People in New Jersey can now mark their gender as "undesignated/nonbinary" on their birth certificates, the latest U.S. state to liberalise its policies.
A report in October that U.S. President Donald Trump's administration was considering defining gender as male or female based on genitalia at birth drew widespread condemnation.
Here are 11 states that grant identity documents with non-binary gender markers - plus Washington D.C., the capital:
Residents have been able to get an "X" on their state driver's licenses since 2010, a policy that few were aware of until it was reported last year by the gay website Into.
The Golden State has offered non-binary birth certificates since the start of 2018 and introduced gender-neutral driver's licences this year.
Colorado became the first state to issue an intersex birth certificate last year to Anunnaki Ray Marquez who identifies as a gender non-conforming androgynous gay man.
After a series of court cases, Colorado also introduced a non-binary option on state IDs in November.
The country's capital introduced "X" options on driver's licences and identification cards in 2017.
Maine residents have been able to get a sticker for their IDs since 2018 that reads, "Gender has been changed to X – Non-binary". Driver's licenses with "X" will be available in July.
The midwestern state's Drivers and Vehicles Services said in October that it was "a business decision to offer a third option to better serve all Minnesotans" when it started offering "X" on state IDs.
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New York City introduced "X" as an option for birth certificates on Jan. 1. A bill that would add "nonbinary" as an option on driver's licenses was also introduced in the state's senate this month.
In 2012 an intersex person was allowed to have "hermaphrodite" on their birth certificate in Ohio. However, "male" and "female" remain the only options on state IDs.
A state court allowed Jamie Shupe, a resident of Portland, Oregon's largest city, to legally be identified as non-binary in 2016, the first such case in the United States.
Oregonians can get non-binary licenses and birth certificates.
The first non-binary state ID was granted by court order in Utah in September.
Non-binary birth certificates have been available in Washington state since January 2018.
The state government said the gender "X" included, but was "not limited to, intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified."