In a sweeping move, the American Medical Association ( AMA ) has rejected gender-affirmation surgery as a requirement for transgender individuals to update their birth certificates.
This announcement comes on the heels of the World Health Organization issuing a similar ruling regarding birth certificates and such surgery.
The AMA House of Delegates ( the AMA's primary policy-making body of the nation's largest physician organization ) adopted the policy at its annual meeting June 9.
The AMA Board of Trustees produced a report, "Conforming Birth Certificate Policies to Current Medical Standards for Transgender Patients," that guided the discussion on the new policy at the request of AMA's Resident and Fellow Section ( a group that represents physicians-in-training at the AMA ). The report laid out the new policy requirements along with the rationale behind their decision.
The new policy rejects state laws that require a court order and proof of surgery to change a person's gender on their birth certificate. Just a handful of states allow for corrections on birth certificates on the basis of clinically appropriate treatment as opposed to surgery.
"Surgery shouldn't be a requirement to align a person's gender identity with their birth certificate," said AMA President Ardis Dee Hoven, M.D. "State laws must acknowledge that the correct course of treatment for any given individual is a decision that rests with the patient and their physician."
The report states that having accurate identification documents consistent with a person's gender identity is essential for individuals to function in today's society in the areas of employment access, housing, health care and travel. "In addition, having identity documents with incorrect sex designation can expose transgender individuals to bias, discrimination, harassment, and even violence, particularly when transgender individuals must disclose those inaccurate identity documents for inspection ... Disproportionate discrimination, harassment and violence against transgender individuals have been shown to contribute to health disparities within the transgender community."
The AMA noted that requiring gender-affirmation surgery is inconsistent with current medical standards. According to the AMA, there are various medical options for transgender people including medically appropriate combinations of mental health care, social transition and hormone therapy, in addition to the option of the surgery.
Also, the AMA's new policy states that no matter what gender is listed on a person's birth certificate they should always receive medically appropriate preventive care.
"Depending on what gender is recorded in these records, certain treatments, screening and procedures may be disallowed, despite the fact that best medical practices require adequate screening and treatment of a person, regardless of the person's gender identity or gender transition," said Dr. Hoven. "The AMA seeks to ensure that transgender patients always receive appropriate preventive care regardless of whether or not it matches with the gender on the birth certificate."
Historically, the AMA has been more progressive than lawmakers, the courts and private companies regarding transgender health policies and this announcement carries on that trend. Another example of this is their support for the inclusion of transition-related healthcare in public and private insurance.
