stringent than those for changing the marker on the birth certificate. Sometimes, the states' requirements and laws conflict with and are dependent on each other; for example, a transgender woman who was born in Tennessee but living in Kentucky will be unable to have the gender marker changed on her Kentucky driver's license. This is due to the fact that Kentucky requires an amended birth certificate reflecting a person's accurate gender, but the state of Tennessee does not change gender markers on birth certificates. Passports The U.S. State Department determines what identifying biographical information is placed on passports. On June 10, 2010, the policy on gender changes was amended to allow permanent gender marker changes to be made with the statement of a physician that "the applicant has had appropriate clinical treatment for gender transition to the new gender." The previous policy required a statement from a surgeon that gender reassignment surgery was completed. Since April 11, 2022, American passports give the sex/gender options of male, female and X by self determination. Third gender option As of 2017, the U.S. federal government does not recognize a third gender option on passports or other national identity documents, though other countries including Australia, New Zealand, India, Nepal, Pakistan, Bangladesh, Germany, Malta, and Canada have begun recognizing this. Third genders have traditionally been acknowledged in a number of Native American cultures as "two spirit" people, in traditional Hawaiian culture as the māhū, and as the fa'afafine in American Samoa. Similarly, immigrants from traditional cultures that acknowledge a third gender would benefit from such a reform, including the muxe gender in southern Mexico and the hijra of south Asian cultures. On June 10, 2016, an Oregon circuit court ruled that a resident, Elisa Rae Shupe, could obtain a non-binary gender designation. The Transgender Law Center believes this to be "the first ruling of its kind in the U.S." Bathroom bills A bathroom bill is the common name for legislation or a statute that defines access to public toilets by gender (restrooms)—or transgender individual. Bathroom bills affect access to sex-segregated public facilities for an individual based on a determination of their sex as defined in some specific way—such as their sex as assigned at birth, their sex as listed on their birth certificate, or the sex that corresponds to their gender identity. A bathroom bill can either be inclusive or exclusive of transgender individuals, depending