More liberal than not though I find that super surprising.
It is a recent-ish change apparently. Laws slowly catching up.
Pennsylvania Birth Certificate Laws
As of August 8, 2016, Pennsylvania Department of Health policy allows individuals to update the gender marker on their birth certificate with a letter from a physician stating that they have had appropriate clinical treatment for gender transition.
To apply for an amended birth certificate, applicants over the age of 18 should submit:
The birth certificate with the requested changes on the reverse side, or if you don't have the birth certificate complete a Correction Form with the requested changes listed; An Application for Certified Copy of Birth Record; A copy of your government-issued photo ID that verifies legal name and mailing address (listed gender does not matter), or two other forms of identification; A check or money order for $20; A physician's statement on office letterhead saying that the applicant has had appropriate clinical treatment for gender transition. You can use our Sample Physician Statement;
To apply for an amended birth certificate for individuals under the age of 18 a parent must complete the application, and no medical documentation is required. The parent must indicate which sex should appear on the birth certificate and sign in the presence of a notary - see the policy for specific instructions.
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If you wake up at a different time, in a different place, could you wake up as a different person? #theresafreakingghostafterus