Per California Health and Safety Code
103430.  (a) The petition shall be accompanied by an affidavit of a
physician attesting that the person has undergone clinically
appropriate treatment for the purpose of gender transition, based on
contemporary medical standards, and a certified copy of the court
order changing the applicant's name, if applicable. The physician's
affidavit shall be accepted as conclusive proof of gender change if
it contains substantially the following language: "I, (physician's
full name), (physician's medical license or certificate number), am a
licensed physician in (jurisdiction). I attest that (name of
petitioner) has undergone clinically appropriate treatment for the
purpose of gender transition to (male or female). I declare that the
foregoing is true and correct to the best of my knowledge."

From reading this it is unclear to me whether SRS is required or not, as the statement "has undergone clinically appropriate treatment", suggests that it is up to the Doctor's discretion; could someone please clear this up for me?

In California HRT is considered "appropriate treatment" and is sufficient to change gender markers.  And the State Department uses the same criteria for issuing US passports. 

Quote from: katiej on August 17, 2014, 03:56:05 PM
In California HRT is considered "appropriate treatment" and is sufficient to change gender markers.  And the State Department uses the same criteria for issuing US passports.

Thanks for the information 

I changed my birth certificate without SRS in California at the age of sixteen. I now have a ten year passport that states female. You just need a good doctor, lawyer, and nice judge.