To provide documentation requested by government organizations in the course of changing legal sex, what exactly does a transsexual announce, document, or certify? Isn’t something as fundamental as sex relatively easy to document? As it turns out, it’s not as simple as one would think, not only because “sex” can be defined in different ways (chromosomes, hormones, secondary sex characteristics, genitals), but because I don’t think the requesting agencies have thought through just what they want to know, and therefore are not consistent in the documentation they request.

Bear in mind, we’re talking strictly about legal change of sex, or erasing the letter “M” from my records and replacing it with the letter “F.” The implications are mostly minor except for laws related to marriage and for health insurance. Everything else, including enabling various officials to identify people positively, is really irrelevant because what matters is how you look, what you call yourself, and how people know you, and these layers of knowledge work independently of whether you have the letter M or the letter F on your official documents.

Social Security is quite straightforward in saying that to correct the “sex” field in a person’s record, the evidence needed is a “Sex-Change Operation: The surgeon or attending physician must provide a letter verifying the sex change surgery has been completed” (bold in the original). The Internal Revenue Service relies entirely on Social Security data, and thus have no separate procedure for changing name and sex.

The Federal Aviation Administration (FAA) asks for one of the following (and I’ve explained in previous posts about conflicting information from them):

a) court order saying applicant has changed gender and/or letter from physician or clinical psychologist verifying that the applicant is undergoing treatment that has altered or will alter the gender,

b) court order saying either that applicant has changed gender or that individual’s gender is male/female and a physician’s statement clearly indicating that the individual is physically the gender noted on the court order

c) court order saying applicant has changed gender OR statement from a physician or clinical psychologist identifying the applicant by name and address or verifying that the applicant is undergoing treatment that has altered or will alter the applicant’s gender.

For the Passport office, according to the NCTE,

“Sex change documentation consists of a letter from a surgeon or hospital that performed surgery and a detailed statement from a medical surgeon regarding the surgery. If your request of prior to surgery, the documentation consists of a detailed statement from a surgeon with whom you have plans to undergo surgery. This statement must outline the plans for your surgery. If you are traveling to undergo it, the passport agency will issue a temporary passport valid for one year.”

Looking only at the federal government, there are two areas that interest me.

First is the authorizing party, or the one who documents a transsexual’s change for the government.

  • Passport Office = surgeon or hospital
  • SSA=surgeon or attending physician
  • FAA=physician, psychologist, or court

There is no doubt that these people or entities are authorities, but their specialties and their scope of knowledge hardly overlap. Surgeons cut patients. Hospitals and physicians treat patients. Psychologists listen to people and help them solve their problems. Courts resolve disputes and issue verdicts or orders. Nowhere in this list of authorities is any prerequisite of specializing in mental or physical issues related to sex or gender. The list assumes — but refuses to mention— such activities and knowledge. It’s as if the words “sex-change” or “changing gender” are so widely known that there is no need to discuss what they mean in official regulations.

The second (and perhaps more interesting) issue is what, precisely, these parties are documenting or certifying. The social security’s surgeon or attending physician is certifying that sex change surgery has been completed. The passport office’s surgeon or hospital is documenting an outline of a plan for surgery or the nature of the completed surgery (of some sort, but it’s not specified). The FAA’s myriad authorities (physicians or psychologists) document treatment that has altered, or will alter, gender, or a statement that the applicant is the same gender as the application requests. The FFA uses “gender” exclusively, while social security and passport offices use “sex” exclusively. Does the federal government intend to use “sex” and “gender” in unique ways, or are they just being used interchangeably? Which is it, sex or gender?

Gender. Is it possible for someone to say objectively that someone is one gender or another? If the FAA means something like “Joyce presents herself full time as a female,” then that’s quite different from “Joyce had genital surgery.” What does it mean for someone to alter their gender, and how long does “alter” imply? Does dressing in drag for a weekend, which certainly counts in my book as altering your gender, qualify? Or does the FAA mean to document that a person shifts permanently from masculine to androgynous? Since gender is both felt and expressed, how is anyone truly supposed to document a change in gender to the FAA?

Sex. My questions about sex are even thornier. Depending on how you define sex, it either is possible or it is impossible to change a person’s sex. XX chromosomes will always be XX chromosomes, no matter how many surgeries one undergoes and no matter how many hormones one injects. But if we are talking about hormones, we could speak of a generally accepted range of hormones to define changing from one sex to the other, but this approach would eliminate tens of thousands of perfectly “normal” people with hormone imbalances. And what about intersex individuals who have chromosomes, hormones, and/or genitalia of both sexes? What about secondary sex characteristics? If you add or subtract breasts, does that count for changing sex? Perhaps, but tens of thousands of women undergo mastectomies, and are no less female after surgery, and lots of men develop gynecomastia (or man-boobs) and are legally no less male because of this change.

Since “surgery” is used in several legal requirements, what surgical procedures, precisely, constitute changing sex? Frustratingly, these procedures are not defined. Is this to be left to the applicant and his/her surgeon or physician? Would a feminizing nose job count (it’s surgery undertaken to change one’s sexual appearance, but is that the same thing as sex change surgery)? Would a FTM’s mastectomy count (I certainly think so)? And speaking of breasts, what about a MTF’s boob job (I don’t see why not).

Or maybe the regulations mean to imply reproduction, and want to count castration (orchiectomy) and hysterectomy. If so, doesn’t this sound a bit like eugenics? But ethical intentions aside, hundreds of thousands of sterilizations take place every year, and they do not constitute sex changes.

I suspect that what is unspoken is the requirement that the penis or vagina be modified, but whether the external genitalia need to be merely removed (penectomy/phallectomy, in the case of MTF’s, and what? clitorectomy/clitoridectomy/vaginectomy? for FTM’s?), or modified (vaginoplasty for MTF’s and phalloplasty for FTMs) is unstated and unclear. With such major surgeries costing tens of thousands of dollars, taking the patient out of the workforce for months, I would think that their necessity would be more rigorously defended and more specifically defined as a prerequisite for federal change of sex.

Overall, I don’t think they know. Does the government mean to imply genital reassignment as a prerequisite for erasing one letter and typing another? Or do they mean the obliteration of birth genitals? Or do they mean sterilization? Or secondary sex characteristics? Or generally accepted features of a target sex, like muscles, noses, beards, and skin?

If you’re skeptical, you’re shaking your head and saying, “Joyce, any fool knows what they mean — they mean sex change surgery,” and I would agree with you that that’s what they think they mean and what they’re either stating plainly or implying. But “Sex Change Surgery” is not defined, and changing sex involves so much more than surgery, like beard removal, hormone treatment, hair transplants, that to focus strictly on genital surgery seems quite narrow. However, this narrow focus is not accompanied by a narrow definition, which is usually the hallmark of regulations, thus leaving everything implied and subject to interpretation and persuasion, and even passability or general aesthetics of the transsexual, which is a horrid thought.

Ultimately, I am not sure why the federal government is in the business of letters F or M. For transsexuals, the issue is personal, psychological, spiritual, and essential to our identity, and the state really has no business getting involved. I suspect we are probably just collateral damage from the much bigger marriage wars, with the Defense of Marriage Act and various other initiatives to define marriage definitively as one M and one F. What would happen if those M’s and F’s weren’t authoritative, but were fluid? It would be impossible to define marriage as anything more than the wedding of two individuals, without the M or the F — but given today’s climate, such a fluidity seems unthinkable.