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DISTRICT OFFICE 67 HANSON PLACE BROOKLYN, NY 11217 (718) 260-9191 FAX: (718) 260-9099 CITY HALL OFFICE 250

BROADWAY, ROOM 1792 NEW YORK, NY 10007 (212) 788-7081 FAX: (212) 788-7712 ljames@ council.nyc.com

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THE COUNCIL OF THE CITY OF NEW YORK

LETITIA JAMES
COUNCIL MEMBER, 35TH DISTRICT

June 8, 2011

Commissioner Thomas Farley New York City Department of Health and Mental Hygiene 125 Worth Street New York, NY 10013 Commissioner Farley: We are writing in regards to the New York City Department of Health and Mental Hygienes requirements that transgender individuals must undergo genital reassignment surgery and post-surgery psychiatric evaluation before updating the gender marker or sex-identifier on their birth certificate. Birth certificates of individuals born within the five boroughs are under the exclusive jurisdiction of the New York City Department of Health and Mental Hygiene (Health Department), under the New York City Office of Vital Records. A birth certificate is a crucial form of identification that is routinely required for applying for public benefits and health insurance, obtaining professional certification, obtaining drivers licenses, demonstrating eligibility for work, and other situations. Part of the departments current requirements for individuals seeking to change the gender-marker (or sexidentifier) on their birth certificate include undergoing genital reassignment surgery (also commonly referred to as bottom surgery), as well as a post-surgery psychiatric evaluation. This creates a number of problems for transgender individuals, the least of which is that the agency is unspecific about the nature of the genital reassignment surgery required, as there are multiple types of surgeries available for transgender persons. This ambiguity creates confusion for those seeking to update their birth certificate to their identifying gender, as these kinds of surgeries can be very costly. Furthermore, nowhere on the agencys website is any information about the process to alter this documentation available. In 2010, the United States Department of State ceased requiring gender reassignment surgery as a prerequisite for passport issuance. Indeed, New York State currently has a simple process for amending the gender or sex-identifier on a state identification card or drivers license, but individuals moving from New York State to another state may encounter difficulty if their birth certificate is also required to receive a state ID there. Overall, presenting their original birth certificate to others may raise problems for transgender individuals when the gender or sex-identifier on the document does not match their identified gender or perceived appearance. Many transgender individuals cannot afford bottom surgery for financial reasons; a high number of these individuals may be receiving hormone therapy through their medical care provider to address masculinization or feminization of appearance. Finally, not all transgender individuals are interested in genital reassignment surgery. It is highly questionable for the Health Department to enforce regulations that are based on generalized assumptions about transgender individuals and their personal, medical choices. Numerous transgender-rights advocacy agencies, as well as the American Psychological Association and the National Association of Social Workers, have encouraged municipalities to abandon surgical requirements for changing identity documents. City and State agencies are recognizing that any regulations in regards to updating gender or sex identification on documents must be based on the standards set by the physicians

actually treating these individuals. The World Professional Association for Transgender Health, the primary health association that sets standards for medical treatment of transgender persons, has stated No person should have to undergo surgery or accept sterilization as a condition of identity recognition. Genital reconstruction is not required for social gender recognition, and such surgery should not be a prerequisite for document or record changes. We request that the New York City Department of Health and Mental Hygiene drop the requirement for transgender individuals to complete gender reassignment surgery and post-surgery psychiatric evaluation before altering their birth certificate. It is deeply inappropriate and intrusive to the privacy of transgender individuals for a City agency to set medical standards for gender or sex identification and documentation.

Thank You,

Letitia James Member of the City Council

Daniel Dromm Member of the City Council

Karen Koslowitz Member of the City Council

Melissa Mark-Viverito Member of the City Council

Annabel Palma Member of the City Council

CC New York City Board of Health, Department of Health and Mental Hygiene

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