"Why does it matter so much; it's just a driver's license?" a government clerk said in response to a transgender patient of mine who was venting about the difficulty involved in getting the gender identification changed on legal documentation. Clearly, this person was lacking both education and empathy. Passing is a challenge in and of itself, and when a government issued document identifies a person differently, even greater obstacles are created than this article has time to explain.
As a physician, I have had many transgender patients ask me to write formal letters for them regarding their sex change. What I find interesting is that different states have different requirements for legal documentation for sex change. No two states are uniform. Because this issue is important to me, I have done research to help my patients, Transequality.org is a great resource to find out what your state-dependent requirements are.
For example, in the state of Washington, where I completed my cosmetic surgery fellowship, has one of the most streamlined and user-friendly processes. You basically have a simple form that is filled out by the treating physician, notarized and mail it in.
However, in Texas they have much more stringent requirements which include obtaining a court order along with legal counsel and court costs. And in Oklahoma the law requires a notarized statement on letterhead from the physician who performed the operation indicating the applicant or licensee has undergone a complete physical sex change. The letter shall state the sex change is "irreversible and permanent".
Which leads me to my next point: The fact that the letter must read that the sex change is "permanent and irreversible" is particularly intriguing to me. An argument could be made that anything we do in cosmetic surgery is irreversible. Any surgery that I perform is permanent, and once done, I cannot go back in time and undo it. That being said, any patient on whom I perform top surgery or breast surgery- whether breast augmentation, chest reconstruction, or breast reduction - I will discuss how the body continues to change with age and if the patient changes his or her mind in the future, there is always an option to remove more tissue, transfer fat, place new implants, or exchange implants for either a larger or smaller size.
Therefore, although the surgery itself is irreversible, one can always perform more surgery reversing the outcome of a prior surgery. To debate the topic further, I would argue that hormone therapy has many irreversible effects when one includes glandular changes, fat distribution, and male pattern hair loss and voice changes.
Stating that a complete physical sex change is also highly debatable as many of my patients focus on what is necessary for them to pass. With regard to bottom surgery, although a priority for some, others may opt against it due to the invasive nature of the surgery, cost, or other personal decisions.
In summary, to add the statement "permanent and irreversible" and to demand a complete sex change, seem not only irrational but also unreasonable, adding additional burden for a person who is already dealing with so many other challenges. With education and empathy, perhaps Oklahoma will follow in the footsteps of Washington regarding this matter.