Gender transition isn't what you think it is, Part 3: Legal Transition
A series on psychological, social, legal, and medical transition & what it means to be trans
Read Part 1: Psychological Transition here.
Read Part 2: Social Transition here.
As I said in Parts 1 & 2, I find it helpful to break down gender transition into several major categories: psychological, social, legal, and medical. This gives us a framework to organize things around, but it isn’t The Truth or The Way.
Let’s talk about legal transition.
Legal Transition
Legal transition involves steps to legalize your transgender/nonbinary identity. This usually means legally changing your name and/or gender marker (i.e., legally recognized sex/gender). These processes are full of hurdles—time, money, legal restrictions, and transphobia. These prevent a lot of trans/nonbinary people from being able to legally transition. Ever.
Some trans and LGBTQ non-profit organizations support people through this process, so check in your local community. Advocates for Transgender Equality keeps a list of requirements for each of the US states. (Given the chaos of early 2025, it may not be up-to-date.)
Name Changes
Name changes are a normalized process since people change their names for lots of reasons. Many people, mostly women, change their last names for marriage (and divorce). People change their names for other reasons, too, such as hating their name or its spelling, wanting to get away from a family name, and needing a fresh start. Because of that, systems are in place to allow for name changes, and trans/nonbinary people use those same systems.
However, it’s not as easy as changing a name for a marriage! Believe me, I’m on my fourth legal name in my life; I changed my last name twice for marriage and once for transition. With marriage, you get a marriage certificate, which provides all the legal documentation you need in the US to change your last name.
You can show the marriage certificate anywhere that must have proof of your legal name, and they’ll update it for you without issue. They’ll even say congratulations. Society supports marriage; marriage is the expected default—no one has to explain why they want(ed) to get married, but single people get questioned all the time about not getting married. Changing your name because you’re trans? Not so supported.
Changing first and middle names for gender transition requires more steps, and faces more opposition and resistance. My process took over three months and required multiple steps and a good chunk of cash.
I had to petition the court for a name change. I filed some paperwork and paid a fee (I sent this in from abroad, via DHL, which is another story). Thankfully, I did not also need a lawyer to do this for me, but some people do. This was the end of October.
I had to announce it in a newspaper. That isn’t a requirement anymore in my state, thanks to trans activists. Posting to a newspaper was true for any non-marriage name change at the time. It is an old practice that was meant to prevent people from changing their names for fraud or to get out of debt. (For some, especially minors, this requirement can be dangerous!)
Based on advice from other trans folks, I picked a local newspaper with the smallest circulation. Some people pick papers that only have print versions and not digital editions, but that’s rare now. It was embarrassing and distressing to have to post my birth name right there with my new name, and state the reason for the change (I wrote “personal”).
Once it was posted, I had to wait 15 days to see if anyone objected. My ex, still my husband at the time, cruelly teased that he would object. This waiting period started at the end of November.
The court had to decide whether to grant or deny my petition. Thankfully, they did, in early- or mid-February. In some states, people have to appear in court and talk to the judge. It’s a roll of the dice if you get a friendly or transphobic judge.
If it’s granted, the court gives you an official name change certificate that states the old name and the new one. You can then use this certificate to request name updates on all legal documentation. I paid for extra copies (I think $5 each) so I could send them to various places (I usually got them back).
In my state, I had to start with the Social Security office. Once that was through, I went to the DMV. Then all the places legal names are used—it’s a LOT of places. Passports, birth certificates,* adoption papers, marriage certificates,* bank accounts, credit cards, title companies, airlines, employers, deeds, leases, health insurance, retirement accounts, work ID… don’t forget all the places your credit card is saved (online stores, app stores). Even Airbnb, CashApp, Venmo. PayPal is notoriously bad at granting name change requests. I had to send in my info multiple times before they bothered, and I’m not the only one.
*Birth and marriage certificates are special cases and what they allow varies by state. Also, there’s your birth certificate, but also your children’s certificates if you have any. My son’s birth certificate is the last legal document that still has my old name. A change requires my ex’s approval.
Because my son’s birth certificate has my old name, any time I have to prove my parentage, I need his birth certificate, my name change certificate, and my new marriage certificate. I have to out myself as trans since I’m the mother on his certificate.
Credit reporting companies (Equifax, etc.) automatically process last name changes for marriage, but not first/middle name changes! So I also had to send in the info to all three companies separately. One of them required paper copies via snail mail.
Since updating names on legal documents is such on process, I waited until I had my gender marker paperwork before starting them both at the same time.
Gender Marker Changes
The sex/gender marker change process varies by country and state and is actively under attack in the US. (I’m using sex/gender here because these are conflated on legal documents; my driver’s license says Sex: M, for example. Stay tuned for a post complicating both sex and gender as social constructs and how they are intertwined and influence each other.)
Equaldex keeps good track of which countries allow gender marker changes, and which require surgery before granting a change. As of writing, 66 out of 200+ countries in the world allow gender marker changes, but 32 of those require surgery. (Genital surgery is sometimes explicitly named, but it is sometimes left open to interpretation, which may include chest surgery for trans men and transmasculine people.)
Executive orders have influenced federal gender marker changes, which affects passports. Be warned that trans people are receiving their passports back with their sex assigned at birth, regardless of paperwork saying otherwise.
The first step for me was my social security card because my state required that be changed before they’d allow driver’s license changes. Although SS cards don’t list sex/gender on them, sex is listed in the system. However gender marker changes are not being granted by the Social Security Administration in 2025!
Currently, gender marker changes vary widely by state. Some allow self-attestation, meaning you can declare it without any paperwork. My state allows self-attestation at the DMV, and the options are still F, M, and X. Trans activists fought hard for self-attestation and the additional X marker. Only 17 countries allow X or other third-gender markers. Biden allowed X on passports; 47 has taken that away.
I updated my driver’s license before self-attestation. I needed a specific government form with three signatures: my own, a medical doctor’s (MD, specifically), and a mental health provider’s. I had the best-case scenario:
I had a therapist who was trans himself and supportive. I’d already been seeing him for a year when I asked for his signature on this form. He was happy for me and said congratulations—as it should be.
My therapist recommended a trans-competent primary care provider, and I was able to book an appointment with her about two months in the future. My first appointment with her was at the end of November (while I was in the waiting period for my name change petition) and I brought the gender marker change paperwork with me. I also needed a letter from an MD stating I had undergone “clinical transition.” Since she is a nurse practitioner, she had to ask a colleague MD to write and sign the letter and form. I was living as a man by then and had come out to a select few about a year previously, but I wasn’t on testosterone and not quite ready to start it, either. In my case, with this provider, that was enough to get a letter. (The MD who signed the letter would later perform my hysterectomy.) I received the letter later in the day through MyChart. I was in a shared office on campus, and when I saw myself referred to as a male, I sobbed with joy. My officemate said congratulations—as it should be.
I sent all that paperwork to the DMV in early December and updated my name and gender marker on my license in mid-February. I told that story here.
Once I had the new ID, I could update documents that list my legal sex/gender: employer and health insurance, airlines, and birth certificate (my birth state allows it, but many do not).
Again, that was the best-case scenario. Most trans/nonbinary people are not so lucky and face barriers to getting and paying for a friendly therapist, or any therapist. Some have to appear in court. Many providers and states require hormones and/or surgery before writing such a letter affirming their gender. Paying for all that out of pocket is ridiculously expensive in the US, and not all insurance companies cover it.
Coverage under Medicaid is relatively new but under attack. A lot of trans people receive health services from federally qualified health centers (FQHCs), which are often the only clinics that provide LGBTQ-specific care for people with no or low incomes. And because of systemic racism, that’s more often Black and Brown people. And immigrants and people who are undocumented. But in 2025, executive orders threaten to take away FQHCs’ federal funding if they recognize the very existence of trans people, let alone care for us!
And in the US, insurance is tied to employment, but unemployment among trans people is especially high. That is in part due to a lack of legal ID with a name and gender that matches their identity! It’s a catch-22: you need the ID to get the employment to get the coverage to get the surgery to get the ID. Again, because of systemic racism in this White supremacist society, more Black and Brown people are affected.
Moreover, housing insecurity is high among trans/nonbinary people, also linked to underemployment and lack of legal paperwork, but also because many families kick their trans kids out. Yep, there are racial disparities here, too.
My name and gender marker changes required a lot of paperwork, patience, perseverance, legal literacy, time, and money. I had the luxury of not having to deal with transphobia along the way. I recognize this is a huge privilege I have as a middle-class, educated White man living in a friendly state and county. Name and gender marker changes are not easy, and my siblings who are Black, Indigenous, and of Color face additional unfair challenges.
Legal Gender Recognition & Health
Lastly, having legal IDs that affirm your name and gender improves mental and physical health. Having laws and policies that positively support trans/nonbinary people improves trans/nonbinary health. The opposite is also true—the more barriers to access and the more stigmatizing laws and policies, the worse trans/nonbinary health is. Last year, I worked on a project looking at all the global evidence on these issues. My role was to carefully and systematically grade all the evidence for its quality and rigor. I pulled all the numbers. I created graphs and charts with a stupid amount of footnotes. A report and publication are forthcoming, hopefully soon!