NEW YORK (AP) — Joann Prinzivalli has gone through a lot to be a woman, and she wants her birth certificate to show it.

Born Paul Prinzivalli Jr., she says she knew her true identity was female by the time she was 4 and broached the subject with a mental-health adviser as a teenager. But it was decades before she bucked family expectations and social pressures, changed her name and underwent electrolysis and hormone treatment to make a change that cost Prinzivalli her spouse, family, home and job.

About 10 years later, she’s still a man in one important context: on her birth certificate. She’s been unable to change the gender listed on the document because of city rules that she and some other transgender people call discriminatory, intrusive and out of step with recent moves by the federal government and some states to make it easier for transgender people to change ID documents.

“Knowing that it was a mistake in the first place, and having that fixed, is pretty important to me,” the 57-year-old title insurance lawyer said Monday as she sued the city. Two other transgender people have filed similar suits in recent days, and a third plans to do so.

They are contesting a city Health Department practice of requiring people to undergo genital surgery and a post-surgery psychiatric evaluation before changing the gender on their birth certificates, according to the lawsuits. Many transgender people can’t have that surgery for medical or financial reasons, and having hormone or other treatment to change gender should be enough, the plaintiffs say.

City lawyers say officials are trying to make sure there are checks on changing an important identity document used for citizenship, Social Security and passport purposes.

“Although we understand the concerns … the Board of Health should not change its requirements without assurance that the amended certificate cannot be misused,” said Gabriel Taussig, a city lawyer. He was responding to a lawsuit filed Monday by Louis Birney, a 70-year-old transgender man. Birney had genital surgery but objects to the requirements for detailed documentation and a psychiatric report, calling them violations of medical privacy.

Updating ID documents has long been an issue for transgender people. Varying local, state and federal rules sometimes mean a person’s sex changes from birth certificate to driver’s license to passport. The patchwork result can cause a host of problems in a security-conscious time when IDs are increasingly demanded and scrutinized, whether for boarding a plane or getting a job.

Transgender-rights advocates have encouraged agencies to abandon surgical requirements for changing identity documents, with some results.

Washington state requires only a doctor’s or psychologist’s note attesting to “appropriate clinical treatment” to change the gender on a driver’s license. Illinois agreed in 2009 to develop new standards for how much surgery is required before a person is eligible to switch the gender of a birth certificate. And the U.S. State Department announced last year that transgender travelers no longer will need surgery — just a doctor’s certification of appropriate treatment — to declare a new gender on a passport.

“Agencies are recognizing that the appropriate standard is that a physician who is actually treating you says you have transitioned,” said Mara Keisling, executive director of the National Center for Transgender Equality. The organization isn’t involved in the recent New York City lawsuits.

In 2006, city health officials considered dropping their requirement for sex-change surgery before switching a birth certificate’s gender. They ultimately decided not to; the health commissioner said the issue needed further study. The agency referred questions Tuesday about the issue to city lawyers.

The state Health Department, which sets birth-certificate policies for areas outside the city, also requires detailed reports of genital surgeries and a psychological report to change the gender on the documents.

The lawsuits say the city discriminates against transgender people by requiring more of them than it does of others who wish to correct birth certificates. Parents trying to fix a mistake in listing a child’s sex need only a letter from the birth hospital, the suits say.

At 30, Sam Berkley has had surgery — a double mastectomy — to become the man he has sensed himself to be since childhood. His New York driver’s license says he’s male, and he’s getting a passport.

But the city has turned down his requests to change his birth certificate, saying he failed to provide proof of sex-change surgery, though he submitted a doctor’s statement saying he’d had irreversible surgery and had “completed sex reassignment,” according to a lawsuit Berkley filed Friday through the Transgender Legal Defense and Education Fund. It also represents Prinzivalli.

“I don’t feel comfortable with the government deciding whether I’m a man or not,” Berkley said Monday.

His female birth certificate caused humiliating confusion when he applied for health insurance at a new job, Berkley said. Patricia Harrington, who also plans to sue, said her birth certificate caused problems when she moved out of New York and tried to get a new driver’s license.

Harrington, 58, began to live as a woman in her 40s after struggling with her identity since childhood.

“It’s been a long journey for me,” Harrington said. “I would just like my identification to reflect who I am.”