The Department of Health is considering a rule change that would allow people to identify as “Gender X” on their birth certificate.

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TACOMA (AP) — Washington natives soon might be able to change the gender designation on their birth certificates to one that is neither male nor female.

Call it gender X or the more clinical term: nonbinary.

Currently, people born in Washington can request a new birth certificate indicating a gender different from the one recorded at their birth on the original certificates.

They can switch genders on their licenses but only between male and female. If the state Department of Health’s proposed rule changes go into effect, there will be another box to check beyond M or F.

The state is in the first stages of proposing a nonbinary option for people who feel they are neither male nor female or both.

“What we are trying to do is just have birth certificates align with people’s gender identity,” said the department’s Christie Spice.

On Aug. 22 the Health Department filed paperwork to begin the process. The rule changes would:

— Formalize the procedure for changing gender designation on birth certificates.

— Create a “Change of Gender Designation” request form similar to the one used by the state Department of Licensing.

— Establish a list of medical and mental health providers who can attest to the gender change.

— Add an option for a “nonbinary” sex designation.

The Health Department periodically reviews rules, Spice said. Officials recently reviewed procedures surrounding changing gender designation on birth certificates. They thought they could improve the process.

“And at the same time we were getting growing requests and interest from the public about having options for sex designation,” Spice said.

The changes would not affect birth certificates issued to newborns. It’s only for individuals waiting to change their own certificates. and would apply only to people born in Washington.

Seth Kirby, director of Tacoma’s Oasis Youth Center, said many of the transgender young people his center counsels deal with paperwork that has gender designations, from school records to medical forms.

Having those forms match their gender identity is important to them, he said.

“Often we’re asked the question, ‘How would I go about doing this?’ And it really varies from state to state, country to country,” Kirby said. “So having clarity about the process is always useful.”

Adding a nonbinary option would be useful as well, he said.

“That’s a tool and a resource that people then can rely on as they think about the steps in their process,” Kirby said.

The Family Policy Institute of Washington plans to oppose the proposed rule, said the group’s policy director, Chris Plante.

“A person’s gender, in nearly 100 percent of people, is binary, determined at conception by the individual’s biology,” Plante said. “To ensure integrity in our public records, official documents ought to reflect this biological reality.”

Gender identity does not refer to sexual orientation or to people with indeterminate gender.

Some people are born as intersex, meaning they are neither female nor male or they have biological elements of both.

Sometimes genitals are ambiguous. In other cases, intersex individuals can have internal or chromosomal elements that make them different from males or females.

The state has a process to note intersex newborns on birth certificates, Spice said.

A recent poll for the lesbian, gay, bisexual and transgender advocacy group GLAAD found that 12 percent of millennials identified as something other than male or female.

Louie Borgen has a Washington birth certificate that lists the 19-year-old’s gender as female.

“I’m uncomfortable with the fact that is says female,” Borgen said. “I don’t identify as female.”

Borgen presents as what many people would describe as male in appearance.

“I feel like if I had to pick male or female, I would pick male but that feels just as scary and weird as picking female,” Borgen said.

The Tacoma native and restaurant worker would welcome a nonbinary option.

“I would be just as uncomfortable with having (a birth certificate) saying male as female,” Borgen said. “A nonbinary option would be awesome.”

Theo Calhoun, 20, is a University of Washington Tacoma student. Born on a U.S. military base in Germany, Calhoun’s birth certificate reads female.

Calhoun describes their gender as trans masculine. Though the new rule would not apply to them, Calhoun would choose the nonbinary option.

“I think that would be awesome — very ideal,” Calhoun said.

If the state adopts a nonbinary option, it would be a stamp of approval, Calhoun said.

“It feels important to see nonbinary reflected in a formal way,” Calhoun said. And, “For other people to see that nonbinary people exist in the world.”

The Emerald Ridge High School graduate saw themself as nonbinary even before they heard the term.

“I can remember being in high school and understanding that there were straight people and gay people and then feeling like no one like me really exists,” Calhoun said. “I thought I was the only one who felt the way I felt.”

Calhoun considered changing the gender designation on their driver’s license to male.

“I have all the paperwork to do it but I haven’t sent it in yet,” Calhoun said, “because it doesn’t quite feel right.”

Skylar Robinson, 16, was born female in Tacoma. He now identifies as male.

The proposed changes, if approved, would make it easier for Robinson to change his birth certificate from female to male, he said.

The Running Start student attends Lincoln High School and Tacoma Community College. He chose Skyler as a new name in kindergarten, but kept it to himself.

“I knew my body wasn’t a boy but I knew that I also didn’t feel like I was girl either,” he said.

Most who meet Robinson would assume he’s female at first.

“My gender identify doesn’t really fit with my body itself,” he said. “So, that’s what’s holding me back from identifying fully with male.”

When he started attending Oasis, Robinson met people with different gender identities.

“I was amazed at how many people were so OK with being themselves,” he said. “I was whoa, this is the most amazing thing I’ve ever seen.”

In March, Robinson switched from using female to male pronouns for a night.

“It was amazing,” he recalled. “Then I did that for a week. And then I did that for a month. Then I came out at school. Then I came out to my dad. It just keeps building on top of itself. The more it builds the better I’ve been feeling.”

Robinson’s parents are involved in his decision-making. He knows it will be awhile before he can change the gender on his birth certificate to male. But, he feels he’s on the right path.

“I’m at the point where I’m so comfortable I can even change my birth certificate,” Robinson said. “It’s like a relief. I’m finally there. It’s this big goal I’ve been working towards my whole life and it’s like the cherry on top.”

The Health Department has notified several groups and individuals that the changes are being reviewed, Spice said.

“We started with people we thought would be interested,” she said.

Those include transgender and nonbinary individuals.

“They’ve given us ideas about what they’d like to see,” Spice said.

Individuals can give input and get updates through the Health Department.

Legislation under consideration in California would give residents the option of a third gender on state identification, including birth certificates.

Earlier this year, Oregonians were given the option of gender X for their driver’s licenses.

“It’s a conversation that is happening across state vital record offices,” Spice said.

The next stage in Washington would be creating a draft rule. At that time additional public comment and public hearings would take place.

“We will move forward based on the public input that we’ve received,” Spice said.

Finally, the secretary of Public Health will make a decision, she said.