While there are federal and state regulations regarding redesignation in legal documents, how to handle these transitions in medicine in our treatment records is not as well defined. When one gender transitions, they seek to align their phenotype with their social identity. Perhaps we can go with transgender people experiencing “their gender identity as different from the sex which was assigned to them at birth.” Sex commonly refers to our biological phenotype gender is more our social identity. Right away, we are in trouble because a definition is not readily at hand.