All I can say is, once the new card arrived, I saw a much happier child and more confident child, once he felt that he was legally recognized as a male," Alice says, speaking about the day her son, now sixteen, got his revised birth certificate in the mail last June. (Alice's name has been changed to protect her family's privacy.)
Though Alice's son wasn't born in North Carolina—her family moved here from the Northeast more than a decade ago—the state where he was born, like North Carolina, requires people to undergo surgery before they can revise the sex on their birth certificate. In her son's case, any irreversible sex affirmation operation would fulfill the requirement, which meant a mastectomy would suffice.
"All of this [was] out of pocket medically, as it is considered cosmetic surgery," Alice says. "This was hard on us financially, but we did it for the mental and physical stability of our child." Ultimately, altering the birth certificate cost the family $8,300.
People born in North Carolina face similar hurdles. According to state statute, individuals have to receive "sex reassignment surgery" in order to change the sex on their North Carolina birth certificate. But there are many types of sex reassignment (better described as "sex affirmative") surgery: mastectomies, hysterectomies, and phalloplasties for trans men; facial feminization surgeries, breast augmentations, and vaginoplasties for trans women. The language isn't clear as to which surgery the law actually refers to.
When I asked Chris Brook, the legal director of the ACLU of North Carolina, about this, he told it was safe to assume, especially given House Bill 2, that the state is referring to surgery of the genitalia. For proof that the surgery has been performed, North Carolina requires a notarized letter from the doctor who performed the surgery or from "a physician licensed to practice medicine who has examined the individual and can certify that the person has undergone sex reassignment surgery."
"You can change your gender marker in North Carolina. It's a very onerous process to do so," Brook told me.
As a North Carolinian born in New York, updating my birth certificate to reflect my proper sex is comparatively easy. No surgery is required, though I would have to submit a notarized affidavit from a licensed physician explaining that I had "undergone appropriate clinical treatment for a person diagnosed with gender dysphoria." It takes about three months to get the updated birth certificate.
I would more than fulfill New York's requirements—and North Carolina's, too, had I been born here. The total cost of the surgeries I've undergone (facial feminization and vaginoplasty) comes to more than $50,000; for the vaginoplasty, I had to obtain two letters from therapists: one to attest that I'd thought through my decision, the other to ensure that I didn't have any mental health issues.
Because I pass so well, however—something I'm grateful for—I'm in no hurry to update my birth certificate. Instead, the document I'm determined to update is my driver's license. My current one still lists my sex as male, an embarrassment I'm forced to face every time I show it to someone.
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