Map detailing sex reassignment surgery (SRS) requirements each state has. Sources are Lambda Legal and Dr. Becky Allison's Instructions for Changing Name and Sex on Birth Certificate.
  State does not require SRS to alter sex on birth certificate
  Altering sex on birth certificate requires SRS134
  State does not alter sex on birth certificates for transsexuals2
1Some Texas officials have refused to amend the sex on birth certificates to reflect a sex change after the ruling Littleton v. Prange; however, a judge can order an amendment. 

2In American Samoa, "the Office of Vital Statistics . . . may change the gender marker on a birth certificate with medical documentation of the change in sex."
This file was derived from: Blank USA, w territories.svg
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