Missouri residents now must provide proof of gender-affirmation surgery or a court order to update their gender on driver’s licenses following a Revenue Department policy change.

Previously, Missouri required doctor approval, but not surgery, to change the gender listed on state-issued identification.

Missouri’s Revenue Department on Monday did not comment on what prompted the change but explained the new rules in a statement provided to The Associated Press.

“Customers are required to provide either medical documentation that they have undergone gender reassignment surgery, or a court order declaring gender designation to obtain a driver license or nondriver ID card denoting gender other than their biological gender assigned at birth,” spokesperson Anne Marie Moy said in the statement.

LGBTQ rights advocacy group PROMO on Monday criticized the policy shift as having been done “secretly.”

“We demand Director Wayne Wallingford explain to the public why the sudden shift in a policy that has stood since at least 2016,” PROMO Executive Director Katy Erker-Lynch said in a statement. “When we’ve asked department representatives about why, they stated it was ‘following an incident.’”

According to PROMO, the Revenue Department adopted the previous policy in 2016 with input from transgender leaders in the state.

Some Republican state lawmakers had questioned the old policy on gender identifications following protests, and counterprotests, earlier this month over a transgender woman’s use of women’s changing rooms at a suburban St. Louis gym.

“I didn’t even know this form existed that you can (use to) change your gender, which frankly is physically impossible genetically,” Republican state Rep. Justin Sparks said in a video posted on Facebook earlier this month. “I have assurances from the Department of Revenue that they are going to immediately change their policy.”

Life Time gym spokesperson Natalie Bushaw previously said the woman showed staff a copy of her driver’s license, which identified her as female.

It is unclear if Missouri’s new policy would have prevented the former Life Time gym member from accessing women’s locker rooms at the fitness center. The woman previously told the St. Louis Post-Dispatch that she has had several gender-affirming surgeries.

Life Time revoked the woman’s membership after the protests, citing “publicly available statements from this former member impacting safety and security at the club.”

The former member declined to comment Monday to The Associated Press.

“This action was taken solely due to safety concerns,” spokesperson Dan DeBaun said in a statement. “Life Time will continue to operate our clubs in a safe and secure manner while also following the Missouri laws in place to protect the human rights of individuals.”

Missouri does not have laws dictating transgender people’s bathroom use. But Missouri is among at least 24 states that have adopted laws restricting or banning gender-affirming medical care for minors.

“Missouri continues to prove it is a state committed to fostering the erasure of transgender, gender expansive, and nonbinary Missourians,” Erker-Lynch said.