CHICAGO — The American Medical Association (AMA), the nation’s largest doctors association, adopted new policies at their national meeting on Monday, clarifying that transgender patients should not be forced to undergo sex reassignment surgery before obtaining new birth certificates.

Most states across the country require some sort of sex reassignment surgery before a new birth certificate reflecting a transgender individual’s new gender is issued.

In a report, the AMA said patients should be able to obtain identification documents consistent with their gender identity, rather than their birth anatomy. Such processes “are essential to basic social and economic functioning,” the Associated Press reported.

“The AMA’s support for eliminating surgery requirements to update their birth certificate will send a strong message to states that lag behind on these policies,” Mara Keisling, executive director of the National Center for Transgender Equality, said in written statement reported by The AP. “Currently only five states and the District of Columbia have modernized their policies to make it clear that surgery is not required to update a birth certificate.”

Keisling added, “Transgender people should not be required to have any specific, costly medical treatments in order to carry the accurate and consistent ID we all need to function every day in the United States.”

Questions over gender identity and birth certificates were highlighted recently in North Carolina, where the statewide high school athletic association adopted new rules saying students could only play on gender-segregated sports matching their birth certificates.

Advocates with the National Center for Transgender Equality and National Center for Lesbian Rights’ Sports Project called the new North Carolina High School Athletic Association rules troubling — especially considering the overwhelming international medical standards which prohibit sex reassignment surgeries for minors.

Director of Policy Harper Jean Tobin said the new high school athletics policy might also cause confusion. While North Carolina and other states may require surgery to change birth certificates, others do not. The result could mean transgender students born outside North Carolina are given an unfair advantage over students born inside the state.

“If they were born in North Carolina and a number of other states, the standard is surgery. In other states, it’s whatever treatment determined medically appropriate for them by their providers,” Tobin said. “In high school that may mean puberty-delaying hormone blockers, it may mean hormone therapy, or it may mean no medications or surgery, simply a psychologically-supported social gender transition, with any other treatment being decided in the future based on medical need.”

Matt Comer

Matt Comer previously served as editor from October 2007 through August 2015 and as a staff writer afterward in 2016.