US appeals court affirms trans Arizonans can amend birth certificates without surgery

In October 2026, the U.S. Court of Appeals for the Ninth Circuit ruled that Arizona state law permits transgender individuals to amend the sex marker on their birth certificates without undergoing gender-affirming surgery. While vacating a federal district court’s permanent injunction, the appellate panel established a binding statutory interpretation: transgender people who transition without surgery are legally entitled to receive amended birth certificates by securing a court order from state judges.

According to the American legal publication Gay City News, the dispute in Roe v. Johnston centered on Section 36-337 of the Arizona Revised Statutes, which governs vital records amendments. Subsection (A)(3) of the statute requires the registrar at the Arizona Department of Health Services (ADHS) to amend a birth certificate via an administrative route upon receiving a written request and a physician’s certification that the individual underwent a “sex change operation.” Meanwhile, subsection (A)(4) broadly directs the registrar to amend a birth certificate upon receiving a “court order ordering an amendment.”

The class-action lawsuit, brought by minor transgender plaintiffs and their parents, arose because several Arizona trial court judges had refused to issue court orders for non-surgical transgender applicants, erroneously assuming that subsection (A)(3) was the exclusive legal avenue for amending a sex marker. In response, Senior U.S. District Judge James Alan Soto ruled that the statute violated constitutional guarantees of equal protection and due process, issuing an injunction that struck the word “operation” from the administrative rule.

Reviewing an appeal filed by the state health department, a Ninth Circuit panel led by Circuit Judge Roopali Desai, joined by Senior Circuit Judge Andrew Hurwitz, determined that the district court erred in declaring the law unconstitutional. The appellate court found that subsection (A)(4) serves as an expansive catch-all provision allowing anyone to petition a state court for an order directing an amendment based on evidence of social or medical transition. Republican legislative leaders who intervened in the case—Arizona Senate President Warren Petersen and House Speaker Steve Montenegro—argued that surgery was strictly mandatory under state law, but the panel rejected their restrictive interpretation.

Judge Desai reasoned that the legislature had a rational basis for distinguishing between the two pathways: individuals with verified surgical procedures can use an expedited administrative process without judicial oversight (comparable to adoption decrees or voluntary acknowledgments of paternity), whereas non-surgical amendments require judicial findings. The Arizona Department of Health Services, headed by Interim Director Deborah Johnston, affirmed in court that it is legally obligated and prepared to honor state court orders to update sex markers without requiring surgical verification.

The plaintiffs were represented by attorneys from the National Center for Lesbian Rights (NCLR), alongside law firms Cooley LLP and Osborn Maledon. Founded in 1977, NCLR is one of the nation’s foremost LGBTQ+ legal advocacy organizations, specializing in litigating landmark civil rights cases in state and federal courts.

The legal rights and healthcare access of transgender individuals remain central issues across the American legal landscape: Uránia previously reported on Arizona and Virginia ending Medicaid coverage for youth gender transition procedures under federal regulatory pressure, and analyzed a Ninth Circuit ruling regarding the housing of transgender women in Oregon correctional facilities.