On February 1, 2019, New Jersey joined Washington, Oregon, and California as the fourth U.S. state to allow its residents to change the gender designation on their birth certificates to reflect a gender-neutral identity. New York City has a law that allows residents to change their birth certificates accordingly as well.The New Jersey law covers transgender individuals who have undergone gender affirming surgery or simply identify as a gender different from what was assigned to them at birth. This includes non-binary individuals who may not identify strictly as male or female. The aim is to allow each individual to make a choice about their own identity, according to New Jersey Health Commissioner Shereef Elnahal. The options now available to New Jersey residents are ‘male,’ ‘female,’ and a third option called ‘undesignated’ or ‘non-binary.’