A federal appeals court has ruled that transgender people born in Arizona can change the sex markers on their birth certificates without undergoing gender-affirming surgery, clarifying a legal process that previously prevented some residents from obtaining documents reflecting their gender identity.
In an October 6 decision, the Ninth U.S. Circuit Court of Appeals determined that Arizona law provides an alternative to the state’s surgical documentation requirement. Transgender individuals can instead obtain a court order directing the Arizona Department of Health Services to amend their birth certificates.
The ruling in Roe v. Johnston stems from a lawsuit filed in 2020 on behalf of transgender Arizonans, including three children, challenging the state’s birth certificate amendment requirements.
Under Arizona Revised Statutes Section 36-337, individuals who have undergone gender-affirming surgery can request an amended birth certificate by submitting verification from a physician. However, a separate provision requires the state to amend birth certificates when presented with a valid court order.
Writing for the appellate panel, Judge Roopali Desai concluded that the second provision applies to transgender individuals regardless of whether they have undergone surgery.
The decision rejected arguments from Republican legislative leaders, including Arizona Senate President Warren Petersen and House Speaker Steve Montenegro, who maintained that surgical verification was necessary for changing a birth certificate’s sex designation.
The court also addressed previous instances in which state judges denied transgender applicants court orders because they believed the health department would refuse to recognize changes without surgical documentation.
Desai determined that such denials were inconsistent with the statute, emphasizing that the health department must comply when a court directs it to amend a birth certificate.
Rachel Berg, senior staff attorney with the National Center for LGBTQ Rights, welcomed the clarification.
“The Ninth Circuit’s opinion removes outdated, burdensome barriers that made it nearly impossible for many transgender Arizonans, particularly young people, to obtain an accurate birth certificate,” Berg said.
Despite the favorable clarification, the ruling was not a complete legal victory for the plaintiffs.
The appellate court reversed a lower court decision that had declared the surgical requirement unconstitutional and ordered the removal of the word “operation” from the statute. Instead, the Ninth Circuit concluded that the existing court-order alternative meant the law did not violate the constitutional protections challenged in the lawsuit.
The case was returned to the lower court for further proceedings.
The decision arrives amid continuing Republican efforts to restrict transgender identification documents in Arizona. In 2025, Democratic Governor Katie Hobbs vetoed legislation that would have further limited birth certificate amendments.
For transgender Arizonans, the ruling establishes an important distinction: access to accurate identity documents cannot be conditioned exclusively on undergoing surgery.
Although obtaining a court order may still involve legal expenses and administrative hurdles, the decision confirms that gender-affirming surgery is not a prerequisite for correcting a birth certificate in Arizona.
