The US joins a handful of countries - including Australia, New Zealand, Nepal and Canada - in allowing its citizens to designate a gender other than male or female on passports.
The State Department did not confirm who received the landmark passport but Dana Zzyym of Fort Collins, Colorado, told The Associated Press in a telephone interview it was their passport.
Zzyym, who prefers a gender-neutral pronoun, has been in a legal battle with the government since 2015 over a passport when they failed to check male or female on an application.
Zzyym (pronounced Zimm) said the fight for the passport with an accurate gender designation was a way to help the next generation of intersex people win recognition as full citizens with rights.
“I’m not a problem. I’m a human being. That’s the point,” Zzyym said.
The US special diplomatic envoy for LGBTQ rights Jessica Stern said the decision brings the government documents in line with the “lived reality”.
Stern said there is a wider spectrum of human sex characteristics than what is reflected in the previous two designations.
“When a person obtains identity documents that reflect their true identity, they live with greater dignity and respect,” Stern said.
“We see this as a way of affirming and uplifting the human rights of trans and intersex and gender-nonconforming and nonbinary people everywhere.”
According to court documents, Zzyym wrote “intersex” above the boxes marked “M” and “F” and requested an “X” gender marker instead in a separate letter.
Zzyym was born with ambiguous physical sexual characteristics but was raised as a boy and had several surgeries that failed to make Zzyym appear fully male, according to court filings.
The department now also allows applicants to self-select their gender as male or female, no longer requiring them to provide medical certification if their gender did not match that listed on their other identification documents.