The American Medical Association (AMA) says that sex should be removed as a legal designation on the public part of birth certificates. The group says including the information can lead to stigmatization of transgender and nonbinary people when they register for school or sports, request or file government documents, get married, or apply for a job or credit check. The sex designated at birth would still be recorded, it just would not be part of the publicly available information. Instead, it will be sent to the U.S. Standard Certificate of Live Birth for “medical, public health, and statistical use only,” according to the group. “Assigning sex using binary variables in the public portion of the birth certificate fails to recognize the medical spectrum of gender identity,” Willie Underwood III, MD, the author of the report said. Forty-eight states plus Washington, D.C. allow individuals to change the sex assigned at birth on their birth certificates. Tennessee, one of the most anti-trans states in the nation, does not. Texas requires a court order before they will make the change. Only ten states allow for a non-binary gender marker. “We unfortunately still live in a world where it is unsafe in many cases for one’s gender to vary from the sex assigned at birth,” Jeremy Toler, MD, a delegate from GLMA: Health Professionals Advancing LGBTQ Equality, added.