Appeals court confirms that Arizona law allows all transgender people the ability to amend the sex marker on their birth certificates by court order

PHOENIX, AZ – Today, the U.S. Court of Appeals for the Ninth Circuit held that Arizona law permits every transgender person born in the state to amend the sex marker on their birth certificate without undergoing surgery. In Roe v. Johnston, the court ruled that transgender Arizonans may obtain a court order directing the Arizona Department of Health Services (ADHS) to amend their birth certificates, and that a trial court may not condition such an order on proof of specific medical treatments.

The decision resolves years of uncertainty for transgender Arizonans, including young people, who had been turned away by state courts and the health department because they had not undergone surgery that minors cannot obtain.

“The Ninth Circuit’s opinion removes outdated, burdensome barriers that made it nearly impossible for many transgender Arizonans, particularly young people, to obtain an accurate birth certificate,” said Rachel Berg, National Center for LGBTQ Rights Senior Staff Attorney, 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.”

Birth certificates are foundational identity documents, used for school enrollment, employment, camp and sports registration, and obtaining driver’s licenses and passports. A birth certificate that does not match a person’s gender identity forces transgender people to disclose their transgender status every time the document is used, exposing them to discrimination and harassment.

The case, Roe v. Johnston, was brought by the National Center for LGBTQ Rights (NCLR), Cooley LLP, and Osborn Maledon, P.A., on behalf of a certified class of all transgender people born in Arizona, now and in the future, who seek to change the sex listed on their birth certificates but have not undergone surgery. The named plaintiffs are three transgender children. Two of them had been denied court orders by Arizona trial courts that believed that ADHS would not honor an order without proof of surgery.

In September 2025, the U.S. District Court for the District of Arizona ruled that the state’s surgical requirement violated the Equal Protection and Due Process Clauses and permanently enjoined its enforcement. ADHS and Arizona legislative leaders appealed.

Today’s opinion, written by Judge Roopali H. Desai and joined by Judge Andrew D. Hurwitz, reached the same practical result through the text of Arizona’s own statute. The court rejected the legislative leaders’ argument that surgery is the only path to an amended sex marker, calling a trial court’s refusal to issue an order for lack of surgery “improper,” and its refusal based on a prediction that ADHS would not comply “doubly improper.” The court emphasized that the statute “leaves no discretion to the agency,” which must amend a birth certificate when a court orders it to do so.

Because the statute already provides every transgender Arizonan a path to an accurate birth certificate without surgery, the court concluded that a constitutional injunction was unnecessary, reversed the district court’s judgment, and remanded for further proceedings.

Under today’s ruling, a transgender person born in Arizona who has not had surgery may petition an Arizona superior court for an order amending the sex marker on their birth certificate. The Ninth Circuit confirmed that courts have the authority to grant such orders without requiring proof of surgery, that Arizona’s court rules allow petitioners to seek to seal those proceedings, and that ADHS must comply once an order issues.

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The National Center for LGBTQ Rights (NCLR) is a national legal organization committed to advancing the human and civil rights of the lesbian, gay, bisexual, transgender, and queer community through litigation, public policy advocacy, and public education. Since its founding, NCLR has maintained a longstanding commitment to racial and economic justice and the LGBTQ community’s most vulnerable.