TX HB2291

Requires Texas birth certificates to include a space for recording biological sex as either male or female, determined by sex organs, chromosomes, or endogenous profile

Prohibits state registrars, local registrars, and courts from issuing amended birth certificates that change the biological sex designation, with limited exceptions

Allows sex designation changes only to correct clerical errors, complete missing sex information, or for individuals born with atypical or ambiguous sex characteristics whose sex is later determined by a physician

Provides an exception for children born with intersex conditions, allowing the sex field to remain blank at birth and be completed later once sex is determined

Directs the Health and Human Services Commission to adopt implementing rules, with an effective date of September 1, 2025