In an effort to “recognize the medical spectrum of gender identity,” The American Medical Association now recommends removing sex labels entirely from birth certificates. As an associate teaching professor at the University of Washington, who teaches human sexuality to about 4,000 undergraduate students every year, I strongly believe that Washington state should follow this recommendation.

In order to assess the birth certificate issue, let’s first try to understand more about the actual people this would affect. The U.S. Census does not ask about gender identity, but according to a report put out by the Williams Institute in June, 1.2% of the U.S. population identifies as nonbinary, meaning their gender identity is neither “man” or “woman” nor “male” or “female.” That’s roughly the population of Dallas. According to a Gallup poll published earlier this year, 1.8% of people born between 1997 and 2002 (Gen Z) identify as transgender, meaning the sex they were assigned at birth and their own internal gender identity do not match.

My job affords me the pleasure of getting to know many trans and nonbinary students. A few are lucky to have come from families and communities that affirm their identities. Others have escaped emotionally abusive situations from people who refuse to accept them. Almost all of them have described instances of discrimination and harassment based on their gender identity. Sometimes this comes in the form of micro-aggressions, such as when people purposefully use incorrect pronouns when addressing them. Often, however, it arrives in more blatant forms of verbal and physical attack.

Given their experiences, it is perhaps unsurprising that transgender and nonbinary individuals are at extremely high risk for mental illness. A recent article published in Clinical Psychology Review found that 64% of transgender people in the U.S. show depressive symptoms, 43% are considered at high risk for suicide and 40% experience alcohol and substance abuse problems. Over half have experienced sexual or physical assault.

According to research from the TransYouth Project, the most major, large-scale, national, longitudinal study of socially transitioned transgender children to date, the biggest predictor of mental health outcomes in transgender children is whether their families and communities support them. Trans children whose families support them in their social transition, who let them choose things like pronouns, clothing and haircuts that match their gender identity are at absolutely no higher risk for depression or suicide ideation than cisgender (non-trans) children. Trans children who aren’t allowed to socially transition, who are pressured to be gender conforming and who are picked on and teased by classmates, demonstrate dangerously high levels of mental illness. As I tell my students, it isn’t being trans itself that makes one depressed and likely to commit suicide. It’s the rejection and denial of one’s personal and very real identity that leads to these outcomes.

A birth certificate may seem like something hardly worth getting worked up about. Some will argue that Washington state’s policy, which allows a person over 18 to change their sex on their birth certificate, makes all of this obsolete.


The problem with this logic isn’t just that it still leaves a hurdle in place should someone want to change their sex label on their birth certificate. There’s a larger issue at stake that reflects the psychological blow that comes from possessing a state document that inaccurately reflects such a major component of your self identity. It’s a form of rejection from your own community, one that’s not much different than dealing with people who refuse to call you by your proper pronouns. The “opportunity,” when you turn 18, to go check a box that says “X” under “Sex” on your birth certificate is not a remedy. It’s a reminder of the fact that you are “other.”

Like it or not, and even in a city as progressive as Seattle, most people are still very married to a binary model of gender. I get that for many older adults especially, modern conceptions of gender seem strange and scary. But this isn’t a “fad” that is going away. It’s much more “natural” than you might think. As the famous sex researcher Alfred Kinsey said in 1948:

“The world is not to be divided into sheep and goats, and not all things are black nor all things white. It is a fundamental of taxonomy that nature rarely deals with discrete categories. Only the human mind invents categories and tries to force facts into separated pigeonholes. The living world is a continuum in each and every one of its aspects. The sooner we learn this concerning human sexual behavior, the sooner we shall reach a sound understanding of the realities of sex.”

Sex and gender diversity reflect a very beautiful reality of our natural world. Let’s embrace and celebrate this fact rather than fight it.