Transgender Arizonans don’t need surgery to update birth certificates, federal appeals court confirms

Transgender people born in Arizona can obtain court orders to change the sex markers on their birth certificates to align with their gender identity without having to undergo surgery, a federal appeals court ruled Tuesday. The ruling clarified a process that has blocked some applicants.

The 9th U.S. Circuit Court of Appeals in San Francisco ruled that surgery isn’t the only path to an amended sex marker and that the Arizona Department of Health Services must comply with a court order directing an amendment, the Arizona Capitol Times.

LGBTQ+ advocates welcomed that conclusion, although the court reversed a lower court’s ruling in the plaintiffs’ favor, rejected their constitutional challenge, and vacated an injunction against the law.

The lawsuit, filed in 2020 and now known as Roe v. Johnston, challenged Arizona’s requirements for amending birth certificates on behalf of transgender people who have not undergone surgery.

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One provision of Arizona Revised Statutes 36-337 allows a person who has undergone surgery to request an amended birth certificate by submitting a written request and a physician’s verification. But a separate provision requires the state to amend a birth certificate upon receiving “A court order ordering an amendment to a birth certificate.”

The appeals court rejected the argument, advanced by Arizona Senate President Warren Petersen and House Speaker Steve Montenegro, both Republicans, that either process required surgery. Petersen is the GOP nominee for Arizona attorney general.

“Simply put, all transgender people can amend the sex marker on their birth certificates under the statute by obtaining a court order. In addition, some transgender people can amend the sex marker on their birth certificate by submitting a physician statement confirming they have undergone a sex change operation,” the ruling reads.

The opinion “removes outdated, burdensome barriers that made it nearly impossible for many transgender Arizonans, particularly young people, to obtain an accurate birth certificate,” said Rachel Berg, a senior staff attorney for the National Center for LGBTQ Rights, who argued the appeal. “Today’s decision makes clear that the Arizona courts permit all transgender individuals to update their birth certificates without requiring a specific medical treatment.”

Related: Arizona Gov. Katie Hobbs vetoes anti-trans bills, and tells lawmakers to 'focus on real issues that matter'

The named plaintiffs are three transgender children. According to the organization, two had been denied court orders because state courts believed the health department would require proof of surgery.

U.S. District Judge James Soto had found the law unconstitutional and issued an injunction striking the word “operation” from the statute and an implementing regulation. The health department and Republican legislative leaders appealed.

Judge Roopali Desai, writing for the 9th Circuit, concluded that the statute already allowed amendments without surgery through the court-order process. The panel upheld the law against the plaintiffs’ constitutional challenge and sent the case back for further proceedings.

The Arizona House and Senate also passed three anti-trans bills in 2025, including House Bill 2438, which would have struck the language that explicitly allowed transgender individuals to change the gender marker on their birth certificates following surgical procedures, as The Advocate reported. All three were vetoed by Democratic Gov. Katie Hobbs, who said of House Bill 2438, “This bill will not lower costs, will not increase opportunity, and will not enhance security or freedom for Arizona. I encourage the Legislature to focus on real issues that matter and impact people’s everyday lives.”