The Brief

Women should not suffer through menopause with hot flashes, night sweats and poor sleep. That's the message from FDA Commissioner Dr. Marty Makary.

The agency announced it will remove "black box" warning labels from estrogen-based hormone therapy, which treat the symptoms of menopause, saying the warnings have made women scared to try the therapy and doctors reluctant to prescribe it.

The warnings stem from the early 2000s when data from the Women's Health Initiative study found hormone therapy increased risks of heart attacks, strokes, blood clots and breast cancer.

But, women in that study were given a type of hormone therapy formulation that is no longer commonly used. And the average age of women in the study was 63, which is now considered too late to start hormone therapy.

Now, experts say there's a lot more known about safe and effective combinations, when therapy is initiated earlier.

"If you're under age 60 or within ten years of menopause onset, when you start hormone therapy, you're going to see improvements in hot flashes, sweats, fewer sleep disruptions, " says Dr. JoAnn Pinkerton , a menopause expert at the University of Virginia Health.

She also points to protection against bone loss and fractures, as well as potential benefits for heart health, brain fog and overall quality of life.

"When it's dosed appropriately, hormone therapy can be given safely and have multiple benefits," she says.

But here's an important reality check: "Not all women can take hormone therapy," Pinkerton says. She says some women have medical conditions or symptoms that can make hormone therapy risky.

"It's really important that women have a discussion with an informed health care provider because you want to know what are the benefits and risks for you," Pinkerton says.

So, here are some things to consider when talking to your healthcare provider about hormone therapy for menopause.

1. When should you start hormone therapy?

Experts recommend starting estrogen therapy before the age of 60 or within ten years of the start of menopause — which begins one year after your last period. Many women remain on birth control through perimenopause, which can help with hot flashes and night sweats as hormones fluctuate.

Once you're through the menopause transition and you don't need pregnancy prevention, then it doesn't make as much sense to use birth control, Pinkerton says, because it's typically stronger than the amount of estrogen used in menopause hormone therapy, so that's a good time to talk to your provider about hormone therapy options.

2. How long should you be on hormone therapy?

In general, women stay on hormone therapy for three to five years, but that's not a hard and fast rule.

"For women who have persistent symptoms or bone loss — which can be treated with hormone therapy — we will continue it," Pinkerton says. But, it's important to keep assessing each year. "It's about working with the patient to come up with what's safest and best," Pinkerton says.

"We don't take someone off [hormone therapy] just because it's been three to five years, " says Lauren Streicher of Northwestern University. She points to differences in how long menopause symptoms persist, noting that Black and Hispanic women tend to experience symptoms for longer  time periods.

3. How has hormone therapy changed?

Science has evolved over the last 20 years , since the results of the Women's Health Initiative came out. And, importantly, there's been a shift in how estrogen is administered, as well as new formulations of hormones. For instance, many women are now prescribed patches instead of pills.

"We know that oral therapy can slightly increase the risk of blood clots and stroke," Pinkerton says, so providers often opt for transdermal therapy for women at risk of these conditions. Transdermal patches, gels or rings deliver estrogen that is absorbed directly through the skin which research shows can lower the risk of blood clots.

Also, women enrolled in the WHI study were given synthetic progestin which was linked to an increased breast cancer risk. But, now doctors can prescribe  micronized progesterone that has fewer side effects. Micronized progesterone is a bioidentical hormone with a molecular structure identical to the estrogen produced in the ovaries.

4. Do all estrogen products carry the same risks?

No. Local estrogen, such as low-dose vaginal creams, target symptoms such as vaginal dryness, painful sex, bladder control and reduced risk of urinary tract infections. This is different from systemic estrogen, delivered through pills, patches or gels. Systemic estrogen is a higher-dose treatment that circulates throughout the body to address symptoms including hot flashes and night sweats, and can carry a higher risk of side effects.

"I think most would agree that with local, low-dose vaginal estrogen therapy that the risks are negligible," says Dr. Monica Christmas , director of the Menopause Program at the University of Chicago. "For local, vaginal estrogen, it's reasonable to remove the black box warning. I don't think we need to scare people unnecessarily," Christmas says.

However, for higher dose, systemic estrogen therapy — which is absorbed into the blood stream — including estrogen pills, Christmas and other menopause experts are more equivocal about removing the black box warning.

"It provides a pause," Christmas says, and prompts patients to discuss the risks with their providers."

5. Who should avoid hormone therapy? 

Some women have medical conditions that can make hormone therapy more risky. This includes women with estrogen sensitive breast or uterine cancer, and women who are at high risk for or have had a heart attack, stroke, blood clot, or pulmonary embolism.

"It's really important that women have a discussion with an informed health care provider because you want to know what are the benefits and risks for you," Pinkerton says

6. Are there alternatives for women who don't want to take hormone therapy?

The Food and Drug Administration has approved two non-hormonal medications to treat severe hot flashes in menopause. According to the FDA, about 80% of menopausal women experience hot flashes which can include sweating, flushing and chills that last for several minutes.

Lynkuet , which was approved last month, and Veozah , which was approved in 2023, are both oral medications that work by targeting the neural activity that causes hot flashes during menopause. Lynkuet has been shown to reduce the severity and frequencies of hot flashes.

The National Institutes of Health has tips for managing symptoms, including limiting alcohol and caffeine, and maintaining a healthy body weight. And early-stage research shows hypnotherapy and mindfulness meditation may help manage hot flashes.

Some people find herbal remedies helpful.  A study of medicinal plants including sage, lemon balm, red clover and licorice finds they may be effective in the treatment of menopausal symptoms like hot flashes.

Copyright 2025 NPR

The memorial to Vietnam veterans in Mile Square Park was supposed to be a smaller version of the revered Vietnam War Memorial in Washington D.C., with an Orange County addition: the memorial would pay special homage to the South Vietnamese army and allies — tens of thousands of whom settled in O.C. as refugees after communist forces took over South Vietnam 50 years ago.

Former Supervisor Andrew Do awarded $1 million in taxpayer dollars for the memorial in 2023 to a nonprofit where his daughter, Rhiannon Do, was an officer. Now, Andrew Do is in prison on a federal bribery charge; the head of the nonprofit is a fugitive; and the memorial stands unfinished, surrounded by caked dirt and dry grass. The county is suing for damages, alleging that most of the money allocated for the memorial was diverted for personal gain.

A hairline crack runs down the surface of one of the black granite-looking slabs that make up the memorial (neither the county nor the monument maker has confirmed the type of material used). The eternal flame sculpture at the center of the memorial is covered in bird poop. The names of soldiers were never etched onto its surface.

“I’m very sad, very, very sad,” said Doàn Trọng upon seeing the unfinished memorial this week. Trong is an Orange County resident and local television host who worked with U.S. troops in Vietnam during the war.

“Who’s going to take responsibility for this?” he said.

Trong and other reporters, including from LAist, saw the memorial up close for the first time on a media tour organized by Supervisor Janet Nguyen, who won Do’s former seat in an election last year. It’s in an area of Mile Square Park currently closed to the public for renovations.

The granite surface of the monument is starting to crack, only about a year after the walls were erected. The etching of soldiers' names was never completed.

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LAist was the first to report on the unfinished memorial and raise questions about its $1 million price tag in August 2024. One architect who visited the site with LAist at the time estimated the work cost around $185,000 or less.

Pham returned $150,000 of the initial $1 million to the county last year, saying the project came in under budget. (Pham’s lawyer at the time said the memorial was on track to be unveiled in October 2024.) But that still raises questions about the rest of the funds — and why the project remains unfinished.

On this week’s visit, the tarps and fence had been removed, leaving the memorial exposed to the elements. Vinyl stencils that had previously covered the blocks, printed with the names of Orange County-based Vietnam veterans, had also been removed.

Nguyen called the unfinished memorial a “disgrace.”

“This is not how we honor our veterans by any means,” she told LAist.

Nguyen said the memorial would likely be demolished, given the high cost of repairing or relocating it.

“Let’s restart and do it right,” she said.

How the memorial came to be

In September 2023, the county signed a $1 million agreement with the nonprofit Viet America Society, or VAS, for the "design, construction, and maintenance" of the memorial. Do later posted a video featuring himself and others reviewing plans for it .

Do did not publicly disclose that his daughter, Rhiannon Do, was an officer of VAS at the time. The failure to do so would be at the heart of an unfolding scandal involving millions in taxpayer dollars that have yet to be fully accounted for.

A mockup of the planned Vietnam War memorial in Mile Square Regional Park, provided in 2024 by Pham's previous lawyer. The memorial was never completed.

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The former supervisor would ultimately direct at least an additional $12 million in taxpayer funds to VAS, according to an LAist investigation . Those funds were supposed to be used to pay for meals for needy seniors. But federal prosecutors and county attorneys say most of that money was diverted for personal gain by using VAS as a cover.

The money for the memorial came from federal pandemic relief funds, a portion of which was assigned to each supervisor to dole out in their respective districts to organizations supporting veterans and infrastructure projects, among other work.

Do is currently serving a five-year prison sentence in Arizona on a federal bribery charge stemming from the misuse of millions of those funds, though not including the $1 million spent on the memorial. Meanwhile, the county is still seeking to recover the money allegedly misspent by Do, including the memorial funds, through a civil lawsuit.

LAist tried to contact Do’s lawyer, Eliot Krieger, by phone but has not heard back.

Pham’s lawyer responds

Peter Pham, the founder of VAS, was indicted earlier this year for allegedly bribing Do to keep the money flowing to VAS. Pham left the U.S. on a one-way ticket to Taiwan in December 2024 and is still a fugitive.

Pham, through his O.C.-based lawyer, Hoa Truong, has denied wrongdoing, alleging he was tricked by Do into creating VAS as a shell organization through which to funnel county funds back to Do. Truong also told LAist that Pham left the country on bad advice from his previous lawyer.

Earlier this year, Truong filed a cross-complaint on behalf of Pham in the county’s civil lawsuit against Do, Pham, VAS and others. In that complaint, Truong alleged that Do took advantage of his friendship with Pham to involve Pham in the scheme to steal taxpayer money.

Truong told LAist that even though Pham is credited on the Vietnam War Memorial as the designer and builder, Pham merely signed the contract, relegating the rest of the work to his longtime business partner, Le Dan Hua.

Hua, who also served as an officer of VAS, is also a defendant in the county’s civil lawsuit over the memorial and other allegedly misused taxpayer funds. LAist left a voicemail for Hua’s lawyer.

“His English is very limited,” Truong said of Pham. ”Do asked him to sign, he just signed because he saw so much money coming in.”

Hua and Pham also did renovations on the North Tustin home that Andrew Do shared with his wife, Orange County Superior Court Judge Cheri Pham , in 2021, according to records obtained by LAist.

Orange County Supervisor Janet Nguyen called the abandoned memorial a "disgrace" and vowed to replace it, perhaps at the future veterans cemetery planned for Gypsum Canyon.

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The memorial’s uncertain future

The new section of Mile Square Park where the memorial is located is scheduled to open by the end of 2026. It’s unclear whether the memorial will still be there by then. Nguyen, the county supervisor, estimated it would cost $25,000 to $30,000 to demolish, and much more to try to move it elsewhere.

If the memorial were to remain in place, the county would likely have to come up with even more money to repair it and put in pathways and other infrastructure to make it compliant with accessibility laws. Nguyen thinks a better option is to build a new memorial, perhaps at the new O.C. veterans cemetery planned for Gypsum Canyon in Anaheim.

Nguyen is among the some 130,000 Vietnamese refugees who settled in Orange County after the Fall of Saigon. She said she’s determined to come up with a new plan for a memorial, though she’s not yet sure where the funds would come from.

“The 58,000 American soldiers who sacrificed for the land I was born in, that’s why I’m here,” she said. “This is not how we honor them, by any means.”

How to watchdog your local government

One of the best things you can do to hold officials accountable is pay attention. Your city council, board of supervisors, school board and more all hold public meetings that anybody can attend. These are times you can talk to your elected officials directly and hear about the policies they’re voting on that affect your community.

• Read  tips on how to get involved  .
• The Orange County Board of Supervisors typically meets on alternating Tuesdays mornings at 400 West Civic Center Drive, Santa Ana. You can check out the  O.C. Board of Supervisors full calendar here for exact dates.
• Learn  how to submit a public comment to the O.C. Board of Supervisors .

As rebuilding from the Palisades and Eaton fires gets under way, some homeowners are choosing to build differently. Instead of the usual wood framing, they’re working with a material typically associated with freeways and skyscrapers: concrete.

Only 7% of homes nationwide are currently built with concrete, according to the National Association of Home Builders. But experts say this hardy, non-combustible material could become more popular in areas with high fire risk, such as the Los Angeles County neighborhoods where thousands of homes were destroyed in January 2025.

While concrete doesn’t make a home totally fire-proof, insurance companies are recognizing its safety benefits by offering homeowners lower premiums. While cost has been a barrier in the past, some homeowners say the expense of concrete now compares favorably with wood.

One recent morning on the Sunset Mesa lot where her home burned down, Karen Martinez adjusted her hard hat and flipped through the blueprints for her new home.

“These are my original chicken scratch drawings, which I love doing,” Martinez said.

Martinez has overseen the building process for many of her previous homes. But this will be her first project using concrete blocks. Technically called insulating composite concrete forms, the bulky gray blocks stacked all over her property are lighter than they appear.

“It's about 87% polystyrene and 13% cement,” said Martinez, who is soft-spoken and self-described as “nutty” about building materials.

“Basically they're non-combustible. So in a fire, you're pretty much safe from the walls burning,” she said.

These blocks, called insulated composite concrete forms, will be used to form the walls of Karen Martinez's new home.

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David Wagner

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‘There are better ways to build’

It didn’t take long for Martinez to choose this material after her old wood-framed home was lost in the Palisades Fire.

“It was just probably a day or two of shock,” she said. “When I finally started thinking about, OK, I have to rebuild, obviously, I'm going to be building with something that's non-combustible.”

Martinez said there are other benefits beyond fire safety: she said the material can withstand earthquakes, and it won’t get termites because it contains no wood.

Martinez saw the need to do things differently. The hardest part, she said, was getting others on board. Securing permits from L.A. County, talking her architect into using this kind of concrete, even helping her neighbors with plans for their own concrete homes.

It all took some convincing.

“Most architects and contractors don't know how to use it,” Martinez said. “All they know is wood and maybe steel. It's hard to convince people to change their ways. That's my goal. I'm trying to just educate people and say that there are better ways to build.”

Some insurance companies agree. Victor Joseph, president and chief operating officer of Mercury Insurance, said his company is offering discounts to those who rebuild with fire resistant materials.

“What we're incentivizing with these types of discounts is really some combination of steel, concrete and glass,” Joseph said.

He said homeowners can get up to 50% off the wildfire portion of their premium by rebuilding with materials like concrete.

“In high wildfire areas, that results in a pretty substantial discount,” he said.

Concrete alone doesn’t fire-proof a home

Concrete blocks have been used for decades to build homes in other countries, but they are still an unusual building material in Southern California homes.

Tom Tietz, executive director of the California Nevada Cement Association , said growing awareness of fire risk could help the blocks catch on with more homeowners.

“There's clearly a desire from folks that have lost their homes to make sure that never happens again,” Tietz said.

Concrete homes aren’t automatically fire proof. Embers can still fly in through vents or windows. Steve Hawks, senior director for wildfire with the Insurance Institute for Business & Home Safety , said even concrete homes need strong sealing.

“The structure is only as good as the weakest link,” Hawks said. “If you only address the siding material and don't address the window and the vents and the other components, you still leave the home very vulnerable to these significant, intense wildfires.”

Learning from L.A.’s concrete home history

Though rarely used in single-family homes, concrete does have a long history in Southern California architecture.

Architect R.M. Schindler built L.A.’s first modernist home in 1922 using concrete slabs poured on site and tilted up to form monolithic walls.

The Schindler House in West Hollywood was constructed more than a century ago in what is now West Hollywood, using concrete and redwood as its main building materials.

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“I think there's a perceived kind of coldness with concrete,” said Maeve Atkinson, education and engagement manager for the Schindler House through the MAK Center for Art and Architecture.

Atkinson said Schindler wanted to use new materials to build a new kind of home, one that was open to the outdoors and designed for not one, but two couples.

“It was about living differently,” Atkinson said. “It was about being much more in tune with the elements and with nature.”

Schindler decided to leave the raw concrete exposed. Its grooves and cracks remain visible, contrasting with the redwood beams that form the rest of the building’s open structure.

Homeowners recovering from January’s fires don’t need to go raw and radical like Schindler. Martinez said her home, covered with stucco, will look much like any other modern L.A. home.

“I'm hoping that this will actually become the future of building,” she said. “I think it's a much, much better way to build, and it's not more expensive. I think actually everybody should be doing it.”

If all goes according to plan, she said, her home should be done before the two year anniversary of the Palisades Fire — and ready to take on whatever comes next.

Mere hours after his Jan. 20 inauguration, President Donald Trump issued an executive order stating that the federal government would recognize only two sexes, male and female. As a result, the State Department immediately eliminated the “X” gender as an option and suspended its previous policy that permitted transgender, intersex and nonbinary people to update gender markers on their passports.  

After a back-and-forth in the federal courts following a lawsuit filed by the American Civil Liberties Union , the conservative-leaning Supreme Court has ruled that the Trump administration can  enforce this policy .

But the latest update is not the end of the road for trans people and gender markers, San Francisco lawyer Alexis Levy said, since “this decision doesn’t dispose of the lawsuit in general.”“That will take several more months at least,” Levy said. “This was  an emergency stay , which is a very specific subset that’s become a very frequent feature in this administration, and the Supreme Court during this administration.”

California still allows people to change their gender marker or use “X” on state-issued documents like their birth certificate or their driver’s license .

Levy, who  specializes in name and gender marker changes through their nonprofit  Identity Affirmation Workshop , said they’ve seen clientele increase “pretty significantly” since the November election.

“People saw the writing on the wall,” said Levy, who has been hosting free gender marker and name change clinics with other LGBTQ+ organizations, including the Oakland LGBTQ Center . “The whole process can be really daunting,” they said.

But what does changing your name or gender marker on official government documents now entail? KQED spoke to Levy about what trans, intersex and nonbinary people can expect during the lengthy process.

Please bear in mind that this is not legal advice, and it’s always a good idea to talk to an expert about your individual situation before taking concrete action — especially because current events may have superseded some information online.

Attorney Alexis Levy poses for a portrait outside the Civic Center Courthouse in San Francisco on Feb. 26, 2025.

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What’s the current situation for trans people’s U.S. passports?

Back in June, the U.S. District Court of Massachusetts ruled that the State Department “must allow people with a gender identity different from their sex assigned at birth to self-select the sex designation on their passport,” leaving a brief window of time in which trans Americans could update or renew their documents accordingly.

But that window is closed once again . Following the Supreme Court’s decision on Nov. 6 , all new, renewed and replacement passports will now use the gender marker assigned at birth — and the ‘X’ gender option is no longer available.

While there’s still another decision to come from the First Circuit Court of Appeals left, which could lead to another brief window in which trans people can once again adjust their gender markers, this timeline is “really hard to predict,” Levy said.

“My advice remains the same: that it is better to have a passport with the wrong gender marker on it than it is to have no passport at all,” they said.

In addition to the confusion and anxiety caused by the frequent policy changes, the situation remains “demoralizing” for many trans, intersex, and gender non-conforming people across the country, Levy said — people who were already reeling from the Trump administration’s January executive order affecting their passports.

A 24-year-old trans man told NPR in February that after filing paperwork to change his gender marker to male on his passport before Trump’s inauguration, he received a passport marking him as female. Euphoria actor Hunter Schafer detailed on TikTok how her new passport lists her as male, despite having female on her government documents since she was a teenager.

“I’m just sort of scared of the way this stuff slowly gets implemented,” Schafer said in her social post, explaining her concerns about possibly being forced to out herself in front of a border patrol agent.

“We are never going to stop existing. I’m never going to stop being trans,” Schafer said in her February video. “A letter and a passport can’t change that.”

“There’s really no purpose for policies like this one, apart from making the people it affects’ lives miserable,” Levy said.

Can people who have changed their gender marker or have “X” still use their passports to travel?

The U.S. State Department’s site said that a passport with an “X” marker or that “lists a sex other than [your] sex as defined by the White House executive order” will “remain valid until its expiration date,” and that you can still use it to travel in and out of the U.S.

Acknowledging the anxiety some may have around traveling these passports, Lambda Legal, an organization serving LGBTQ+ people , said it’s not aware of any confirmed incidents “where individuals have faced problems leaving or reentering the United States using an unexpired passport issued prior to the 2025 policy changes — including those with an X gender marker.”

“There have also been no verified reports of passports being confiscated upon reentry,” the group’s website reads.

However, stressed Lambda Legal, travelers should weigh their personal circumstances, “including how you use your passport, your plans for international travel, and your individual safety needs and risk tolerance.”

Which documents can I change my name and/or gender markers on?

There is no one universal application where you can change your name or gender marker for all of your documents and changing one does not prompt another document to change. You have to do it “manually 100% of the time,” Levy said.

Levy said the four major documents people have historically wanted to change to reflect an update to their name or gender identity are:

Federal:

• Passport
• Social Security card and record

State:

• Birth certificate
• Driver’s license  or  REAL ID

California, along with several other states, still allows people to change their gender marker or use “X” on state-issued documents like their birth certificate or driver’s license.

Other documentation or information that a person might update to reflect a new name or correct gender marker could potentially include: green cards, visas, foreign passports, citizenship certificates, health insurance, insurance and information around banking and credit cards. And name changes, especially, don’t have to be confined to government documents, Levy said.

“Anywhere where your name is attached to it is somewhere where eventually you’re going to have to update it,” said Levy, who went through the name change process themself last summer.

These updates could include mail, magazine subscriptions or their identity at a club or nonprofit.

How can I legally have a change of name and/or gender identity recognized?

To update a lot of your major documentation to reflect a new name and/or correct gender marker, you’ll need to go to  your local county court and obtain a court order.

In California, you can ask for the court to recognize:

• A change of name “to make it match your gender identity”  or
• A change of gender identity  or
• A change of both name and gender identity  at the same time.

Depending on your individual situation, you will have to fill out at least two — and potentially several more — forms , which will be filed with your local clerk (and be sure to make a copy of all of them). See which forms might be required to change your name and/or gender identity in California.

Some local courts will ask for their own additional forms to file, which  you can check with your court’s clerk . Levy notes that some counties may ask for more biographical information for background-checking purposes, including height, weight and place of birth.

After you’ve provided the information required by your county, generally, the clerk will then send the forms to a judge, who will then  sign a name change and gender recognition order .

This certified signed order helps you change your other official documents, like state IDs . You will need  multiple copies of the signed order to change each document.

This process is also available to  people born or married in California but who now live out of state.

Are there any documents I can change without a court order?

Levy said you could change your gender marker on California documents — such as birth certificates and driver’s licenses/IDs — without a court order, although you’ll still be asked for some “specific supporting documentation.” Name change recognition, however, almost always needs a court order.

Some people may still consider obtaining the court order regardless of having their gender marker changed, even if it’s possible to do so in California without the order, Levy said. That includes people born in another state or country that does require a court order to make such a change. Californians may also consider obtaining the court order as a kind of insurance against potential future changes in federal policy regarding self-selection on gender markers, Levy said, since the Constitution mandates that the federal government. As well as other states, must respect a state court order .

The bureaucratic process of updating a birth certificate without a court order can also be intricate and specific, according to Levy. And since any administrative mistakes on the applicant’s part can lead to long delays, they recommend you consult a legal expert if you choose to go this route.

Do I need permission for a physician to change my name or gender marker?

No. After a 2018 law, California residents do not need  a physician’s letter for a name and gender change petition.

Once I’ve obtained my court order recognizing my name and/or gender identity change, how can I start updating my documents?

Updating your Social Security card

You can change your name on your Social Security card through  the Social Security Administration .

The card does not list a person’s gender marker, but the agency said it “maintains information in its computer records on everyone who has a Social Security number, including name, date of birth, and sex.”

The California Department of Motor Vehicles — as well as the State Department, banks, insurance companies, credit card companies and more — often use the Social Security database to cross-reference and confirm people’s identities. Changing a name with the Social Security Administration is almost always a prerequisite before updating other government IDs (except birth certificates) and insurance, Levy said.

Lambda Legal, an organization serving LGBTQ+ people , notes that as of Jan. 31, the Trump administration has directed the Social Security Administration to “stop processing gender marker updates” associated with their records.

Advocates for Trans Equality, a trans advocacy group, has noted that Social Security benefits are not dependent on sex. However, “when applying for Medicare, Medicaid, or Obamacare health insurance through the marketplace, use the sex that matches Social Security,” the group said.

Updating your driver’s license or RealID

These are state documents, so you can update your name and/or your gender marker through your local Department of Motor Vehicles . According to the state, you should change your name on your Social Security card before you request a name update on your driver’s license or RealID.

Updating your birth certificate

You can update your name and your gender marker on your birth certificate through the  California Department of Public Health . Updating your name requires a court order , but updating your gender marker does not .

Updating your passport 

You can update your name on your passport through  the U.S. Department of State .

Updating your marriage certificate

If you had a public marriage, you can update  your name or gender marker on your marriage certificate with the State Registrar . If you had  a confidential marriage , you can update your marriage certificate with  the county recorder’s office that issued the certificate.

How long would changing my name or gender marker take?

According to the state, the decision period in which a judge signs the name change and gender recognition order is six weeks . But in many cases, this can vary, Levy said, and the process can be delayed even longer if there are mistakes in your paperwork.

And once the court order is approved, “each of those individual documents takes different periods of time,” Levy said. “So California birth certificates take about four months. … Usually [with] Social Security, you do that, and you get a new card in the mail within two weeks.”

How much money will changing my name and/or gender markers cost?

Name and gender marker changes can be a pricey process, with just some of the costs including:

• A  court petition is $435 to $450 , with  some fee waivers available  for people whose household income is below a set amount or who receive public benefits if a judge approves it.
• Each  copy of a certified order is $40 . (This is free if you qualify for the fee waiver.)
• Reissuing an updated  California birth certificate costs $26 .
• Social Security cards are reissued for free .
• An  updated driver’s license is $36 .
• Passport renewals are  $130 .

Do I need to circulate my name in the local newspaper?

No. If you are changing  your name according to your gender identity , you do not need to have your name change printed in a newspaper.

What if I am worried about my safety?

Court documents are usually public records. If you are in the state witness program or the  Safe at Home address confidentiality program , you can ask to keep your name change confidential by  asking your local court .

Do I need to be a certain age to update my name or gender marker?

If a person is under 18 and in California, they would need parental permission to change their name and gender marker on their state ID.

Young people can also use their preferred names and pronouns in public schools without having to show any legal documentation . KQED has  a guide further explaining the rights of trans students in public K–12 schools .

Andrea and Milo Ronquillo sit with attorney Alexis Levy (right) near the Civic Center Courthouse in San Francisco on Feb. 26, 2025.

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Beth LaBerge

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KQED

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Where can trans folks find support and resources around documentation changes?

Levy holds regular clinic with their firm Identity Affirmation Workshop  and said the service is pro bono to anyone living in California or, if they live out of state, born or married in the state.

Other organizations offering advice in this area:

• Trans Equality
• Lambda Legal’s help desk
• Trans Lifeline
• More about the name and gender marker changing process  if you are incarcerated .

KQED’s  Natalia Navarro  contributed to this report.

This story was originally published on March 6 and has been updated to reflect that Alexis Levy’s nonprofit is called Identity Affirmation Workshop.