Regulations regarding changing sex on birth certificates differ by state—some will not allow changes to sex on certificates at all, some will only allow changes if SRS (Sex Reassignment Surgery) has been completed, and some will allow changes regardless of surgical status.

States also differ in how they define SRS, and some will allow HRT (Hormone Replacement Therapy) in place of SRS to change records.

Information on your specific state should be available in Lambda Legal’s Changing Birth Certificate Sex Designations: State-By-State Guidelines.