NASHVILLE, Tenn. (AP) — A federal appeals court panel ruled 2-1 on Friday that Tennessee does not unconstitutionally discriminate against transgender people by not allowing them to change the sex designation on their birth certificates.

“There is no fundamental right to a birth certificate recording gender identity instead of biological sex,” 6th U.S. Circuit Court of Appeals Judge Jeffrey Sutton wrote for the majority in the decision upholding a 2023 district court ruling. The plaintiffs could not show that Tennessee’s policy was created out of animus against transgender people as it has been in place for more than half a century and “long predates medical diagnoses of gender dysphoria,” Sutton wrote.

He noted that “States’ practices are all over the map.” Some allow changes to the birth certificate with medical evidence of surgery. Others require lesser medical evidence. Only 11 states currently allow a change to a birth certificate based solely on a person’s declaration of their gender identity, which is what the plaintiffs are seeking in Tennessee.

Tennessee birth certificates reflect the sex assigned at birth, and that information is used for statistical and epidemiological activities that inform the provision of health services throughout the country, Sutton wrote. “How, it’s worth asking, could a government keep uniform records of any sort if the disparate views of its citizens about shifting norms in society controlled the government’s choices of language and of what information to collect?”

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The plaintiffs — four transgender women born in Tennessee — argued in court filings that sex is properly determined not by external genitalia but by gender identity, which they define in their brief as “a person’s core internal sense of their own gender.” The lawsuit, first filed in federal court in Nashville in 2019, claims Tennessee’s prohibition serves no legitimate government interest while it subjects transgender people to discrimination, harassment and even violence when they have to produce a birth certificate for identification that clashes with their gender identity.

In a dissenting opinion, Judge Helene White agreed with the plaintiffs, represented by Lambda Legal.

“Forcing a transgender individual to use a birth certificate indicating sex assigned at birth causes others to question whether the individual is indeed the person stated on the birth certificate,” she wrote. “This inconsistency also invites harm and discrimination.”

Lambda Legal did not immediately respond to emails requesting comment on Friday.

Tennessee Attorney General Jonathan Skrmetti said in a statement that the question of changing the sex designation on a birth certificate should be left to the states.

“While other states have taken different approaches, for decades Tennessee has consistently recognized that a birth certificate records a biological fact of a child being male or female and has never addressed gender identity,” he said.