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Several physicians expressed support for a from the American Medical Association (AMA) Board of Trustees recommending that the sex designation be removed from the publicly available portion of birth certificates at a Special Meeting of the AMA House of Delegates.

Currently 48 states and DC allow people to change the sex designation on their birth certificate to align with their gender identity, but only 10 states allow a gender neutral option. Two states, Ohio and Tennessee, prohibit changing the sex marker on a birth certificate entirely, according to the report.

"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," said Jeremy Toler, MD, a delegate representing GLMA: Health Professionals Advancing LGBTQ Equality (previously known as the Gay & Lesbian Medical Association), who spoke in support of the report's recommendations.

Given that laws around birth certificate criteria vary by state, eliminating sex on the public part of the birth certificate would "serve as an equalizer among individuals who were injured due to their state of birth," he stated.

Sophia Spadafore, MD, a delegate for the Resident and Fellow Section, authored the original resolution that led to the report. She spoke on her own behalf, and shared the story of Preston Allen, her friend and a transgender man. Allen transitioned 4 year ago, and most government documents have been revised to reflect the transition. But in order to amend the birth certificate, Allen had to rely on "'people who may work against me because of their personal issues with my identity,'" Spadafore quoted Allen as saying.

Continuing to quote Allen, Spadafore stated, "'This is an example of a myriad of situations, in which mine and other trans people's lives, jobs, and safeties could be threatened by having to reveal documents that locked us into a box at birth, and force us to exist through that lens forever.'"

Allowing the sex designation on a birth certificate to remain private would be "life-changing" for a lot of people, Spadafore said, and it would "set a new much needed standard that a body part, and a word on a piece of paper, does not and should not define who any of us are."

One delegate at the virtual committee meeting questioned the recommendation. Robert Jackson, MD, an alternate delegate for the American Academy of Cosmetic Surgery, spoke on his own behalf, saying that he knows he's "old-fashioned" but that he was taught throughout medical school, residency, and his specialty training to track "all of the physical findings" of the patients in his care.

"So I think when a child is born, they do have physical characteristics of either male or female, and I think that probably should be on the public record. And that's just my personal opinion," Jackson said.

The committee also discussed a second report from the Council on Science and Public Health (CSAPH) focused on preventing youth suicides.

Given the significant increase in youth suicide in recent years, CSAPH member Mary LaPlante, MD, stressed the importance of physicians accessing tools to help them identify youth at "imminent risk" of suicide, and to be able to respond appropriately.

The CSAPH report called for the AMA to encourage the development and dissemination of resources, such as screening tools, safety plans, and appropriate follow-up care including treatment. The council also encouraged more research into suicide risk and prevention efforts among high-risk subpopulations, such as Blacks, LGBTQ, and Indigenous/Native Alaskan youth.

Joanna Bisgrove, MD, a delegate for the Women's Section Governing Council, requested that the report specifically include young people with intellectual disabilities among those high-risk subpopulations. Teens with disabilities are between three and nine times more likely to attempt or complete suicide, she said. She also noted that people with and attention deficient-hyperactivity disorder () are more likely to attempt suicide.

Samantha Rosman, MD, MPH, a delegate for the American Academy of Pediatrics, requested that the report include an acknowledgement of the current pandemic-related "pediatric mental health crisis." She cited CDC data from January to October 2020 showing age-dependent .

Rosman said her own ED has about 60 beds, and roughly half are being used by "boarders" waiting for "mental health beds."

"So while screening is very important -- and we certainly don't say to wait until [something bad] happens -- we need to acknowledge the crisis," she said.

This and other policy recommendations will be decided in the coming days and potentially voted on by the House of Delegates.

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