Sample templates have been released that show what the State Department expects to see from a doctor writing your letter for your gender marker change on your passports. It is suggested that you use one of these for quickest success on your passport change.

7 FAM 1320 APPENDIX M EXHIBIT B MODEL LETTER FOR ATTENDING PHYSICIAN CERTIFYING TO THE APPLICANT’S GENDER CHANGE

(CT:CON-334; 06-10-2010)

Attending Physician’s Letterhead

(Physician’s Address and Telephone Number)

I, (physician’s full name), (physician’s medical license or certificate number), (issuing State of medical license/certificate), DEA registration number), am the attending physician of (name of patient), with whom I have a doctor/patient relationship. (The letter must indicate that the physician is either an internist, endocrinologist, gynecologist, urologist or psychiatrist.)

(Name of patient) has had appropriate clinical treatment for gender transition to the new gender (specify new gender male or female).

Or

(Name of patient) is in the process of gender transition to the new gender (specify new gender male or female).

I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.

Signature of Physician

Typed Name of Physician

Date