Surgery should not be a requirement for changing the gender marker on Birth certificates. Surgery is a medical decision that should be made between the person and their doctor. Not only is surgery not a requirement for gender transition, for many it is not a viable medical option due to health or financial reasons. Most all insurances exclude trans Healthcare and most do not have the $10,000+ to pay out of pocket. In addition, having to appear in court is costly and an extraneous step that some trans people cannot afford, monetarily or time wise.