It is easy for Transgender Americans to get our gender marker changed with social security with a letter from our physician stating that "Name of Patient has had appropriate clinical treatment for gender transition to the new gender (specify new gender male or female)."
The same letter can be used to attain a passport but not all of us can afford or get one for whatever reasons. The problem here is that some states will not accept this type of letter and they want proof of Gender Reassignment Surgery, which again a lot of us can't afford, etc.
So that leaves us with a ID in some states with a gender marker that doesn't match SS and our true selves. It hurts when it comes to employment, etc.
This may make some states update policies, so that markers match on a state and federal level.