The Brief

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to an expert about your individual situation before taking concrete action — especially because current events may have superseded some information online.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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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.

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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‘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.

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 Aquarium of the Pacific in Long Beach isn’t just a major attraction for tourists and locals alike — it’s also a sea turtle rescue, endangered shark breeder, a frog nursery and more.

The aquarium has long supported conservation efforts across the Pacific Ocean, and now those efforts are expanding.

“There are international conservation efforts all around the world that would benefit from the knowledge and expertise of the professionals at the aquarium,” said new Chief Executive Officer Jeffrey Flocken . “So we're going to be learning in both directions, taking what we learn from other groups, but also trying to bring the knowledge that we've already built here.”

Flocken, who is trained as a lawyer and previously served as president of Humane Society International, succeeds Dr. Peter Kareiva, who had a five-year contract starting in 2020 and left his post at the aquarium to pursue science and conservation advocacy work.

Reporters this week got a behind-the-scenes look at the aquarium’s growing sea turtle rescue efforts and a new partnership to boost populations of the endangered Indo-Pacific zebra shark.

Rescuing green sea turtles

The San Gabriel River has become home to a population of green sea turtles — the creatures have made a remarkable comeback after once being on the brink of extinction.

But living in one of most urbanized rivers in the world has its risks. Earlier this year, aquarium staff rescued a young turtle entangled in fishing lines, caught on debris, and on the brink of death. The turtle was found by volunteers participating in the aquarium’s Southern California Sea Turtle Monitoring community science program .

Aquarist Stacy Hammond with Porkchop, who is having a breakfast of romaine lettuce.

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One of the turtle’s front flippers was tangled in fishing lines and stuck in debris. The line cut off the blood to one of her front flippers, so staff eventually had to amputate it. A fishing hook was lodged in the back of her neck.

Now, the sea turtle has gotten a second chance at life — and having just three flippers doesn’t seem to be hindering her. (Experts aren’t entirely certain of the turtle’s sex, but guess she is female given the smaller size of her tail.)

“It has not seemed to faze her at all. She navigates great,” said senior aquarist Stacy Hammond. “She ate right away, which is uncommon for our rescue sea turtles. She eats very well.”

Aquarium staff say Porkchop is recovering well and will soon be released back into the wild.

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It’s why staff nicknamed her Porkchop. They expect to be able to release her back into the wild before the end of the year. She’s one of four the aquarium has rescued this year.  

The aquarium has rescued and rehabilitated a variety of sea turtles since 2000 , all of which found in U.S. waters are either endangered or threatened species. Now they’re expanding that work by building an expanded enclosure with specialty equipment and medical supplies.

Saving endangered zebra sharks

Fern, a female zebra shark who is helping to repopulate her endangered kin in Southeast Asia.

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A baby male zebra shark will go to another aquarium to help breed the species.

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Visitors can see the ultrasounds of zebra shark eggs. This image shows the mouth of a zebra shark developing.

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Veterinarian Brittany Stevens conducts an ultrasound on a zebra shark egg.

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The aquarium’s expanded conservation work also includes joining a global effort to recover populations of the endangered zebra shark in Indonesia, where overfishing and habitat degradation has decimated the population.

The aquarium is home to a zebra shark named Fern , who has the necessary genetics from that region. Her viable eggs will be flown first to the Seattle Aquarium, which will prepare them for transport to Indonesia. Then, when the shark embryos hatch and mature, they’ll be released into a marine protected area off the coasts of the Raja Ampat archipelago to help recover the species’ population there.

“We had one of the first successful artificial inseminations with the zebra shark here at the aquarium, and that becomes important as a potential means of managing genetics across populations,” said Nate Jaros, the aquarium’s vice president of animal care. “So this is all part of rebuilding that population.”