Please update this outdated process. Requiring explicit details of one's medical treatment is invasive and unnecessary. Requiring surgery is unrealistic and pointless. Many people have lived for years as a gender different from what their birth certificate says, and have not had reconstructive genital surgery because of personal or financial reasons. This surgery is incredibly expensive, out of reach for many people, and is totally irrelevant to any interactions they have other than those specific to their sexual partners or doctors. Having a birth certificate that conflicts with their life, appearance, identity, and other legal ID causes immense problems.
Surgery is not needed to change other forms of ID, including passports and social security cards. It should not be necessary for VA birth certificates.