Map detailing <a href="https://en.wikipedia.org/wiki/Sex_reassignment_surgery" class="extiw" title="w:Sex reassignment surgery">sex reassignment surgery (SRS)</a> requirements each state has. Sources are <a rel="nofollow" class="external text" href="http://www.lambdalegal.org/publications/sources-of-authority-to-amend">Lambda Legal</a> and <a rel="nofollow" class="external text" href="http://www.drbecky.com/birthcert.html">Dr. Becky Allison's Instructions for Changing Name and Sex on Birth Certificate</a>.
<div class="legend" style="direction:ltr;line-height:23px;"><div class="legend-content" style="display:inline-block;vertical-align:top;box-sizing:border-box;width:34px;height:23px;overflow:hidden;font-size:15px;border:thin solid #333;background:Purple;color:#202122;text-align:center;"> </div> State does not require SRS to alter sex on birth certificate</div>
<div class="legend" style="direction:ltr;line-height:23px;"><div class="legend-content" style="display:inline-block;vertical-align:top;box-sizing:border-box;width:34px;height:23px;overflow:hidden;font-size:15px;border:thin solid #333;background:Fuchsia;color:#202122;text-align:center;"> </div> Altering sex on birth certificate requires SRS<sup>1</sup><sup>3</sup><sup>4</sup></div>
<div class="legend" style="direction:ltr;line-height:23px;"><div class="legend-content" style="display:inline-block;vertical-align:top;box-sizing:border-box;width:34px;height:23px;overflow:hidden;font-size:15px;border:thin solid #333;background:Red;color:#202122;text-align:center;"> </div> State does not alter sex on birth certificates for transsexuals<sup>2</sup></div>
<hr><p><sup>1</sup>Some Texas officials have refused to amend the sex on birth certificates to reflect a sex change after the ruling <i><a href="https://en.wikipedia.org/wiki/Littleton_v._Prange" class="extiw" title="w:Littleton v. Prange">Littleton v. Prange</a></i>; however, a judge can order an amendment. 
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<sup>2</sup>In American Samoa, "the Office of Vital Statistics . . . <a rel="nofollow" class="external text" href="http://www.transequality.org/documents/state/american-samoa/">may change the gender marker on a birth certificate with medical documentation of the change in sex."</a>
<a href="https://en.wikipedia.org/wiki/User:Theshibboleth" class="extiw" title="w:User:Theshibboleth">Theshibboleth</a>
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