Washingtonians who do not identify as men or women will have the option to choose a new gender designation on their birth certificates starting on Jan. 27.

The Washington State Department of Health announced on Wednesday that a new rule will allow people to change the sex designation on their birth certificates to X.

The new rule removes a requirement that adults obtain medical validation of a change in gender and expands the list of health care professionals that can make such an attestation for minors, who will require it and consent by their parents or legal guardian.

Under the rule, X can include but is not limited to people who are intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, male-to-female, pangender, nonbinary, transgender, Two Spirit and gender-fluid.

Health care providers that qualify to attest to a minor’s gender identity include psychologists, advanced social workers, independent clinical social workers, marriage and family therapists and mental health counselors, according to DOH.