Sam Berkley and Joann Marie Prinzivall, two transgender people, are suing New York City in an attempt to change a 40-year-old law requiring them to have “corrective surgery” to have their gender changed on their birth certificate. A third transgender person, Patricia Harrington, has not yet filed papers, but says she plans to do so.

“For one thing, it’s expensive, and insurance companies often deny coverage for this,” Noah Lewis, a lawyer for the Transgender Legal Defense and Education Fund, told reporters. “It’s just a highly individual decision about whether you want to have surgery on your genitals. There are risks with this surgery. People might be more inclined to stick with what they have.”

Lewis said that 80 percent and 95 percent of transgender women and men respectively have not yet undergone the surgery, for whatever reason. For that matter, he said some are medically unable.

Transgender people are already able to have their gender changed on their drivers’ licenses and passport with nothing more than a letter from their doctor stating they are the gender they wish to change it to. This group is hoping the birth certificate regulations will be changed to something similar.