After a years-long effort by the state of Montana to deny transgender people the right to update their identity documents, two transgender women filed a class-action lawsuit against the state and several of its agencies and officials. 26 states and the District of Columbia issue new birth certificate and do not require sex reassignment surgery nor court order in order to change gender marker, while Montana is one of five states that prohibits any changes.

In May 2025, two transgender adolescents and their parents filed a challenge in Kansas state court against SB 63, a state law prohibiting access to gender-affirming medical treatments for transgender people under 18. Access to gender-affirming medical care, such as hormone therapies and pubertal suppressants, for transgender adolescents is supported by the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics.

Amelia Marquez is transgender woman and life-long Montanan. John Doe is a transgender man who was born in Montana, but currently lives out of state. Both wish to correct the sex marker on their birth certificates to reflect who they are. However, a law enacted in 2021, Montana Senate Bill 280, sought to prohibit transgender individuals born in Montana from correcting the sex marker listed on their birth certificate without obtaining a court order indicating that their “sex . . . has been changed by surgical procedure.” The ACLU, the ACLU of Montana, and Nixon Peabody LLP have sued, claiming that SB 280 violates the equal protection and due process clauses of the Montana State Constitution.

The North Carolina Department of Public Safety has continually denied Kanautica Zayre-Brown, an incarcerated transgender woman in their custody, access to gender-affirming surgery.