Albany, N.Y. — The state has overturned its longstanding policy requiring transgender New Yorkers to provide proof of gender reassignment surgery — a sex change — to switch the male or female designation on their birth certificates, effective May 23, 2014.

Though medical, financial and personal reasons often dissuade people from seeking sex-change operations, the procedure was previously necessary for those wishing to change the gender marker on their birth certificate. While that’s no longer the case, individuals looking to amend their birth certificates to reflect personal gender identity must still obtain a medical provider’s affidavit verifying that they are receiving “appropriate clinical treatment.”

Here are 6 questions about recent changes to New York State’s policy for switching genders on birth certificates. Click on the question to find your answer.

1 – How do I change the gender on my birth certificate?
2 – What does “appropriate clinical treatment” mean? What does transgender mean?
3 – What if I was born in New York City?
4 – What have LGBTQAA organizations said about the shift?
5 – What other policy changes are transgender rights advocates promoting?
6 – Have other states passed similar laws? What about at the federal level?

1 ­– How do I change the gender on my birth certificate?
Applications to amend birth certificates must be submitted to the state Department of Health Vital Records section. Only people aged 18 or older may submit applications.

While the DOH website offers extensive information about obtaining a copy of a birth certificate, there is not a page dedicated to making corrections. The Vital Records department can be reached by telephone toll-free at 855-322-1022 or by email at vr@health.state.ny.us.

2 ­– What does “appropriate clinical treatment” mean? What does transgender mean?
Transgender New Yorkers seeking the documentation change must provide a notarized affidavit from a medical practitioner verifying that they are receiving treatment for gender dysphoria. Details such as specific treatments need not be included.

There are regular debates about the ‘right’ way to talk about topics such as gender identity and sexual orientation. However, for legal purposes, the American Psychiatric Association guidelines and definitions are typically used.

According to the APA, transgender is “an umbrella term for persons whose gender identity [an internal sense of being male, female or outside the binary of the two], gender expression [the way people communicate their gender identity] or behavior does not conform to that typically associated with the sex to which they were assigned at birth.”

The APA defines transsexual as people whose gender identity differs from their assigned sex. Gender dysphoria, previously called gender identity disorder, is defined by the as “people whose gender at birth is contrary to the one they identify with,” and was revised for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, in an effort to reduce stigma and make it clear that gender nonconformity is not a mental disorder. In a statement, the APA said, “The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.”

3 ­– What if I was born in New York City?
Because the Big Apple issues its own birth certificates, the state policy shift does not apply to those born in NYC. However, the Transgender Legal Defense and Education Fund has filed a lawsuit against New York City and its Department of Health and Mental Hygiene in an effort to force policy change.

Following the state’s recent policy revision, the city health department said it’s considering a similar revision. The department said to the AP, “We are considering a similar change through the Board of Health, and look forward to discussing this important issue with members of the transgender community soon.”

4 ­– What have LGBTQAA organizations said about the shift?
Groups such as the Transgender Legal Defense and Education Fund, Empire State Pride Agenda and other LGBT activists have praised the change, which they hope will help to alleviate harassment and discrimination caused by inconsistency between identities and documentation, or even between multiple pieces of documentation.

“Having accurate documentation is necessary to people’s lives, from employment to school to housing,” Dru Levasseur, transgender rights project director at Lambda Legal, told the AP. “These policy changes will have a real impact.”

Michael Silverman, executive director of the Transgender Legal Defense and Education Fund, the organization that has filed the lawsuit to encourage NYC to amend its policy, told Time, “A birth certificate is a fundamental form of identification. This will ensure that transgender people can obtain accurate birth certificates that reflect who they are.”

The new policy now aligns with the state’s Department of Motor Vehicles policy. Since 1987, the New York’s DMV has allowed residents to change gender identification on driver’s licenses without providing proof of a sex-change surgery.

5 ­– What other policy changes are transgender rights advocates promoting?
Many have called for transgender health care improvements in the state, including expansion of Medicaid to cover hormone treatment and gender reassignment surgery.

“If the federal government can treat transgender people fairly through Medicare, then certainly New York can do the same in Medicaid,” Michael Silverman of the Transgender Legal Defense & Education Fund, told the New York Times for an editorial about transgender rights and health, published June 9, 2014.

The state deputy secretary for civil rights, Alphonso David, released a statement in response to the new policy. David said, “Under Governor Cuomo’s leadership, New York is reclaiming its rightful place as the progressive capital of the nation and made significant progress to advance the rights of all New Yorkers, including members of the transgender community. Much work remains, and this administration is committed to promoting laws and policies that are fair and just for all.”

6 ­– Have other states passed similar laws? What about at the federal level?
California, Oregon, Washington and Vermont, as well as in the District of Columbia, have adopted policies similar to New York’s new birth certificate guidelines.

Some states have moved in the opposite direction. Earlier this year, New Jersey Gov. Chris Christie vetoed a proposal to allow people who have undergone “clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition” to apply for an amended birth certificate.

Transgender rights activists also won a recent victory at the federal level. In May 2014, an appeals board from the Health and Human Services Department expanded Medicare coverage to sex-reassignment surgery. The procedure was previously excluded from coverage because of a Medicare policy that was established in 1981. While Medicare only covers Americans who are 65 and older, its policies often influence insurance companies, so the decision is expected to have a greater impact over time.

Policies similar to New York’s new rules have also been adopted by federal agencies such as the Social Security Administration and the U.S. Department of State. In 2010, the State Department stopped requiring proof of surgery to change gender on passports. Lambda Legal has published state-by-state guidelines for changing birth certificates gender designations, as well as other resources for amending documents.

Jeff Stein is the founder and former editor of the Ithaca Voice.