This paper uses data from the Behavioral Risk Factor Surveillance Systems (BRFSS) survey over the period 2014-2021 to analyze the impact of new state-level policies allowing individuals to identify as gender-neutral (‘X’ gender marker) on their government-issued driver’s license. In many states, this “third” gender category is not an option, and transgender and gender-nonconforming (TGNC) individuals face multiple barriers, including legislative restrictions, when seeking to adjust their gender identity and names on legal documents. A counterfactual framework exploits variation across states and years in enactment of gender-neutral driver’s license laws to show that a gender-neutral ‘X’ marker shows promise for attenuating inequality in overall physical health among gender-nonconforming adults. These findings highlight the potential benefit to physical health that allowing a gender-neutral option on legal documents might have for gender diverse individuals.
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