Amending the gender marker on a birth certificate in Arizona is difficult for children under eighteen, or for anyone who does not necessarily want to have a surgical procedure for the sake of changing vital records paperwork.
Arizona will amend the gender marker on a birth certificate “for a person who has undergone a sex change operation or has a chromosomal count that establishes the sex of the person as different [than on original certificate].” (Ariz. Rev. Stat. § 36-337 (A)(3) (2006)).
An operation as severe and as permanent as gender reassignment surgery is not recommended until the child reaches a certain level of emotional maturity. Most children are not ready for any kind of surgery until they are of majority (18 or older). Most doctors will not perform surgery until the child is of majority. Not all transgender people want surgery of any kind.
For the transgender students attending Great Hearts schools, surgery is not an option. Without surgery, the Arizona Department of Vital Records will not amend the birth certificate.
This particular Arizona statute is arcane, but that is a separate discussion.