The forum where I posted this seems to have eaten it, so for posterity and for anyone to whom it might be relevant, here's:I decided to take advantage of the new US State Dept. policy for gender marker changes, since I have an upcoming international trip and would rather not explain in a second language why I have a beard and my passport says I'm female.Because I didn't trust the system to work correctly without prodding, I made an appointment to appear in person at the Seattle Passport Agency. You have to do this using an automated phone system, and you can only apply for a passport in person if you can prove that you're travelling within two weeks. You also have to wait to make the appointment until your departure is two weeks away or less. I would never advocate fraud, but I suspect a printed-out hotel reservation for someplace in Canada or Mexico might suffice as proof of travel, or even perhaps a train itinerary (and both hotel reservations and train tickets are usually refundable). I used a print-out of the e-ticket itinerary that my airline emailed to me and that turned out to be fine.I had my psychiatrist write a letter according to the boilerplate in the State Dept.'s policy document. (For the text of the letter, go to the end.) When I got to the passport agency, I presented my old passport and this letter, along with my filled-out application and photos. The clerk had obviously never dealt with a gender marker change (at least not since they changed the policy, maybe at all) and when she read my letter she asked what "appropriate medical care" meant. Rather than answering, I showed her a printed-out copy of the policy from the State Dept.'s web site. She also asked me whether I had attempted to get the change made before. I thought that might be a way of asking by proxy about surgical status, but my answer was no, so it didn't matter. She then called attention to my letter not being on official letterhead (my psychiatrist just changed offices, so she printed the letter on regular paper and attached a business card instead). I thought that probably reflected that they would look for any reason to deny the request. I pointed out that the business card was attached, and that seemed to satisfy her.I was told to come back about four hours later, and when I did, the new passport with my correct gender was ready. I had to pay $160 for the privilege (most of which was the surcharge for using the expedited passport service).I hope this is useful to anyone thinking about getting their passport corrected under the new policy. It's a little disappointing that no one apparently bothered to tell the passport center clerks about the new policy (especially when it comes to reminding them not to ask irrelevant questions), but not surprising. On the whole, though, it seems like more or less anyone who has access to a sympathetic medical professional can get a correct passport now, and that's good news.Here's the text of the letter. I don't believe there's such a thing as "gender identity disorder", but suspending disbelief seems a small price to pay.[doctor's name, address, phone number, fax]To Whom It May Concern:I am a fully licensed and board certified physician in good standing with the Oregon Board of Medical Examiners, State license number nnnn. My DEA number is nnnn. I am writing this letter as supporting identification to obtain a passport for one of my patients, [me]. I am the attending psychiatrist for him.[me] has been a patient under my care for 2 years. He has gender identity disorder. To my knowledge, he has had appropriate medical care to transition gender from female to male. This being the case, his passport should represent his gender as male.I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.If there are any further questions, I can usually be reached via my answering service at [phone], 24 hours a day.Thank you for your assistance in this matter.Sincerely,[doctor]