To obtain a passport that reflects a gender change, you need a Medical Certificate from your doctor.  It is imperative that all of these elements listed below are addressed in the letter. 

• Physician’s full name, address, and telephone number (in the body of the letter, even if it is listed on the letterhead)
• Physician’s medical license or certificate number
• Physician’s issuing state or other jurisdiction of medical license/certificate
• The body of the letter must include:
• That the physician has a doctor/patient relationship with you
• That the physician has treated you or has reviewed and evaluated your medical history
• You have had, or are in process of having, appropriate clinical treatment for transition to the updated gender.  The language specifically needs to say “transitioning/transitioned from male to female,” or “transitioning/transitioned from female to male.”
• This statement: “I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.”

Note that individuals who have “had appropriate clinical treatment,” are eligible to receive a full 10-year passport, and individuals who are going through transition will get a limited validity passport valid for 2 years.  The limited validity passport will indicate the gender you are transitioning to.  Once your transition is completed, you will be eligible for a 10-year validity passport.  The language of the letter ultimately determines whether or not you are issued a 2 year or 10-year passport.  Here is a suggested format if you have “had appropriate clinical treatment,” and here is a suggested format if you are going through transition.