroad," which is essentially an official birth certificate issued for U.S. citizens who are born outside of the U.S. No additional medical records, other than the physician's statement, will be required.

What constitutes "appropriate clinical treatment for gender transition"? There are detailed guidelines, but it will not include sex reassignment surgery.

The significance of this change goes far beyond providing relief to trans people who wish to travel abroad. The federal government has essentially declared that federal law now recognizes that legal sex is not synonymous with anatomical sex for all purposes.

More explanation of what this highly significant development means, and my own passport horror story with Secretary of State Hillary Rodham Clinton, after the jump.

The press release is a bit unclear. It states that "it is also possible to obtain a limited-validity passport if the physician's statement shows the applicant is in the process of gender transition."

A "limited-validity passport" has meant, in the past, that a passport valid for a year would be issued with the new gender. The underlying assumption was that a person who wished to obtain sex reassignment surgery was required to live in the opposite sex role for at least a year in order to fulfill the medical prerequisites to surgery.

Since sex reassignment surgery is no longer required for gender change, it was unclear to me why a limited-validity passport would be necessary

I was able to speak with Mara Keisling, Executive Director of the National Center for Transgender Equality about this.

She explained that the new policy will require a letter from the applicant's physician attesting to the "appropriate clinical treatment for gender transition." A model letter will be included with the policy to assist physicians in writing the letter. "Appropriate clinical treatment" is left undefined in the policy, and what is appropriate in particular cases will be decided within the doctor-patient relationship.

Prior to completion of this "appropriate clinical treatment," however, the "limited-validity" passport will be made available upon a statement by the doctor that such treatment is in process. It will be valid for two years.

The press release also notes, comfortingly, that passport issuing officers at embassies and consulates abroad and domestic passport agencies and centers "will only ask appropriate questions to obtain information necessary to determine citizenship and identity." That implies, I hope, that passport officers and agents will receive some training on what to ask and what not to ask. Otherwise, I would expect the status quo of raised eyebrows and intrusive questioning to continue. I would like to know what training passport officers and agents will receive to ensure that this really happens.

The Real Story

As I noted, the real story here is that the State Department appears to be acknowledging that gender identity and sexual anatomy can really and truly be different. In other words, genital surgery doesn't make one into a man or a woman.

This is not only being done for passports, which are a mere travel document, but also for the Consular Report of Birth Abroad. That is a form of birth certificate issued for US citizens who are born outside the U.S. That's a big deal. There was a big brouhaha a few years ago when New York City tried to change the law to recognize sex reassignment on birth certificates prior to surgery. Iowa is the only jurisdiction in the US I know of that permits this.

That is, aside from the federal government, as of now.

The Knife Doesn't Cut It

Many people, including the well-intentioned, believe that the dividing line between man and woman is a certain anatomical configuration. If it were possible to wave a magic wand and create the requisite anatomy, that might not be so bad. But that view doesn't come close to the reality.

Sex reassignment surgery is medically difficult and expensive. Average cost for male-to-female vaginoplasty is about $20,000, and female-to-male phalloplasty is about $30,000. Costs can be less in other countries, like Thailand, and the surgeons are reputed to be excellent, but there have also been many stories about sub-standard and even dangerous follow up care if complications require an extended stay abroad. Secondary costs of travel and follow-up care add to this burden. There can be serious, long-lasting and irreparable complications even in perfectly healthy people, as we discussed a few days ago on this blog, and many common ailments constitute serious contraindications. It's also not available to those under 18 except in very rare situations.

Many female-to-male transsexuals opt against phalloplasty because of lack of sensation and erectile inability without an implanted pump. It also requires a skin graft from other areas that can create serious disfigurement. Many opt instead for hysterectomy, vaginectomy and metoidioplasty. These are less invasive, and often more satisfactory to the individual.

The fact that the State Department has taken the time and effort to understand these issues is quite a breakthrough in sensitivity to trans identity. After years of dealing with well-intentioned people who can't seem to fathom the idea that sexual anatomy is not the dividing line between male and female, this is like a breath of fresh air. Whether it will smell like roses or not will depend on what the actual regulations say.

A lot of people deserve credit for this. Those I know of include Secretary of State Hillary Clinton and her staff, Reps. Barney Frank and Steve Israel, NCTE, NCLR, the Task Force, GLIFAA, and the Council for Global Equality, the American Medical Association and the World Professional Association for Transgender Health.

Me And Hillary

Now for a history lesson. It was Spring 2001. My boyfriend was taking me to Paris.

Only one problem.

My passport had an old name and an old gender. I was planning on SRS (sex reassignment surgery) at some point in the future, but I wanted to wait until I was really, really sure. (I had started living as a female at the beginning of '98.) I had friends who had opted for it early on, and they were having some trouble adjusting.

I also had no money, as I was working as a secretary, and I had child support payments to make, and high expenses travelling from New York to Western Massachusetts every two weeks to see my 8 year old son.

I was very concerned about being stopped at airport security. My "awkward transsexual" phase was over, and it wasn't obvious to most observers that I was trans. The "M" on my passport, the male picture, and the male name would stand out like a sore thumb when presented by a female-looking person. My driver's license already had an "F" on it, so that would raise even more questions if requested.

What joy could I have in anticipating a trip to Paris, if I was constantly worrying that I would not be permitted to board the plane, perhaps charged with some kind of fraud, or worse yet, detention in a foreign country?

I called the passport agency to ask about the rules, and no one there seemed to know. I finally, after hours of trying, got someone on the line who purported to know the answer. The answer was there was nothing I could do, except update the picture. I didn't have a court order changing my name, and I didn't have sex reassignment surgery. In New York State, a name change requires a petition to the New York Supreme Court, takes months, and is not guaranteed if the judge thinks it's not appropriate to allow a male to change to a female name. (Advocates are still working on this problem.) Attorney fees run into the hundreds of dollars. (Now there are free name change clinics available, but there weren't then.)

I decided to call my U.S. Senator's office -- Senator Hillary Rodham Clinton.

I was referred to a very nice, sympathetic constituent services person there. He did some research, and said that I couldn't change my name, but I could use an "AKA" on page 24 of the passport that would say "Jillian." The front page would still have the old name, but at least I could refer people to that page to show them why my air tickets, customs form and hotel registration used a different name. However, I had to show three years of previous tax returns using the new name. Since I hadn't been using the new name for three years, that was a problem. (I wound up filing amended returns for the last three years.)

I couldn't change the gender, however. That left me concerned. I explained to the nice man why I was concerned. Airport security (even in those pre-9/11 days) sometimes caused major problems for trans people. And I didn't know what faced me on the other side of the border, where I didn't know the language or the culture. We talked about different ways to address the problem. He said he would speak to the French consulate and find out the best way to handle the issue.

He called me back after speaking to the French consulate. Apparently, their office would issue a letter to me for use just in case there was a problem in France.

However, there was a catch. They wanted me to go to a doctor of the consulate's choice for a genital examination. Then, if everything "checked out," they would issue a letter in French. I was stunned. Submit to a medical examination? I did not like the idea at all of some person I didn't know asking me to drop my drawers and taking a gawk. It was demeaning, and it also made no sense. Why would I lie about not having surgery? My passport said "M"; and I was being open about the fact that my genitalia didn't match. What did they expect to find in my underwear, flowers?

I explained my dissatisfaction with the procedure suggested. I asked if he could call them back and ask them to accept a letter from my doctor. He declined. "Do you want to do this or not?" he testily inquired.

I went to the doctor. She was a very nice older woman with a heavy French accent. She was nice, but matter of fact. She asked me to disrobe, and probed around a bit, asked no questions. I felt humiliated, but turned my head and thought of Paris.

I got my letter. I went to Paris and had a wonderful time.

P.S. Three years later, in 2002, I went to Canada for SRS. After I recovered, I went to the passport agency in Manhattan to present my surgeon's affidavit, along with my old passport and a generic form requesting a new passport. I waited on the line until I got up to the window. There were several windows right next to each other. Everybody could hear everything every one else was saying. I submitted my forms silently to the woman behind the thick plexiglas. She looked at the forms I had submitted, but could not figure out what the requested change was. She asked me a question I could not hear. Eventually after putting my ear right up to the window, I figured out that she was asking why I was asking for a new passport. I whispered "change of sex." "What?" she mouthed. "Change of sex," I whispered, a little louder. "What??" she mouthed.

Finally I gave up trying to be quiet. "I changed my sex!" I shouted into the window. The entire enormous room got very quiet for a moment. I did not look up, my face red.

After a moment, the cacophony resumed, and she accepted my papers.

This is all now ancient history. I rarely think of these incidents, and they're filed under "Curiosities" in the back of my mind.

I am glad that a new generation of trans people will not have to endure official disrespect when they get a passport.

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If it makes you feel any better, physical examinations are/were not only required of transfolk trying to travel, they were (still are?) required of people getting green cards. My wife had the humiliating experience of getting examined as a prerequisite to getting permanent resident status. that was over 10 years ago - i don't know it they still do that. but my point is that medical exams seem to have been a standard prerequisite for all kinds of immigration and travel concerns.

No, I hadn't heard that, Lurleen. It actually does make me feel better, for some reason. Thanks for writing in to say.

Yeah, every time I come into France on a long-stay visa (three times now, and I'm applying for another), I have to go through a silly medical exam. Chest x-ray, vaccinations, listen to the heart and lungs, a few other things. They're looking for communicable diseases, but it's a slow part of the bureaucracy. I showed up in August of last year and it took until March for me to get an appointment for the tuberculosis exam... I think I'd have spread it by then if I had it.

It's always great because it usually comes with some fat-shaming and orders barked out for not moving fast enough in an office with about 200 other people waiting for their exams. Good times.

INS has always had the physical exam as a pre-requisite for a green card. It is a general physical, not simply one to verify genitalia. The purpose always has been to make sure that seriously ill persons have financial means to take care of their conditions without immediately going on welfare and medicaid once qualifying for permanent residence.

"What did they expect to find in my underwear, flowers?"

Classic...I love it.

Something to check:

Does the new policy include a waiver absolving the government of responsibility and need to act in the event of a conflict in another country arising from gender presentation varying from genitalia?

Ours does. And although I'm not aware of Canada ever washing their hands of a trans traveler in trouble, it's always a worry.

holding my breath, waiting for a certain group to catch a sniff of this thread...

If you meant me, prepare to turn blue and pass out......

I think this is a wonderful development that has a direct positive effect on all intersexed people for once.

I know of several women of intersexed history who did not require "standard" SRS to correct their bodies who were totally screwed under the old system because it required specific details of surgery, was only US surgeon recognized and frankly medical history invasive as all get out.

And contrary to the popular belief, I have always been in favour of civil rights for transgender people as well as transsexual ones. My issues with TG activists were that they were screwing over women of history with their antics. Please note, this is still binary specific which I have zero problem with.

Well, I wasnt thinking of you in particular! :)

However, I *was* worried that this could be seen as legitimizing trans women who didn't intend to ever have SRS. I *am* glad to see that this change has broad support! :)

Oh, and personally, tho I may not agree with your positions at times, I *do* always find your comments interesting, and have come close to complaining to the Editors a few times when your comments were removed, as I felt you made some good points.

Carol :)

News like this is fantastic. Hopefully with this change individual states will change how they do things as well. I think it would just be nice to be able to get a gov't ID for my pre-op gf that says "female" on it.

That's going to be *the* beauty of the thing, honestly. Not many people frequently travel internationally. But, most people have need of a valid picture ID nearly daily. Passport is that (and comes in convenient card-form these days). You live in a state where changing gender marker on a drivers license is difficult? Who cares! Use the passport card as everyday ID, the DL never needs to leave your car.

Not only can one get and use a passport as ID in states that are more resistent to accurate IDs for transpeople, but once you have a passport, you can use it to apply for a DL or other ID with the same gender. This probably won't work if you are already in the state records system, but absolutely if you move to a new state as a passport is a suitable replacement for a birth certificate and in many states the second proof of identity document is often something like a SS card which doesn't indicate gender.

Absolutely. I wasn't going to go to that level of nitty-gritty. But a bit of imagination and creativity could leverage this ID in a variety of situations where documentation requirements are less stringent.

Jeannie Robert | June 10, 2010 4:30 PM

As a French citizen, I would like to apologize for this degrading treatment from a representative of my native country. And I am glad that you did have a good time in Paris regardless.

Things seem to be getting better, though. I just traveled to France this year, and I am probably at the same transition stage that you were at the time (and with the same worries about traveling, except for knowing the language!). My French passport is 8 years old so at first glance the picture doesn't look much like me anymore. I wore unisex clothing (jeans/sweatshirt) for the transatlantic travel days and had no problem on either side.

But one day we rode the train from Italy to France and I had not expected any border control on the train, so I had a more feminine appearance (I usually drive and never have to stop between most European countries). The French customs guy looked at me, looked at the picture, looked at me again, and said "Is this your passport?". I said "Yes", he looked at me again, gave me back the passport without a word, and went on to the next passengers. It's amazing how the simplest answers work sometimes...

Renee Thomas | June 10, 2010 6:03 PM

Oh gawd no!! Hush now child . . .

Uhh Jillian, Senator Clinton was not a Senator until 2001 if I recall correctly. You said this happened in 1999? Was that a typo?

Yes, it was a typo. It was actually 2001, but pre-9/11

Hi Jillian.

It took me 20 months, and a legal fight, before I was granted an Australian passport - of any kind.

The procedures they had in place for Trans people were bad enough - and Govt policy changed in the middle, so they stopped issuing 1-year passports (as authorised by law) for those going overseas for SRS, as part of "anti-terrorism meaasures". I'm not joking.

But my own case was different - I was deemed medically female before surgery. I won't go into the complexities, but here's what the legislation says:

Section 6.3 – Documents of identity

A document of identity is normally issued to Australian citizens in relation to whom the Minister (or a delegate of the Minister) considers it is either unnecessary or undesirable to issue a passport (paragraph 6.3(1)(a)).

89. Other examples include:

...Australian citizens who are transgender, that is are living in the identity of a member of the opposite sex; and

Australian citizens being repatriated or deported to Australia or extradited; and...

Australian citizens whose travel the Minister believes should be restricted.

A DOI does not give the right to return to Australia: neither is it a recognised travel document for travelling to the USA etc.

It took me 6 months before I was even offered a DOI.

Here's what I wrote at the time - though it was to be a year before I finally got my passport.

Monday, 18 September 2006
The Great Passport Fiasco Summarised
January - I book the surgery for November 15th, necessitating travel on or about the 11th November 2006.

Februaty 26th : I get final psychological clearance for surgery. It can now be confirmed, and the balance of the fee paid (just under $20,000).

April 10 : Application for UK passport. I'd first contacted the UK passport people back in October, it just took me a long time to get the required documentation together to apply.

April 24 : It's granted. Total time to process: 10 working days

June 4 or possibly a few days earlier : Application for Australian Passport, and a problem almost immediately, on June 7

June 14 : The day I could reasonably expect a passport to be issued.

July 3 : First written communication from the APO, demanding gynacological tests

July 25 : Nothing in writing, but the passport is being refused. Or is it?

July 26 : So a letter to the Minister - still no official decision in writing.

July 31 : Medicare provides proof of gender and diagnosis

August 1st : Attempt to deliver this to the APO fails, no-one present is cleared to receive it.

August 2nd : I finally see the case officer, and hand over the Medicare evidence, plus a letter from my PhD supervisor showing the necessity for overseas travel to complete my PhD

August 3rd : They appear unimpressed But still nothing in writing that I could appeal.

August 4th : Section 13 letter sent to try to get something, ANYTHING in writing, rather than this constant delay. Under the law, they have 28 days to reply.

August 7th : A decision hasn't been made according to the Passport Infoline. Or has it?

August 8th-10th : Complete co-operation from DIMIA (Immigration - I'm Naturalised). They couldn't give me what I asked for, but they pointed out alterantives, and what evidence I'd have to give them. Help, not obfuscation and delay.

August 18th : My application has been refused, and withdrawn. Wait, no it hasn't!

August 21st : There's now a "ministerial" about it. Maybe my letter to the Minister of 4 weeks ago is finally bearing fruit?

August 24th : New Citizenship certificate from Immigration, and if I'd had that in the first place, perhaps this whole mess could have been avoided.

September 1st : Deadline for a written reply to my Section 13 letter passes.

September 5th : OK, this is ridiculous. Give them another 7 days to reply to the section 13 letter, showing the decision, all evidence considered, and why they came to that decision.

September 8th : Finally, something in writing! Except it doesn't mention the Section 13 letter, it's obscure, and is a reply to my query to the Minister from back in July!

September 9th : The stress starts to show. Guess I'm not Supergirl after all.

September 11th : An amazing and upsetting phonecall from the APO. This clears up many obscurities in the letter (without putting it in writing, naturally) but I get a summary recorded while I can remember it accurately. To get any passport in a female Gender, I must divorce, by decree of the APO. No mention is made of a 1-year passport. And I won't be treated like deportees, suspected terrorists, passport traffickers or criminals with outstanding arrest warrants: I'm not offered a Document of Identity, I'll have to apply for one, and perjure myself too if I'm to get it. No hope of completing my PhD of course.

Also September 11th : I contact my lawyer, this is outrageous.

September 13th : Application for a Ministerial review of the decision, now I have something in writing at last. Of course, it will be too late now, from past performance it will take months. I have to leave soon.

September 14th : Immigration offers a ray of hope.

September 15th : Not Exiled After All, thanks to the Public Service provided by DIMIA. I can see and hug my little son on Christmas Day after all.

A Conjecture of why this happened. But it doesn't explain away the evasion, the lies, and the contempt my legally enforcable request for information was held in. Malice or Gross Incompetence? Pick any two.

And you know what? What other woman in this position would have the resources I do? How many could do all the hundreds of hours of legal research, trying to find some way, any way of getting around this mob? How many would have the emotional strength to endure the unendurable (and I came close to losing it). Emotional Pain and Suffering? Oh yes. Hopefully I can get my PhD progress back on track.

I'm alright now. But I can't let this continue, it's... inhuman. Un-Australian. Maybe it's ego, but I don't think so. I used to get in trouble for beating up bullies who were shaking down younger kids for their lunch money, I just couldn't ignore that way back in 1966.

I guess some things don't change.


I ended up returning to Australia, an Australian citizen, using a UK passport with a special (and costly - $500) visa in for return. It was the best Immigration could do.

As it turns out, when under FOI I got a copy of the regulations, as soon as I'd been issued a new citizenship certificate, I should have been authorised a new passport too. They weren't even following their own regulations.

And I had to go to the public office counter - as you did - and explain the details yet again - as you did - at least once a week for over 12 months.

They cracked before I did, and eventually I got an official apology.

Jillian, WA. state will change their birth certificates for trans people based on the same standard now apparently being adopted by the State Department, of having received "appropriate clinical treatment". This does not necessarily include surgery. This policy was adopted July 1, 2008, and I personally know people who have their birth certificates changed without having had SRS. I can e-mail you the procedure privately, if you like.

One of the biggest advantage with this is in the states that require proof of SRS to get your driver's license changed. You can flip them the bird and use your passport when you are asked proof ID with a picture on it . . . except to a police officer who pulled you over for a traffic violation.

One more step in the right direction now if we can just make it as easy in all the states as many still wont change a birth certificate.

Both the policy, and NCTE infopak thereon are hot of the presses!
Believe the hype! Just as advertised. Shockingly straightforward. Not a poisoned phrasing in sight. Not to mention, already effective!


Good morning. Yesterday when I learned of this change I was shocked, happy and naturally wrote to everyone and anyone who'd care, telling them about it. That was before I read the Fine Print...

Having read the fine print now, I wonder about a few things, for example the "Limited Valid Passport". From what I can find, it is issured for only a two year period of time. What happens after two years??? Will I be required or even allowed to apply for a second, or a third passport lasting only 2 years, or is there a more permanant way (other than surgery) to attain a normal passport?

Is there an example of the letter the doctor will need to sign for us to follow since this is all so new?

I am sure there are many other questions I and others with have in the near future, but at the moment these are the two most on my mind.

I would like to thank Everyone who was involved in this much needed change and certainly Everyone here who have so generously kept us informed.


First, look at the policy. Dr. Weiss notes she's added it at the top of the article.

The "limited/permanent" distinction appears more a CYA compromise by DoS. A way to extend the right liberally, while providing some cover from accusations they're giving away the farm to any curious/confused individual who merely manages to wangle a hormone prescription.

It embodies an assumption that transition is a finite process completed in a limited time-frame. Thus, someone with the limited passport, should have progressed to the permanent status after 2 yrs. Erroneous as this may be, it does resemble the most typical situation (not the majority experience even, but the plurality, surely). Given the assumption, I doubt they even considered situations where renewing the 2-year document would be necessary. It's not *expressly* forbidden, and there's two years to clarify the issue.

Anyway, the physician has more-or-less unlimited latitude in making the distinction, IMHO. You'll note that the "has had . . . treatment" standard and "in the process of gender transition" one are not clearly distinct [e.g. I am "in the process" but also "have had treatment" for a year--or many years by some lights].

At a stretch, one could even interpret these standards as being the reverse of their intent [e.g. Some may claim transition is a process without end (or ends only after cessation of hormones in old-age). Thus, and contrarily, "has had" is only descriptive of somebody who terminated transition--after a month, even!].

As a practical matter, most Docs will probably use being "full-time" as the line between the two catagories. But a sympathetic physician who can parse a phrase, might easily not draw the line at all.

Thank you Aislin and Kimberly, for providing the link to the policy. It is now also at the top of the main post under "UPDATE."

Here are some important parts. These show that other forms of identity in the new gender may suffice to change the gender on the passport, or, in the absence of that, a letter from a treating physician. Sex reassignment surgery is not a part of these requirements. See the links above to the policy for more details.


d. Sexual reassignment surgery is not a prerequisite for passport issuance and such documentation must not be requested.

e. Medical certification of gender transition from an attending medical physician as described in 7 FAM 1320 Appendix M is the only documentation of gender change required. Other medical records are not to be requested. If a passport adjudicating officer or consular officer has questions about this guidance or a particular case, see 7 FAM 1380 Appendix M.


a.(2) Evidence of identity. The applicant must be asked to submit acceptable evidence of identity in the new gender, if available, and must submit evidence of the new name, if changed...If evidence of change of gender in the identity documents is not obtainable because of state or local requirements, the passport may still be issued in the new gender based on the medical certification outlined below in paragraph b(1)(f).



Attending Physician’s Letterhead
(Physician’s Address and Telephone Number)

I, (physician’s full name), (physician’s medical license or certificate number), (issuing State of medical license/certificate), (DEA Registration number), am the attending physician of (name of patient), with whom I have a doctor/patient relationship. (The letter must indicate that the physician is either an internist, endocrinologist, gynecologist, urologist or psychiatrist.)

Name of patient) has had appropriate clinical treatment for gender transition to the new gender (specify new gender male or female).


(Name of patient) is in the process of gender transition to the new gender (specify new gender male or female).

I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.

Signature of Physician
Typed Name of Physician

As soon as I saw the title, I knew you were going to tell the passport story. It's a fantastic illustration of why this sort of change is needed.


Almost all of us who jumped the hoops have some sort of "horror" story of a public official making our very private matters open and public often long after the i's were dotted and the t's crossed. I have a couple of my own since I moved to New York shortly after 911 and getting a new DL had the damn clerk questioning my legal gender and requiring my surgeon's letter to put female on the DL despite the fact all my ID other than my birth certificate had my long established common law name change and sex clearly indicated. This was all contrary to New York law but I was unaware of this at the time.



sounds like someone was expressing their own personal politics there...

Thank you for the example!

For the record, and for what it is worth, below this paragraph is what I wrote in to another listserve after the new State Department rules were linked to and I had a chance to read them. I would like to note, I believe the Gender Identity Disorder diagnosis has caused me to have a lot of problems getting adequate endocrinological treatment. GID fosters stigma and affords physicians with excuses for doctors who don't want to provide adequate care to patients by focusing on transsexualism as a psychological issue when it is convenient and/or a matter of volition when complications develop as was demonstrated earlier this week by a Bilerico poster.

Anyway, this is my initial reaction to the new rules:

I don't understand. The document only reads Gender. I don't see the word sex anywhere. My passport doesn't have a "gender" designation. My passport only has my "sex" designation. What does "gender change" mean? I see the changes are based on WPATH recommendations, which means submission to a GID diagnosis in order to get approval for endo treatment and hormones. Will all passports now have "gender designations" or will that only be for those who have "gender changes". Is that a stupid question? Am I just being a
nitpicker, staying up late when I should be worrying about other things?

I also notice that there is now a legal definition for "intersex" -

// "Intersex" is a group of conditions where there is a
discrepancy between the internal and external genitals (previously this was referred to as
hermaphroditism). Unless the applicant has undergone gender transition as outlined in this appendix, the gender listed on the
applicant's birth documentation will determine the gender to be listed in the passport.//

It is all too easy for me to see that it is almost a miracle I was able to have surgery. I would be lying if I said it didn't make a very big difference but I can't imagine how unjust it would be for me to have been left out if circumstances had prevented that. Ideally, I think there should be no classification. I think things would emerge naturally. I don't think people want to be where they feel
uncomfortable but, inevitably, there will always be forced segregation, exclusion and discrimination. How are these new changes going to pan out? I think the repeal of DOMA and marriage equality would take a lot of pressure off how someone's sex is recognized. There will, however, always be the problem of shared private spaces.

Will the new rules have any weight in other areas of the law? If they do will they carry equal weight for everyone, so that everyone is equal in the sex/gender they are happiest with whether assigned at birth or whether
their sex is newly recognized? What is going on with the rules for intersex? There seem to be a lot of questions there. Is Klinefelter's and XXY not intersex again? , etc, etc, etc. . . I will let someone else answer those questions, in spite of the fact that I am aware of how widely the opinions vary.

When it comes to sex and gender, it seems there is no solid ground whatsoever for people in the middle.

What happens to the State Department rules if a new
administration is voted in in 2012?

I was re-assured by someone who wrote in answer to my last question:

"The State Department can, and has, changed the rules on a whim.However, any changes will not adversely affect passports already issued (shortof going back to Congress for approval of proposed changes)."

Edith, I also have a reaction to the use of the term "gender" when "sex" is the appropriate word.

My understanding is that "sex" is one's legal status as male or female, whereas "gender" is a social status.

That means the marker on your passport is a "sex" marker, not a "gender" marker, and the term "gender reassignment surgery" is incorrect, as the surgeon's knife can't reassign a social status.

But I've long since given up trying to correct people.

OK, so I pulled out my passport and looked at it for the first time in years. There is a picture, and information such as place of birth, name, expiration date etc and one little place it says "sex". I know women who look very masculine and yet travel without problems. So what is the big deal with a picture that looks like a woman and an "M" in the sex box? Seems to me that the picture and the other identifying information like the country issuing the passport and the passport number are the important elements. Would some port of entry really care if the passport picture showed a female that matched the person standing in front of them yet the sex said "m"?

Whatever means available to NOT conduct this high-minded, esoteric debate with an immigration official in Kampala, Karachi, etc. would be significantly to one's advantage. Conversations ending in "I want to call my embassy" are generally best avoided.

Deena, before I had SRS, I travelled several times on a Canadian passport with my current name and a recent photo but "Sex/Sexe: M" on it as well. I was never questioned about that. Either none of the border personnel ever looked at it, or they saw it and didn't care.

Once, about 10 months into my transition, still pre-op, I had to travel to the US on my old US passport (long story) on which were my old name and ugly old photo. I was still addressed as "ma'am" and was flagged as female for a search at SeaTac. I was surprised but pleased.

Of course, this was before the Underwear Bomber when security got even tighter, or so I'm told.

Thanks Véronique. That is kind of what I suspected. It almost seems like the horror stories are not about travel or ports of entry so much as about those who are/have been hassled in getting wanted changes.

between the two posts, your argument sounds trollish in the extreme! Only sense I can make from it is "if policies don't produce problems in typical circumstances, then they're not problematic policies."

Utmost nonsense, that! Exceptional cases are precisely those that reveal problems in general policies. I can hardly imagine anyone finding that controversial.

You sound like Toni who loves to level the charge of troll against anyone who has a different perspective. In Fact when I read your posts they are remarkably similar to Toni's style. But hey, its OK with me if someone posts under several names.

No, my point is quite simple. The purpose of passports is for identification not to serve the insecurities of a traveler. I have had a number of friends who had great anxieties over the gender marker on their passports and could only get the picture updated. They traveled without incident and found their anxieties misplaced. I have found in life that fears are often unfounded. That is why I asked if there were any horror stories actually centered on traveling with passports where the picture was accurate but the "marker" was in apparent conflict with the picture. Can you handle that? Or would you prefer ad hominum attack tactics instead?

Is there an example anywhere of an appropriate doctor letter? Should I phone my embassy to ask about credentials for overseas doctors?

My passport is about to expire. Very happy that I can get is corrected.

Generally, that's top of the article, and elsewhere above in the comments thread. Not hard to find!

If I'm reading you correctly (a US citizen, but foreign resident, with foreign "treatment" only) then you may be fucked. Or you may have imprecisely stated your problem?

Hi Jillian,

My understanding of what sex is is a lot more complicated than two possible configurations of one's genitals. As far as the surgeon's knife is concerned, it is a sword that cuts both ways. For me it was positive experience. If it cut the other, way as my doctor prescribed for me at puberty, it might have been the wrong way. I will never know because it didn't happen. For others it did cut the wrong way. This is not a simple matter.

I am tempted to go on and on about this. I don't want to get back on the subject of mobius strips but hormonal interplay, whether it is endogenous or exogenous, with the brain should be considered when defining sex, along with characteristics occurring all over the body. I think all this should be considered before deciding who's a what, what it is that makes them who they are and just how many possibilities there are. Sex/Gender designations can never be anything more than a necessary evil that will do injustice to many people.