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Over a dozen Republican-led states are advancing bills that could deny transgender people legal recognition.
The pieces of legislation say there are only two sexes, male and female, that are defined based on what genitals the person was born with
Kansas enacted a law last year that ended legal recognition of trans identities, meaning people cannot change the sex on their birth certificates or passports.
A law in Florida this last month stopped transgender people from changing the sex on their state driver's license.
But 11 other states - including West Virginia, Alabama and South Carolina - are considering similar measures, which LGBTQ groups have described as a 'spit in the face'.
Measures to narrowly define sex as male or female, or to conflate the terms gender and sex are cropping up in over a dozen US states this year
The most recent proposal comes from Alabama, where lawmakers are advancing legislation to define man and woman based on sperm and ova
The measures don't make it illegal to socially transition, or take drugs that help their bodies align with their preferred gender.
But campaigners warn there could be unforeseen consequences - such as trans people being put in prisons with inmates of a particular gender they do not identify with.
Trans people in states where the bans are advancing have described the feeling that comes with handing over a license with their old name and sex on it or hearing the wrong pronouns called in government offices as 'gross' and 'frustrating'.
Other states floating the legislation include Arizona, Idaho, Indiana, Iowa, Mississippi, Missouri, Oklahoma, Utah and Wyoming.
The most recent proposal came from Alabama, where lawmakers have advanced legislation that defines sex based on reproductive anatomy.
According to the bill's language, a female is someone who has a 'reproductive system that at some point produces ova', and a male as one who has a 'reproductive system that at some point produces sperm.'
Based on those definitions, the bill also says schools and local governments can establish single-sex spaces, such as bathrooms.
It requires any state-sponsored agency that collects any information related to sex to 'identify each individual as either male or female at birth.'
The Alabama senator behind that bill, April Weaver, said when introducing in the legislature that definitions will guide courts in interpreting existing laws and 'codifies the time-honored definitions of male, female, woman, man, boy, girl, mother, father, and sex.'
And state representative Susan DuBose, who authored the House's version of that bill, told DailyMail.com that the purpose of the bill is 'purely definitional' and would not affect driver's licenses or other state-issued documents.
An opinion poll found that at least 8 percent of trans adults have already left their neighborhood or state due to the new rules affecting them, and another 43 percent are thinking about making a move
But in practice, trans advocates say it will mean that a person's formal identification issued by the state will not accurately represent who they are in the present moment.
This is playing out for many trans people living in these states. One of them is Mack Allen, an 18-year-old high school senior from Kansas whose driver's license still identifies him as female, despite him having transitioned to male.
He described sideways glances and snide remarks from police officers and being called the wrong name and pronouns by staff in doctors' offices, telling the Associated Press: 'It just feels gross because I've worked so hard to get to where I am now in my transition, and obviously I don't look like a woman and I don't sound like a woman.'
Advocates for transgender people argue that politicians in Republican-led states are making their basic rights a political wedge issue.
Tori Cooper, the director of community engagement for the Human Rights Campaign's Trans Justice Initiative, told Vox: 'These lawmakers want to homogenize the lives that people are living, and they have this very small-minded idea of who people are and how people should look, live their lives, and should think.
'There is an intentional effort to use misinformation and disinformation to deceive folks who don't know any trans, nonbinary, or queer people personally to perpetuate harm and dissuade folks from living honest and true and accurate lives.'
The proposals also throw into legal limbo those Americans who are 'intersex', meaning they were born with physical traits that don't fit typical definitions of male or female.
Some of them create vague exemptions for this population. For instance, the proposal out of West Virginia says that someone who is intersex is 'not considered a third sex', though the measure says people with a 'medically verifiable' diagnosis of it should be accommodated.
And lawmakers in Alabama added language that says sex can be designated 'unknown' on state records 'when sex cannot be medically determined for developmental or other reasons.'
Lawmakers behind efforts to codify a binary definition of sex into the law have said that their goal is to acknowledge the fundamental biological differences between males and females.
Iowa Gov. Kim Reynolds, who put forth a proposal for her state that would require transgender people's gender at birth to be listed alongside their current gender on driver's licenses, said: 'Women and men are not identical; they possess unique biological differences. That's not controversial, it's common sense.'
Critics say those definitions are simply too narrow and deprive trans people of the ability to live authentically with legal documentation that reflects who they are.
According to the United Nations: 'Trans persons are particularly vulnerable to human rights violations when their name and sex details in official documents do not match their gender identity or expression. Today, however, the vast majority of trans and gender-diverse persons in the world do not have access to gender recognition by the State.
'That scenario creates a legal vacuum and a climate that tacitly fosters stigma and prejudice against them.'