All providers need to be aware of the impact of government documentation as a social determinant of health. Trans people who are unable to change their name and/or sex designation on government documentation can face barriers in accessing health care, employment, housing, and income. Having a sex designation that is inconsistent with one’s gender presentation on government documentation can also leave individuals vulnerable to violence and harassment. Supporting clients to get the documentation they need will enable them to access other supports and services, and ultimately support them in reducing barriers in their day-to-day life.
What you need to know
- Physicians should be aware of the regulations and requirements that pertain to name and sex designation change on official government documents given their current role in facilitating these changes and the overall transition of their patients.
- Be prepared to assist your patients when they request documentation to support changes to their government identification or health card, and ensure they know you are willing to provide this information if/when they require it.
- Clients will often ask where they should start in the process of changing their ID and government documentation. There is no particular order in which these documents must be changed. Different people will make different choices about what documentation they would like to change and when to change it. However, RHO recommends beginning the process with changing provincial identification, as you can use these documents to change your federal identification more easily. If you are changing multiple
identification cards or certificates, we suggest starting with your Ontario birth certificate, if applicable.
- Clients who were not born in Ontario face different challenges in obtaining and changing government-issued documentation that are beyond the scope of what’s covered here. Generally speaking, it’s easiest to start with obtaining a birth certificate from the province or country of origin, and then to proceed from there.
- Obtaining and keeping ID can be a particular challenge for people with no fixed address. Street health services will often provide a mailing address and/or ID storage for people that require this service. For instance, people in the GTA can access these services at over 40 sites through the Partners for Access and Identification (PAID) Project.
Some trans and non-binary clients may choose to not change their sex designation or name on any document. Why?
Certain clients may choose not to change the sex designation or name on any of their documentation. Some of the reasons for choosing to not change documentation include:
- It may not seem important or relevant to them.
- They may want to make a political point. For instance, they are proud that they don’t meet the gender expectations of the name and sex they were assigned at birth.
- They may be worried that they will lose access to services that are specific to their assigned gender. For instance, trans men who have a uterus might choose not to change their sex designation to “M” on their health card because they are worried that they will face barriers in getting a hysterectomy if they ever need one.
- Some people may choose to have different names and sex designations on difference pieces of ID if they need to pass as different genders in different contexts. For instance, some people may not be out to their families or in their workplaces and they maintain that situation by retaining the name and gender assigned to them at birth on certain pieces of ID.
- In some cultures family inheritance only passes through the male line. Some trans women may choose to keep a male designation on their documentation to ensure that they are not excluded from their inheritance.
- Many clients may feel that their gender is not binary (i.e. that they are somewhere along a spectrum of gender expressions, and/or that they have many gender expressions that can’t be confined to either an “M” or an “F”). Some of these clients may choose to keep their assigned gender on their documentation, while others choose to change their sex designation.
To learn more about gender transition and government identification in Ontario, see the research report Trans Ontarian’s Sex Designations on Federal and Provincial Identity Documents: A Report Prepared for the Canadian Human Rights Commission (Bauer 2012), from the Trans PULSE project.