Limited Gender Markers Add Hurdles for Nonbinary People

When the State Department began offering a nonbinary X gender marker on passports in April 2022, Ruth Carter, an Arizona attorney who identifies as nonbinary, immediately updated their passport.

Carter had already amended their birth certificate in California and used that document to request a new Arizona driver’s license.

But when it was time to update their Social Security card, Carter hit a significant roadblock.

Despite an agency representative telling Carter over the phone that a nonbinary gender marker was available, Carter says the employee they met for the in-person appointment had different news: the Social Security Administration offers only binary gender options.

Unable to leave the question on the form blank and unwilling to lie by choosing an inaccurate marker, Carter decided to leave their Social Security records as they were, creating a mismatch with other identification records.

Carter’s experience highlights the thicket of contradictory federal and state policies that are leaving many people with mixed messages and mismatched records, especially Social Security records.

This mismatch bleeds into other areas of everyday life for nonbinary individuals when binary gender markers are commonly the only option, such as when purchasing an airline ticket, scheduling a flu vaccine or enrolling in a health care plan. Having to confront this predicament can take a toll on nonbinary people emotionally and sometimes financially.

In October 2022, the Social Security Administration announced it was investigating adding a nonbinary X gender marker option to the Social Security card application process. Approximately 1.2 million people in the U.S. identify as nonbinary, according to 2021 research published by the Williams Institute at the UCLA School of Law.

But the continued wait for a decision from the Social Security Administration underscores how differing federal and state rules can leave many people with inconsistent identification documents, administrative delays and anxiety.

The State Department provides an X gender marker on passports, for example, but some states, such as Oklahoma, have banned nonbinary gender markers on birth certificates. Others, such as Tennessee and Montana, have limited changes to gender markers on state-issued IDs.

“When we talk about the impact of systemic oppression on the individual, this is just one of those instances,” says Rex Wilde, a consultant based in Los Angeles who helps organizations with transgender, nonbinary and gender-expansive initiatives. Wilde identifies as nonbinary.

When Wilde legally changed their name in 2015, California offered only male and female gender markers. California began offering an X gender marker in 2017, but Wilde hasn’t legally changed their gender marker on state documentation.

“It’s not reflected federally, and I have a huge amount of concern of what happens if I have an X gender marker on my identification and I’m going into a state where that is not something that’s commonplace,” Wilde says.

For many people, having conflicting gender markers on state and federal identification often comes with anxiety.

According to a 2023 study published in Psychology of Sexual Orientation and Gender Diversity, feelings of invalidation are associated with lower mental health scores among nonbinary individuals. Additionally, a study published in Lancet Public Health in 2020 found that having IDs consistent with one’s gender identity is associated with a 32% reduction in psychological distress and up to a 25% reduction in suicidal ideation and planning.

“There are so many different ways that people will perceive me based on their own gender lens,” Wilde says. “It’s in those moments where it becomes particularly concerning. If they’re perceiving me as male right now and they see female, my gender marker, what is that going to do? And how is that going to impact this interaction?”

A standardized X gender marker would ease the anxiety, Wilde says.

Inconsistent documentation can also present professional or even financial hurdles.

“I can’t become a notary in Arizona, because you can only apply online and it has the gender question and only two options,” Carter says. While notarizing documents would be an extra service Carter could offer, their inability to register as a notary leads to lost income.

Updating records can rack up out-of-pocket expenses. Georgia, for example, charges $10 to change the gender on a driver’s license, though making updates to physical features such as weight are free.

Nonbinary people also face extra steps as they negotiate health care and health insurance coverage.

“If you don’t have a gender marker that is reflecting the actual type of biological care that you need, then you actually have to go through additional steps in order to get that type of health care approved,” says Wilde.

Nonbinary patients who need health care that conflicts with their recorded gender markers have to work with their insurance companies and providers to have necessary procedures covered to avoid paying for them out of pocket.

State recognition of LGBTQ+ rights has historically required federal government influence, and this issue will likely need the same consistent federal response. The SSA didn’t respond to NerdWallet’s requests for comment and hasn’t provided public updates on the progress of its decision.

Carter says they also emailed the agency repeatedly in the year after the announcement, asking when a nonbinary gender marker would be available.

“I guess they got annoyed,” Carter says. “They were like, please stop emailing us. Please stop asking. There is no more information that we can give you.”

A governmentwide nonbinary gender marker would likely influence other areas where nonbinary people either have to forgo a service or have to indicate an inaccurate gender identity.

When Carter was offered a medical insurance plan through the Arizona Bar Association, for example, they decided to keep their old plan because there wasn’t coverage for nonbinary people. Signing up for a binary plan felt like a lie.