A surgery requirement for changes to vital records is not in alignment with policy statements of all leading medical, psychological, and psychiatric organizations, including the American Psychological Association, the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the Endocrine Society, and the World Professional Association for Transgender Health (WPATH).

Additionally, I agree with Ted Heck's comment: "...the Vital Records regulations should allow for gender change upon submission of a statement from a licensed provider, rather than requiring a court order. Forcing people to discuss their gender identity and any medical treatment they have undergone in open court can cause significant discomfort and be psychologically traumatic. Further, the expense of securing legal counsel is beyond the means of many transgender people, a significant number of whom are unemployed or underemployed because of employment and education discrimination. Taking the gender change process out of the courts and placing it into the hands of the vital records agency will bring consistency and efficiency to the process, and also has the benefit of reserving court resources for more appropriate matters."

This update will bring Virginia in line with other states who have already recognized and corrected outdated policies.

In addition, an administrative route to request a gender marker change should be created, no longer leaving it to the varying decision of individual judges and consistency of updating gender markers across all government documents is best practice and necessary