In medical communities with these restrictions, patients have the option of either suppressing transsexual behavior and conforming to the norms of their birth sex (which may be necessary to avoid social stigma or even violence) or by adhering strictly to the norms of their "new" sex in order to qualify for sex reassignment surgery and hormonal treatments. Attempts to achieve an ambiguous or "alternative" gender identity would not be supported or allowed. Sometimes sex reassignment surgery is a requirement for an official gender change, and often "male" and "female" are the only choices available, even for intersex and transgender people. For governments which allow only heterosexual marriages, official gender changes can have implications for related rights and privileges, such as child custody, inheritance, and medical decision-making.