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This statement was read by Dr. Randi Ettner, Ph. D., at the press conference announcing the filing of Kirk v. Arnold. Dr. Ettner is a clinical and forensic psychologist who specializes in the treatment of gender conditions and whose practice is located in Evanston, Illinois.

As a psychologist who specializes in the treatment of gender conditions, and the author of three books on this subject, I have seen approximately 2500 individuals who have what is known as gender dysphoria鈥攁 rare and misunderstood condition that often requires medical interventions. In the most severe cases, the only effective treatment is gender confirmation surgery.

Gender dysphoria, previously known as transsexualism, affects approximately 1 in 12,000 people born male. Often, these individuals鈥� earliest memories are of wanting to be a girl or believing they are a girl. As children, if they discuss this with a parent, or dress in girl鈥檚 clothes, they are typically reprimanded or shamed, and quickly learn that these feelings are 鈥渋nappropriate.鈥�

What follows is a life-long struggle of trying to live in the birth gender. This fails, as efforts to talk one out of this condition or otherwise 鈥渃hange鈥� them are ineffective and unethical.

Gender confirmation surgery is successful because it makes the body and the inner self congruent. Finally, the transgender person feels whole; and the body and the brain are no longer in conflict. My clients who have this surgery, and decades of research from around the world, confirm that this is the final step in overcoming this lifelong obstacle and living authentically as one鈥檚 true self.

Illinois, like the vast majority of states, recognizes the importance of changing a birth certificate to reflect a permanent gender transition. Yet, the State does not recognize gender change in patients who choose to go out of the country for this important surgery.

There are many reasons why my patients have chosen to go abroad for surgery鈥�.these reasons range from financial to preferring a particular surgeon鈥檚 approach.

The result of the State of Illinois鈥� refusal to recognize non-US surgeries is that these individuals have documentation that is false and misleading. If one鈥檚 essential identity document鈥攖he birth certificate-- doesn鈥檛 reflect the truth about a human being, than that person is at risk. My clients live in fear of such risks鈥攈arassment, shame, the potential for violence, and the destabilization of mental health that results from this incongruency.

My clients want to be able to select the best surgeon for their individual medical requirements. The State should not dictate this choice. For the health and well-being of the plaintiffs in this case, my clients, and others who have this condition and will require surgery in the future, it is critical that we change this policy. The birth certificate is a fundamental identity document. It confirms and affirms an essential truth about an individual. The birth certificate must be changed when someone has surgery outside the United States to accurately reflect reality.