Straight from the aerospace medical division of the FAA came my official airman’s medical notification a couple of days ago, and while it’s a very good thing that ends a long chapter of frustration, the document is not without thorns.

The good news is that I do have a medical certificate (below), but it carries more restrictions than my previous certificates — I have to carry a letter of authorization with me whenever I fly, for example. Here’s what the medical looks like:

medical certificate

medical certificate

But more interesting is the letter of authorization, which invokes the regulations, parts 67.113, 67.213, and 67.313, which are simply identical and parallel subparts covering first-, second-, and third-class medicals, and deal with general medical conditions that aren’t generally specified in the rest of the part:

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the medication or other treatment involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or
(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

I don’t know where the FAA gets the idea that gender issues (or the medications, if any, related to gender issues) would “make a person unable to safely perform the duties of the airman certificate,” and I find the suggestion pretty insulting.

The letter (below) also mentions 67.401, which deals with the letter of authorization. The rationale given in this section is largely public safety with language like this: “…capable of performing airman duties without endangering public safety.” This stands in contrast to the aforementioned sections, which appeal to the airman’s ability to perform duties. To its credit, this section recognizes that holders of 3rd class medical certificates are private pilots:

[The FAA needs to] consider the freedom of an airman, exercising the privileges of a private pilot certificate, to accept reasonable risks to his or her person and property that are not acceptable in the exercise of commercial or airline transport pilot privileges, and, at the same time, considers the need to protect the safety of persons and property in other aircraft and on the ground.

Despite this “freedom” paragraph, my letter makes no mention of the fact I’ve sought a 3rd class medical (for private pilots versus commercial ones), and I’m curious why a private trans*pilot can’t just be left alone, using this paragraph as FAA rationale.

So anyway, we have these twin rationales, a) that people with gender issues may not be able to perform their duties as pilots and b) that people with gender issues may pose a threat to public safety. These two dubious claims lie at the core of the “conclusion” stated in my letter, namely that gender identity disorder is inherently a disqualifying condition that causes trans* pilots to have to go through this nonsense in order to keep flying.

I would certainly agree that people who can’t perform their pilot duties and/or who pose a public threat probably should be automatically disqualified, but what I’d like to know is just where those two assertions about trans*people come from. They cannot be based in empirical facts — I’ve looked through the NTSB accident reports and can find no mention of transgendered pilots as the cause of any incidents or accidents. Where is the hearing or the memo or the commentary that glued these twin falsehoods onto trans* people? I would love to read that rationale.

Notice on page two that an olive branch is held out: next year, if I have no changes in my current medical condition, they’ll consider removing the requirement for a letter of authorization. Fair enough, but my question is Just what is my current medical condition? I’m healthy, productive, and capable. I’m already bound to ground myself if I develop a medical condition that hampers my ability to fly, and I would think that such a rule would already apply to trans*pilots (as well as all other pilots). Does the letter mean to say “my current psychological condition,” or does it mean to include everything? The second paragraph says, “Because of your history of GID and GRS, operation of an aircraft is prohibited at any time new symptoms or adverse changes occur.” The word “history” is instructive here — maybe the FAA means that my history makes me suspect, and not necessarily my current state as a fairly normal pilot. If that’s the case, then how long does that “history” stick with me and compel me to carry around this letter when I fly and when I go for my next aviation medical exam?

I feel as if I’ve been branded as someone we need to watch, someone who might “get sick” again. I’m not sure what that would look like, but the GRS is a done deal, and the GID has gone away. What if I take up cabaret singing? Or take a turn towards butch-dom? Just what are these relapses that the FAA imagines might happen to me? These recurring conditions constitute a third area that I’d like to understand better — did the FAA approve trans*people for flying some time in the past, but their behavior or demeanor led them into an accident, and thus triggered this rule that they have to be watched in case gender issues return? If so, where are those records, those stories that would provide grounding for the current rule? If they don’t exist, then does the FAA just make up random nonsense to justify argumentative nonsense arrived at via non-existent data about public safety and pilot abilities? I’m starting to think this is precisely how it works.

medical authorization, p. 1

medical authorization, p. 1

medical authorization, p. 2

medical authorization, p. 2

I received my new pilot’s license a couple of days ago, and it correctly lists my ratings and my sex as “F.” I also just received the following email from Dr. Salazar, as well, saying that my medical certificate nightmare is over:

Ms. Bailey – Oklahoma City finished the administrative processing and we picked up your case today. I have directed my staff to issue a medical certificate under special issuance. All that implies is we would follow your case for at least a year primarily to ensure no post-op problems have occurred.

The context for this entire episode can be found at the following posts:

New Aviation Medical visit
Gender Issues “Disqualifying Conditions” for FAA
FAA Bureaucracy and Web Misinformation
Name and Sex at the FAA
Just Following Regs
Surgeonocracy

While I’m happy that I’m thought of as female and am legal to fly again by the FAA, I am nevertheless baffled about why the FAA needs this level of scrutiny about my genitalia (at least the passport office has some sort of need to identify its citizens, even though I think their fetish about what’s between its citizens’ legs is also uncalled-for).

In the case of the FAA, there are two distinct issues. First is their refusal to change the gender marker (the “M” or the “F”) until the pilot produces a surgeon’s letter. The FAA regulations never mention sex, nor does the Airman’s Information Manual (AIM) — it’s telling that the bureau’s “rules” about the surgeon’s letter come from an unpublished circular that field inspectors are supposed to follow. It’s just like my passport experience, where there are no written rules about changing gender markers, and thus it just falls to lore or to secret documents.

The second issue is this vexing assertion that gender identity disorder, or “gender issues” in general, are disqualifying conditions for holding a valid aviator’s medical exam. “Gender Issues” is so broad as to include drag queens, occasional crossdressers, and deeply closeted transsexuals, among others, and if these conditions are disqualifying, then thousands or tens of thousands of pilots are technically violating the law when they do not disclose these feelings to their AME (Aviation Medical Examiner), and I simply don’t think that’s right.

First, I don’t see why any gender issues should be disqualifying. It is certainly true that GID is characterized by depression, especially as the transgender person grapples with their fate and struggles to accept him/herself. But depression is already a condition that must be reported in an aviation medical exam, and I would think that this type of disclosure would be sufficient (assuming you think it’s any business of the FAA’s if a pilot is depressed). Whether a woman feels like a man and is thinking of changing sex automatically disqualifies him from flying is another matter (and an irrelevant matter, I’d argue).

In any case, I have my new medical certificate, albeit one that requires I be monitored for a year, just in case I flip out. Dr. Salazar’s note mentions monitoring surgery, but I’m unaware of any other surgeries that require a year’s worth of monitoring — I would imagine that this is a veiled language to allow the FAA to monitor trannies in the sky.

Visited Dr. Reynolds today for a new aviation medical, armed with a sheaf of papers from surgeons and psychologists saying I was a reasonable transsexual (as reasonable as can be expected, I guess). I passed the office tests easily: the color blindness, the vision (near and far) test, moving my limbs easily, the urine test, the hearing test, and the full disclosure of all conditions, doctor visits, and hospitalizations over the course of my life.

The nurses were quite chatty and helpful, while the doc seemed a bit gruff. He said at one point that maybe I’d get my medical and I could learn to fly, to which I responded I have over 700 hours, my multi- and single-engine private pilot’s license with an instrument rating and complex aircraft endorsements. Furthermore, my last flight was a few weeks ago, just about the time Dr. Salazar opined that my current medical had been handled completely improperly.

“Oh,” he said. “Well, maybe things will go well in Oklahoma City, then.”

It was nothing, and my paperwork now goes to the regional medical examiner, who will determine if I’m mentally OK to fly. I understand how the FAA works, but I find the whole “Gender Dysphoria is disqualifying until documents are submitted” argument feels as if a certain group of people is being picked on unreasonably.

I believe I’ve finally fixed my pilot’s license (name change, gender change, new multi-engine rating), but I recently learned a key assumption at the FAA Medical Branch regarding Gender Identity Disorder. After months of going around and around with their Oklahoma office and arguing that I already have a valid medical certificate by virtue of an exam last summer with Dr. F, I learned that GID is a disqualifying condition until certain paperwork has been filed with their office and thus, no individual medical examiner may issue a medical certificate on her own, based on the results of the exam in her office. Here’s the eye-opening email thread that finally put me and Dr. Salazar (Oklahoma City) on the same page:

First Clarification

Ms. Bailey - to make sure I have my facts correct since the last email sometime in April 2009. You reported you had an FAA physical August 7, 2008 by Dr. KF in Bedford Falls prior to him being dedesignated. To date we have not received a copy of that physical exam, i.e., the actual 8500-8. This has created the problem that even though you now have produced a second-class medical certificate, the agency has no formal verification of its existence except for the piece of paper in your possession. The last official examination/certificate on file for you was a second-class certificate issued July 12, 2006; at this time that
certificate is not valid for any class.

Even though you have a second-class medical in your possession, we now have to consider the fact you are undergoing sex reassignment surgery. In my opinion, Dr. F erred in issuing you that certificate in August of 2008. He had previously issued you a certificate in 2006 as a male ("oldname"), but issued you a new medical certificate in 2008 as a female (Joyce Bailey). He should not have done that - he needed to have deferred issuance to the agency.

Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received, and the agency is satisfied that no adverse issues exist. To date we have received no treatment records; therefore, the agency cannot render an opinion on your qualification to hold a medical certificate. As I previously explained, this matter is further complicated by the fact we have no official record of a current physical exam on file for you, and you now have a certificate in your possession that was issued in error. Because we have no official record, it makes it difficult if not impossible to reexamine your qualifications to hold that certificate.

My recommendation at this time is to wipe the slate clean and this matter be started over again. I would request you go to an AME and make an application (either before the surgery, if you have time, or after you have recovered), explain the gender change and have the AME defer the issuance. The agency will then request you provide detailed treatment records, operative reports, and the NP evaluations. Once everything has been reviewed and the agency is satisfied successful recovery has been made, a proper certificate can be issued. By doing things this way no one can challenge the validity of that certificate.

At this time you have in your possession a medical certificate issued in error, with no supporting physical examination on record. Therefore, I am concerned that this presents a serious problem, and the agency will not issue you a replacement medical certificate at this time. I would strongly recommend you do not use the certificate in your possession to fly as pilot-in-command as this could represent a violation of 14 CFR Part 61.53.

My first reply
A bit unnerved by that last part, the suggestion that I may have been violating the FAR’s, I wrote the following for clarification (being a bit snarky, I admit):

I still have my previously issued medical certificate, which is still good through august 31. Are you saying this one is also tainted because a doctor did not turn in his form?

It sounds as if you're advising me to abandon my second class medical as well as one year of my third class medical, even though I had a stellar exam last August. Are pilots usually held responsible for AME actions beyond their control?

I will seek a new AME and get a new medical exam after i'm back from surgery in 2 weeks, then. I do think it all stinks, as I've asked the FAA and my AME about ny condition from the very beginning, and I find out only now that all that effort at full disclosure was for nought.

And here is Dr. Salazar’s definitive answer:

Ms. Bailey - We have 3 physicals on file for you: July 2, 2002, July 14, 2004, and July 12, 2006. The July 12, 2006 examination expired for ALL classes on July 31, 2008.

I cannot be any clearer in that Dr. F issued the August 2008 certificate in error and since he did not forward the application the agency could not have know. It was not until April 2009 that the agency found out about your intent for gender reassignment surgery and the fact there was a 2008 examination that had not been transmitted. At that time we had no record of a valid medical certificate. Today I receive confirmation from you in the form of a copy of that certificate. That changes the entire picture and it is my responsibility to inform the certificate holder of any problems with any certificate they hold.

Dr. F's issuance was "less than stellar" since you were not qualified at the time he gave you the certificate. I have discussed this matter with an agency attorney who concurs on questioning the validity of the 2008 certificate because no 8500-8 is on file and also because the AME knew you had a disqualifying condition and still issued the certificate.

However, the key issue is that you have a disqualifying condition; therefore, any certificate in your possession is called into question until the matter is reviewed by the Aerospace Medical Certification Division and a determination is made of your eligibility for medical certification. While I understand your concern about "walking away" from a medical certificate, but you must understand that certificate has major problems and could legally be viewed as an invalid certificate. Dr. F has created this problem and I am simply trying to undo his errors.

Uncle
Since I had just earned my multi-engine rating and was on my way to Trinidad for GRS, I figured it was a good time to cry uncle and ground myself, seeking a new medical exam when I returned, and thus I wrote the following to Dr. Salazar after my surgery:

Dear Dr. Salazar,

On your advice, I have scheduled a new medical exam with Dr. R in Bedford Falls on July 28th, and we will try to fix this whole mess that Dr. F's inappropriately-documented medical exam last summer has caused. I will bring every scrap of medical and psychological paperwork I have so that Dr. R can make sure we submit a whole file of proper documentation required by your office.

Having just completed GRS in Trinidad, Colorado, last week, I'm obviously self-grounded, and I intend to remain so until Dr. R and I have satisfied your office.

Thank you for your frank and authoritative help. I apologize if I've sounded frustrated over the past few months; I was just perplexed about Dr. F's medical certificate from last summer and the steps I needed to take to rectify this situation so I can continue flying.

He returned with his own “uncle,” vowing to expedite my paperwork:

Ms. Bailey - as long as Dr. R defers certificate issuance to Oklahoma City under the special issuance process, your case will be handled appropriately. Although Oklahoma City will handle the issuing, if Dr. R notifies my office when the case is transmitted and deferred, I will have my staff work to expedite the processing. I cannot give you a specific timeframe, but if we monitor the progress it will move quicker.

While I’m relieved to finally have a clear plan, several things frustrate me. First is the FAA’s assumption that gender issues of all sorts are automatically disqualifying and put the onus of proving mental and physical health upon the trans* person. Hell, Dr. Salazar’s language puts ALL gender variance into this category, so I assume even weekend drag queens could have their pilot certificates called into question:

Gender dysphoria, gender identity disorder, sex reassignment surgery and gender variant issues in general, are initially disqualifying conditions until all treatment records, including neuropsychological (NP) assessments are received

My second frustration comes from my trust in my medical examiner last year — he told me quite authoritatively that the medications I was using (estradiol, progesterone, and spironolactone) were authorized drugs and that I was thus free to fly. As far as I knew, I had disclosed everything to the FAA, honestly and openly, and I only now find out that I have been skirting the edge of the law. It’s frustrating to follow all the regulations and to disclose everything and then discover that one key person didn’t follow their rules, thus putting my good name and my pilot certificate in jeopardy.

I’m sure my new medical exam will go swimmingly next week. I will be sure to remind the doctor that he cannot issue the certificate, but that we need to submit surgeons’ and physicians’ and psychologists’ letters to Oklahoma City so that they may issue the medical certificate.

You may recall my difficulties in changing the M to an F with the FAA (here, here, here, and here), but I am happy to report that I finally buckled and complied and have now been issued an airman’s certificate that has my new name and new sex written on it.

One of the problems with the FAA regarding gender marker changes is that their policy is inconsistent and incoherent, which is kind of unusual for an organization that defines everything. Where I got on the wrong path (and perhaps it was unavoidable) is that the FAA website makes it sound as if gender marker changes are easy, but that the actual FAA regional officers don’t use the website, but rather a field manual called FAA Order 8900.1. You see, on the very first page of the FAA website that deals with pilots, the requirements are pretty plain and make it seem as if all you need is a letter from a psychologist:

Gender change

To obtain a new airman certificate that reflects a gender change, it is necessary that you appear at an FAA Flight Standards District Office (FSDO) for positive identification. One or both of the following documents must be presented to an FAA Inspector:

1. A court order issued by a court of the United States or it's territories stating that the applicant has changed his/her gender, and/or
2. A statement from a physician or clinical psychologist treating the applicant that contains:
* Identification of the applicant by name and address, and
* Verification that the applicant is undergoing treatment that has altered or will alter the gender

However, this information is incorrect, as the field inspectors use an internal document, as I was told at my local field office. This document, they said, requires a surgeon’s letter. However, a visit to the FAA and a search for “8900.1” reveals that there’s a whole website devoted to Flight Standards Information, http://fsims.faa.gov/, and if one searches that site for gender, one finds the current version dealing with exchange of valid pilot certificates, and at 5.317, part D, “Changes to personal data,” we find

D. Change of Gender. For a change of gender on an airman certificate, the original copies of two documents must be provided to the certifying ASI. After examining and verifying these documents, the ASI photocopies the documents and attaches the photocopies to Form 8710-1. In block I, under “Other”, the ASI notes gender change reissue. The file is then forwarded to AFS-760 for processing. The required documents are:
1) A court order, issued by a court of the United States or its territories, stating that the individual has changed his/her gender to ___, or a court order stating that the individual’s gender is ___; or
2) A physician’s statement clearly indicating that the individual is physically the gender noted on the court order.

I do not know where my office gets the “surgeon’s letter required,” but suffice to say that was what I had to do to change the gender marker.

But the point of this blog entry is to highlight inconsistencies, so I wrote the FAA webmaster about the wrong information on their website, and here’s the letter I received in return:

Your are correct:

Our web page at http://www.faa.gov/licenses_certificates/airmen_certification/name_change/ does not specify a physical gender change while FSIMS Volume 5, Chapter 2, Section 5, para. 5-317 does.

We are researching his discrepancy. You may contact the Flight Standards Web Manager, Joel Wilcox, for the status of this research: 202-493-4876.

It’s small, but at least it’s a recognition that there is an inconsistency. What’s frustrating is that this labyrinth of information isn’t easy for the transgender pilot to navigate. A system of information that was user-oriented, one that anticipated that there’s a transgender pilot who wants to change information, would try to answer, unambiguously, that person’s question. Instead, the web gives us false hope, the official regulations (FAR’s) mention nothing about gender, and order 8900.1, which pilots don’t even know exists, is the “ultimate” guide — but even this order seems to have been revised with multiple versions floating around out there.

After looking through the records of my name change and noticing a spot where my local FAA office (read the history here, here, and here) had recommended I call Washington for more help on changing the “M” to an “F,” I decided to call that number. I spoke with a very helpful fellow named Bruce Lansford (who has a column in the AOPA magazine, by the way), who told me that no, surgery wasn’t necessary to change the gender marker. What I needed was a letter from my doctor saying I was in the process (or had completed the process) of changing gender, and that was about it. He said they do this all the time, and it shouldn’t be any trouble.

This was quite a pleasant surprise, so I wrote my local FAA office and said I would like to re-initiate contact with my local FAA officials so that I could proceed with a name and sex change.

Nothing is ever easy with bureaucrats, of course, and I received the following note from the FSDO, which pasted a copy from a manual into the email, explaining that I needed the following documents:

A complete FAA Form 8710-1 Airman Application for the name change and gender change. For the name change you will need appropriate documentation acceptable to the Administrator, which substantiates the validity of the requested change.

For a change of gender on an airman certificate, the original copies of two documents must be provided. After examining and verifying these documents, we will photocopy the documents and attach the photocopies to Form 8710-1. In Block I, under Other, we will note gender change reissue. The file is then forwarded to AFS-760 for processing. The required documents are:
1) A court order, issued by a court of the United States or its territories, stating that the individual has changed his/her gender to ___, or a court order stating that the individual’s gender is ___; and
2) A physician’s statement clearly indicating that the individual is physically the gender noted on the court order.

Surprised, I wrote back:

I’m a bit confused as to how to reconcile what you’re telling me with what Mr. Lansford told me, and I asked him quite directly about this when we spoke on the phone. I asked if I needed to be “physically” female, as your request of my physician suggests, or whether my process of becoming and my daily existence as female was sufficient, and he said very forcefully that it was the latter, not the former, that the FAA cares about. He said I needed to present a letter to the FAA from my physician stating that I have been undergoing treatment (psychological and medical) that has altered or will alter the gender and he specifically said that I did NOT have to undergo surgery in order to change my airman’s certificate.

The reason I ask is that only about 5% of all transgendered people choose to change their genitals, either because of preference or because of funding issues, so I suspect there must be hundreds of transsexual pilots out there who are living in their new sex roles, but who haven’t had surgery, and who really, really ought to have identification that matches their name and appearance.

Second, and this relates to the previous point, just what does “physically the gender noted on the court order” mean for the purposes of my physician’s letter? Does the FAA mean genitals? chromosomes? hormones? All three of these can be considered physical aspects of sex. My physician can write you a letter saying I’m hormonally female, but I’ll always have XY chromosomes and I have not had genital surgery. My psychologist can write you a letter saying that I am permanently female, physically, mentally, and socially, having transitioned about a year ago. But I just don’t know what the FAA means by “physically.”

I would like to change my name on the airman’s certificate in any case, but I would also like to change the gender marker from M to F if I can do this within the constraints outlined above. I’ve got all the paperwork necessary for the name change, and I really don’t feel comfortable flying around the country with all my ID saying Joyce and female, and my FAA license saying [oldname] and male.

My next email came from Gordon’s supervisor, Steve:

We have contacted Mr. Lansford of AFS-760 to determine if he had other guidance we should follow. Our discussion with Mr. Lansford revealed he had provided you with guidance from a superseded Inspector Handbook (FAA Order 8700.1) which was replaced by the 8900.1 in 2007. After further research with our regional Technical Support Branch, we were informed that the physician’s statement must be from a Designated Medical Examiner or a Regional Flight Surgeon’s office. If you have additional questions regarding the medical information and applicable documentation please contact Dr. G.J. Salazar, Regional Flight Surgeon, Southwest Region at (817) 222-5300.

We will be obligated [sic] to process your request once you can submit the required documentation.

OK, I thought. We’re going backwards. Now it’s not just my physician, but an FAA physician. I replied:

Thanks for your reply. I guess we’re getting somewhere, even if it feels like it’s going backwards. Can you point me to the AME or FAA manual that is going to give the FAA medical examiner guidance as to this statement: “A physician’s statement clearly indicating that the individual is physically the gender noted on the court order?” In other words, my previous questions as to what “physical” means are still unanswered, and I would hope that the FAA, which defines everything, right down to the arc-minutes below the horizon the center of the sun needs to be as a definition of “sunset,” would be able to clarify for me and for its AME’s.

Seeing as how this is clearly going to take a long time, I would like to set up an appointment ASAP to submit to you my name change documentation.

The regional FAA Flight Doctor, who had been cc’d on this exchange wrote me back:

Dear Joyce — I have been asked to address some of your questions with respect to medical information that may be required with individuals who have requested a reclassification of gender identity to the FAA. Although I prefer not to discuss specifics on anyone’s medical information over an email I will try to respond to your email queries. I also noticed you do not have a current medical application on file so my response will be very general and it will only apply to aeromedical certification and not to the pilot license issue being addressed by the Bedford Falls FSDO.

The Guide for Aviation Medical Examiners does not have every possible medical condition listed in the contents — that would be an impossible undertaking. The Guide is exactly that, a guide and not policy. An Aviation Medical Examiner is expected to defer these cases to Aerospace Medical Certification Division (AMCD) in Oklahoma City for issuance of the medical certificate, which in part explains why there is no specific guidance in that publication. I would suggest that no medical reports be provided to the AME at the time of the FAA physical — AMCD will send the applicant a letter making it very clear as to what medical information is needed.

AMCD has considerable experience with requests for medical certification of individuals involved in the gender identity change process. It is rare for the agency not to medically certify an applicant who has made that request. In general terms the process the agency follows varies for every applicant depending on the specifics of the case. When a new deferred medical application is received and the applicant has identified that they are in the gender change identity process AMCD will ask for additional medical information from their treating physician(s). This request is initially general in nature, i.e., stage in the process, medications and dosages, any underlying medical problems, is surgery anticipated, etc. They will likely ask for a current psychological assessment to make sure no stressors may be present that could preclude issuance. Depending on what information is received additional requests for information will be made. When the agency is satisfied medical standards are met, a medical certificate is granted most likely under the special issuance process, with follow up reports requested. Again this is a very general description and each case will vary.

If you are interested in obtaining medical certification, please visit your AME and start the application process. They will defer issuance and AMCD will notify you what is needed. I have taken the liberty in forwarding a letter today to you explaining the need to start the medical application process.

There were many good things in his email, including the statement that the FAA has lots of experience in gender-changes, and several troubling things, like his statement that there is no current medical certificate for me on file even though I did a new one last August, and the waffling answer that the medical guide can’t possibly answer everything. In other words, “physically the gender indicated on the certificate” can mean whatever the physician wants it to mean. Since I do have a current medical certificate, I wrote back thusly:

Thank you very much for your mail. I do, in fact, have a 2nd class medical, but you’ll need to look up my old name in the FAA records, as I was advised to wait by the Bedford Falls FSDO to do the gender/name change all at the same time: [oldname], private pilot, cert #99999999. I passed my 2nd class physical a year ago — as a woman — with flying colors, so what’s being requested at this point is not a new medical, but rather a change in my pilot’s airman’s certificate noting the sex is F, rather than M.

I am visiting our FSDO on Monday to initiate my name change, as it appears this sex-change request may take a while. I will show Gordon my 2nd Class medical certificate at that time and ask if that document is sufficient to get the ball rolling on changing the M to an F.

And he replied:

Joyce — now I am confused. I had been given the name [oldname] by the FSDO and looked you up in the system prior to emailing you. The date of the last exam I have on file is July 12, 2006, which would make that certificate expired for all classes. If you had a physical in 2008 (or 2007) and your AME did not transmit it as required that is worrisome — the agency would have no way of knowing you have a valid medical in your possession and that can cause a problem during a ramp check. Could you please identify your latest AME and the exact date on the certificate — the last AME on record for you is Dr. KF in Bedford Falls and he did your 2006 exam.

And I replied:

Yes, I’m looking at it right now, a white certificate, second class medical, signed by KF, examiner number 99999-1, and we did the exam in the late afternoon of August 7th, 2008. I do know that he had some traumatic medical events in his life shortly after my exam last August, and maybe it’s the case that some of his last bits of paperwork didn’t get filed? I don’t know.

And he ended the conversation thusly:

Thank you — please ask him to provide you or us a copy of the physical if he has it — but you would be better off to get a new physical when you decide you wish to pursue medical certification under a different name. That way there is no confusion with regards to the nature of the application. Simply for information, Dr. KF no longer is an AME.

In addition, it would be helpful if you could fax a copy of that certificate (and the physical if you obtain it) so we have it on file. Our fax is 817-222-5965.

OK, at least I’m still legal to fly because I’m in possession of a medical certificate. I think Dr. Salazar’s argument that I should get a new medical for the new name rings a bit false — I don’t recall anywhere that changing your name due to marriage, etc, requires a new medical examination. I don’t know if this is progress, but the dialog is productive and, more importantly, it’s moved beyond the local FSDO’s domain and includes the regional flight medical examiner.

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.