Abstract
BACKGROUND: Identification documents like passports, driver’s licenses, and birth certificates are a cornerstone of citizenship and an important sociolegal determinant of health. Gender-affirming identification is a vital form of gender affirmation for many transgender people, preventing discrimination, stigma, and violence. The objective of this study was to document the administrative and criminal legal burdens for obtaining gender-affirming identification. METHODS: Qualitative trajectories documenting the name change process for 61 transgender people were created via a community-engaged mixed-methods approach. Data were collected in Miami, Florida, USA October 2022 to June 2023 and were analyzed using an inductive analytical approach. RESULTS: Of the 61 people intending to complete the name change process, 33 successfully filed with the courts and 28 dropped out of the process before filing. People living in poverty, people who were unhoused or unstably housed, and people with criminal legal records were systematically pushed out of the name change process. Among petitioners who file the onerous name change paperwork, discretion at the clerk and judicial level can cause additional administrative burdens. CONCLUSIONS: Barriers to gender-affirming IDs are one critical way transgender people experience intersecting forms of structural oppression and social marginalization. Streamlining the name change process at the local level is one structural intervention that can alleviate discriminatory practices by police, healthcare providers, and others, thereby reducing health inequities.