I am a born Virginian, licensed school teacher, and mother of a transgender young adult child.  I want to state my support for the updates to 12 VAC 5-550.  These important updates will remove outdated language and clarify the gender change process for Virginia birth certificates.  According to medical evidence, there is no one way to transition.  Some individuals choose to undergo surgical treatment, other include hormone therapy, and some just undergo mental healthcare for many reasons.  Just as many medical interventions range from waiting the course, to medication, to surgery, not every instance of gender dysphoria requires surgery.  During my time attending a local support group for parents of transgender children, I have heard many stories of how the judges in different localities can interpret "medical intervention" in different ways.  An update to 12 VAC 5-550 would make it easier, and more equitable, for transgender people who do not want surgery, cannot afford surgery, or have health issues that prohibit them from having surgery, to live without being "outed" as transgender, or being discriminated against.  Please update 12 VAC 5-550 to make sure that all Virginians can have a birth certificate that accurately reflects their gender and live without fear of discrimination.