With legislation making it more difficult for transgender and gender non-conforming people to change their passports and other documents, it is now a race against the clock to change as many of them as possible. 

Trans Maryland and Advocates for Trans Equality are among the groups that offer workshops and online resources.

Here’s how I did it in Maryland:

A letter from your primary care provider

The first thing you’ll need to get any of this rolling is a document from your primary care provider that shows proof of hormone therapy, gender incongruence, or both. In my experience, this is important to have prior to getting anything started because some states require some sort of proof in order to certify the change.

Some courts may need a therapist’s letter as well, but it depends on what state you live in. With this document, you’ll be able to bring it to the respective offices and it will give a valid reason for you to get your desired gender marker.

A court order

The next thing you will need is a court order that recognizes your gender identity. It is a precaution just to avoid any wasted time or confusion at any offices going forward. You will go to the circuit court website for what state/county you reside in and find a document that is a petition to change your gender. Here is an example from Maryland. 

You will print that document and fill out the petition for your respective titles with or without a name change and take it to the Circuit Court. Some courts may require the appointment. There, you will present the petition and letter and pay a fee — Maryland’s fee is $165, however there are fee waivers for those that apply. After, you will wait some weeks for the court order to show up.

Social Security card

Unfortunately, as of January 2025, the Social Security Administration has ceased any gender changes in their system. As with the fight for passports reflecting the holder’s proper gender identity, the Human Rights Campaign and the American Civil Liberties Union may bring a case to regain access in the future.

Identity card/driver’s license

After getting your primary care letter and court order, make a standard appointment for Identification Services at the local DMV and bring the paperwork. Though the Maryland Court’s website says there is no need to get a court order to change any documents, the clerk at the Maryland Motor Vehicle Administration (Maryland’s DMV) stressed that I needed the updated Social Security card changed in order to get an updated ID.

I was able to get it changed prior to the Trump-Vance administration, however given the current circumstances, if there is any pushback from any clerk or official who say they require a Social Security card, very adamantly cite the official gov website if applicable, and use the court order, despite the fact you should not need one to get your ID updated.

Birth certificate

Should all have gone well with the ID, the last document to amend is the birth certificate. 

Unfortunately, this may be the most difficult document that you are able to amend because it must be done within your home state and some states, such as Oklahoma, Florida, Tennessee, and Texas, have already banned altering birth certificates 

In D.C., where I changed my own, there have been no known issues or legislation passed for changing the name and gender marker on the document. You will search your state government websites for the vital records department, find a Gender Designation Application and fill out the necessary information. The D.C. application is here:

On D.C.’s application, you must sign the document in front of a notary in order for it to be valid. Several mail offices, such as UPS, offer notary services for relatively cheap. Upon getting the application notarized, you can bring all documents you have already updated along with the court order and primary care letter to an appointment at the vital records office. All the previous work done should make this fairly easy if you are in a state that hasn’t made heavy strides to halt the process. 

All in all, with about a month of your time, about $300, and a state that supports your right to self-actualization, you should still be able to change most of your documents.

As an LGBTQI+ activist from Argentina, a country currently facing deep setbacks under an openly anti-rights government, I understand the frustration and fear many are expressing about attending WorldPride 2025 in the United States. I also understand the symbolic weight of showing up anyway.

Following the announcement by Egale Canada and the African Human Rights Coalition that they are withdrawing support for WorldPride due to the Trump administration’s anti-LGBTQI+ stance, concerns have rightly been raised about safety, complicity, and principle. These concerns must not be dismissed. But they must be responded to with a deeper strategic reflection: Visibility, presence, and collective action remain our greatest tools in confronting oppression.

Boycotts may offer symbolic protest, but absence creates silence

WorldPride is not organized by the U.S. government. It is a platform created by and for LGBTQI+ civil society — local activists, grassroots groups, trans-led collectives, BIPOC-led organizations, and everyday people building community despite hostile political environments. Boycotting this space sends a message not only to the Trump administration, but to our own movement: That when things get hard, we retreat.

History teaches us otherwise.

In 1990, amid the AIDS crisis and government neglect, activists did not boycott — they stormed the National Institutes of Health and the FDA. In 2014, when Russia passed its “gay propaganda” law, global solidarity at the Sochi Olympics became a powerful moment of protest and resistance. And in 2020, amidst a pandemic and police violence, Pride went digital but never disappeared.

If we set the precedent that global LGBTQI+ events cannot happen under right-wing or anti-LGBTQI+ governments, we will effectively disqualify a growing list of countries from hosting. That includes not only the U.S. under Trump, but Hungary, Italy, Uganda, Poland — and even my own country, Argentina, under Javier Milei. Yet ILGA World still plans to convene its 2027 conference in Buenos Aires, and rightly so. We must not surrender global platforms to the very governments that wish to erase us.

WorldPride is not a reward for good governance. It’s a tool of resistance

To those who say attending WorldPride in D.C. normalizes Trump’s policies, I say: What greater statement than queer, trans, intersex, and nonbinary people from around the world gathering defiantly in his capital? What more powerful declaration than standing visible where he would rather we vanish?

Safety is paramount, and all governments — including the U.S. — must guarantee the protection of LGBTQI+ participants. But refusing to engage is not the answer. In fact, visibility in hostile spaces has always been a hallmark of our movement’s strength. We showed up at Stonewall. We marched on Washington in 1979. We protested during the AIDS crisis, and we will show up again now — not in spite of adversity, but because of it.

We are in a global moment of rollback. Division is what our opponents want

The rise of anti-gender ideology and trans-exclusionary narratives has created fertile ground for far-right movements worldwide. In this moment, LGBTQI+ solidarity must be global, intersectional, and uncompromising. We cannot afford to fracture our own movement based on geopolitical fault lines.

Egale Canada and the African Human Rights Coalition raised legitimate criticisms — of U.S. foreign policy, immigration barriers, and systemic racism. But those issues must be confronted within WorldPride, not from outside it. We must bring those critiques into plenaries, panels, and the streets of Washington. We must create space for diasporic, racialized, and grassroots-led voices. We must use this moment to hold institutions accountable and shift the power of Pride to those most affected.

Because that is what solidarity looks like — not abandonment, but engagement.

WorldPride 2025 must not be a party disconnected from reality. It must be a protest rooted in our global truths.

Let us not cede this space. Let us make it ours.

Mariano Ruiz is the president of Derechos Humanos y Diversidad Asociación Civil in Argentina. He is also a 2019 Columbia HRAP Alumni.

Even though 86% of transgender Americans have health insurance, one in four reported being denied coverage for gender-affirming care in the 2015 and 2022 U.S. Transgender surveys. These denials can occur when an insurance plan contains a categorical exclusion of gender-affirming care. It is important to note that transgender employees who receive insurance coverage through their employers are entitled to legal protections. 

Employers are responsible for ensuring that the insurance plans they provide do not violate any laws, including anti-discrimination laws. In 1983, the Supreme Court ruled that under Title VII of the Civil Rights Act of 1964, employers are legally required to provide employees with equal pay and benefits, including health insurance. This protection now extends to transgender employees after the Supreme Court’s ruling in Bostock v. Clayton County (2020), which clarified that sex discrimination under Title VII includes gender identity discrimination.

Since Bostock, several transgender employees have successfully sued their employers for discrimination because they were denied coverage of gender-affirming care by their employers’ insurance. While employers can be held liable under Title VII, it remains unclear whether insurance companies will be held liable under Section 1557, the antidiscrimination provision of the Affordable Care Act (ACA), in the future.

Most—if not all—courts have ruled that employers can be held liable for choosing insurance plans with categorical exclusions of gender-affirming care. A categorical exclusion is when an insurance plan has a blanket ban of coverage for certain services. Although discrimination cases generally require proof of intent to discriminate, it is not required of transgender employees because categorical exclusions of gender-affirming care are facially discriminatory (i.e. the policy is explicitly and obviously discriminatory in nature).

In Kadel v. Folwell (2024), the Fourth Circuit court considered the Fourteenth Amendment, Title IX, and ACA claims in a consolidated case considering two state health plans: the State of North Carolina’s insurance plans for teachers and West Virginia’s Medicaid program. The Fourth Circuit court held that it is impossible to ban coverage of gender-affirming care without discriminating against transgender people because (1) gender dysphoria is a legitimate medical diagnosis which requires medically necessary treatment; and (2) the services provided under gender-affirming care are also provided to cisgender patients for other medical diagnoses. In short, there is sufficient evidence of discriminatory intent because categorical exclusions of gender-affirming care are facially discriminatory. Under Kadel, the Fourth Circuit also ruled that a policy does not have to explicitly exclude transgender patients. “Rewording the policies to use a proxy,” like sex changes or sex modification, is still facially discriminatory.

Along a similar vein, in Lange v. Houston County (2024), the Eleventh Circuit court found that the Sheriff’s Office’s categorical exclusion of gender-affirming care was a violation of Title VII. Agreeing with the reasoning in Kadel, the court cited a 1991 Supreme Court Case which ruled that proof of intent to discriminate is not needed for facially discriminatory policies. The court also held Anthem Blue Cross liable because third-party administrators in the Eleventh Circuit (i.e., Alabama, Florida, and Georgia) can be held liable as an employer if they make employment decisions as the authorized agent of an employer. However, this decision is unique to the said jurisdictions, and the liability of third-party administrators/insurance providers remains generally unclear. Moreover, the decision is not final because the court granted an en banc appeal, and a panel of all twelve judges re-heard the case in February 2025. The decision after re-hearing remains to be seen. 

Recently, Executive Order 14168 and the EEOC’s motion to dismiss its lawsuit against Harmony Hospitality on behalf of a transgender worker prompted concerns over transgender employees’ ability to bring federal discrimination claims. While such concerns are understandable, there has yet been any mandate prohibiting the EEOC from issuing right to sue to transgender individuals. In other words, even if the EEOC may not investigate and file lawsuits on behalf of transgender individuals, it does not bar private parties from doing so. Ultimately, the executive branch alone does not have the power to make changes to the Constitution or any federal statutes. It is up to the legislatures to amend laws and the Constitution, and courts to interpret and rule on constitutionality. 

Protections Against Discrimination by Insurers Under Section 1557 Remain Unclear

While employers can be held liable for categorical exclusions of gender-affirming care, employees may be less likely to find relief for legal claims against insurers regarding discrimination on the basis of gender identity. Since Bostock, courts have found insurers liable for denying coverage of gender affirming care under Section 1557 of the ACA, extending sex discrimination to include gender identity. Recent litigation surrounding Section 1557 and the new presidential administration may precede a change in this trend.

In May 2024, the Biden administration issued a final rule implementing Section 1557.It reversed the rule put forth by the Trump administration four years prior, which had revised the Obama administration’s interpretation of the statute. The Biden administration’s final rule defined sex discrimination to include discrimination on the basis of gender identity and sexual orientation. Additionally, under the new rule, a wider swath of insurers and third-party administrators that receive federal financial assistance would be subject to Section 1557. 

However, in July 2024, a Mississippi District judge granted a nationwide injunction preventing the Department of Health and Human Services from enforcing the final rule’s prohibition of sex discrimination with respect to gender identity. Additionally, executive orders during the early days of the Trump administration, and guidance from the Department of Health and Human Services that followed, rescinded wide swaths of Biden-era guidance extending sex discrimination protections to include discrimination based on gender identity. It is not yet clear how the new administration’s position on Section 1557 will impact courts’ decision-making regarding insurer liability and the extent of sex discrimination provisions in relation to gender identity going forward. 

As the recent history of Section 1557 demonstrates, executive actions may influence the implementation of statutory antidiscrimination provisions, but do not change the law itself. While employers continue to face liability for discrimination towards employees seeking insurance coverage of gender-affirming care under Title VII, some protections remain on less certain ground as the United States enters a new presidential administration. 

Ting Cheung, Luke Lamberti, and Neha Sharma are with Sanford Heisler Sharp McKnight.