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This article examines shifts in the legal, medical, and common-sense logics governing the designation of sex on birth certificates issued by the City of New York between 1965 and 2006. In the initial iteration, the stabilization of legal sex categories was organized around the notion of “fraud”; in the most recent iteration, “permanence” became the measure of authenticity. We frame these legal constructions of sex with theories about the “natural attitude” toward gender.