HB 3451 allows individuals born in Texas to apply for a new birth certificate that reflects a change in their name and sex. To qualify, applicants must provide a signed statement from a physician confirming they have undergone or are in the process of undergoing medical transition. Minors require parental consent, and individuals with felony convictions or sex offender registrations have additional notification requirements. The bill also establishes a process for issuing an accompanying certificate of change, which includes prior and updated identification details, and sets a fee structure with waivers for those unable to pay​.