Transgender
One effort to quantify the population gave a "rough estimate" that 0.3 percent of adults in the US are transgender, overlapping to an unknown degree with the estimated 3.5 percent of US adults (1-in-30) who identify as LGBT. More recent studies released in 2016 estimate the proportion of Americans who identify as transgender at 0.5 to 0.6%. This would put the total number of transgender Americans at approximately 1.4 million adults ().
Transgender disenfranchisement in the United States
As of March 2018, surgery is a prerequisite for changing one's gender marker on birth certificates issued by 25 states. Those states are: Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Carolina, North Dakota, Pennsylvania, Rhode Island, Virginia and West Virginia. The remaining states either may change the birth certificate without proof of surgery or will not change the birth certificate at all.