The Choices: Documentation
Changing name or gender on identity documents can be complex; there are more documents involved than you think. Even transgender people who want to change all of their documents are likely to have some discrepancies between documents because of state or agency laws prohibiting changes, prohibitive fees, not knowing that a particular document exists, or other reasons. It may also be impossible to change some documentation; for example, if another person owns that document (e.g., a nephew is listed in his uncle's will). Some states do not allow legal gender changes unless a person has undergone a particular surgery, further limiting transgender people's ability to change documents if they do not plan to have or cannot afford surgery.22
Some states (or cities) will not change a birth certificate under any circumstances, others will change the name only and never change the sex, and still others will allow individuals to change both their name and sex. Some locations will amend birth certificates to add the new information, but will not remove previous information. Likewise, laws regarding changing name and sex on driver's licenses or identification cards vary by state.
Some transgender individuals may not want to change their documents or may have an identity that doesn't lend itself to changing documents (e.g., a person who cross-dresses on the weekends, or a bigender individual who moves between genders).