In the past year, Florida’s health department has declined to amend gender markers on birth certificates for both transgender adults and minors. Although the agency says it is basing denials on pre-existing state statutes, transgender Floridians had previously been able to update their birth certificates for at least a decade. Now, they face an opaque process that seems designed to reject all applicants. 

Transgender Floridians have been denied updated birth certificates even when all of their other government-issued identification reflects their current gender identity. When applicants provided paperwork detailing clinical treatment for their gender transition and their legal name change, they were still denied. This is at odds with how the agency has handled this approval process for years — and is the latest example of Florida’s state agencies enacting anti-LGBTQ+ policies even when anti-LGBTQ+ laws fail to pass. 

In 2023 and 2024, trans minors and adults who applied for amended birth certificates received denial letters from the state health agency’s Bureau of Vital Statistics. In those letters, reviewed by The 19th, the bureau says the paperwork that has long been accepted to update gender on birth certificates — like proof of clinical treatment and a legal name change — no longer works. 

“Specifically, the documentary evidence does not establish that the sex identifier on the birth record contains a misstatement, error, or omission,” one denial letter from March 2024 reads. 

The denial letters also offer conflicting requirements. One, from August 2023, states that for trans minors, “documentary evidence established prior to the child’s seventh birthday is required.” In another letter, the bureau says that trans adults trying to update their birth certificates must provide documentation “established prior to the registrant’s 18th birthday.” Many transgender adults did not know they were trans as children, or did not pursue gender-affirming care as children even if they did realize their identities — rendering either requirement difficult, if not impossible, to navigate. 

Simone Chriss, an attorney with the Southern Legal Counsel in Florida and the director of the organization’s transgender rights initiative, has worked with around 80 clients who she says have all been denied updated birth certificates since last August. None of their appeals, including an administrative hearing overseen by Florida’s health agency, have worked. As a result, none of them have been able to update their birth certificates.

“Most are just being ignored,” Chriss said. “I’ve filed many. There’s at least five that I have pending at this moment that the department hasn’t responded to.” 

The Florida Department of Health and its Bureau of Vital Statistics did not respond to requests for comment.

Republican lawmakers in Florida have repeatedly failed to pass legislation that aims to prevent transgender people from being able to obtain accurate birth certificates. This year, a proposed bill to require that state identification and licenses reflect Floridian’s sex assigned at birth failed to pass. Last year, a bill that would explicitly prohibit gender markers being changed on birth certificates also failed to pass. Despite the lack of legislation, Florida agencies have moved to enforce such restrictions on their own. 

In January, the Florida Department of Highway Safety and Motor Vehicles told local officials that the state would no longer allow transgender people to update their driver’s license with their correct gender. That move was not prompted by any new law, and was simply based on a new agency policy. LGBTQ+ and legal experts believe the rule likely takes Florida out of compliance with federal law, which the state disputes. 

Now, Florida’s Bureau of Vital Statistics within its health agency has reversed course on birth certificate updates, arguing that discrepancies between sex at birth and gender identity do not constitute a paperwork error in need of fixing.  

Updating all of the necessary identity documents is costly. The name change fee in Florida is $400 and fingerprinting for the background check as part of that name change is $50. The requirement of a doctor’s letter for updating the gender marker on a birth certificate means paying out of pocket for a doctor’s visit or at least a copay. Then, there’s the $20 application fee to amend the birth certificate; applicants may also pay more if they opt for rush service. 

For many transgender Floridians, the entire process appears to have ended on a brick wall, with no public notice that a policy change has taken place and no clear path to access accurate documentation. And the new policy appears to be based on a definition of sex that excludes transgender people — a change from what was put on the books less than a decade ago.

In 2018, Florida relaxed its conditions for updating gender markers on birth certificates following pressure from LGBTQ+ and legal advocacy groups. Until then, the state had required proof of sex reassignment surgery in order to change the gender marker — which at least twelve other states still do, according to the Movement Advancement Project. After 2018, Florida’s health agency began accepting letters from medical providers documenting clinical treatment for gender transition. This broadened the scope of who could apply for new documentation since some transgender people never pursue surgery. 

Across the country, only five other states do not update gender markers on birth certificates. Many transgender people pursue this documentation as they legally change their name or update their gender on their driver’s license or Social Security card.

Without accurate personal documents that align with their gender expression and other forms of identification, trans people face harassment or discrimination when going about their daily lives, like when applying for a job or enrolling in a new school. The risk of being “outed” by an incorrect piece of paperwork can have dangerous consequences for trans people, especially in a state considered dangerous for LGBTQ+ people. 

“Despite making, I think, very compelling arguments as to why the department is violating the rights of transgender people born in the state of Florida, they have come back with the same rationale over and over for denying it,” Chriss said. “Which is … ‘sex doesn’t change.’” 

Right now, the best option for trans Floridians seeking an updated birth certificate is to update all of their other government-issued documents to reflect their gender identity, Chriss said. Passports, a primary identification document, can be used in most cases instead of state identification. 

“It’s clear the only avenue or the only route to reversing or striking down this policy is using federal impact litigation, like we have in all the other areas where trans folks’ rights have been eroded in Florida. We are planning to challenge this in federal court as well,” she said.