Immediately it should be noted that in countries such as Belize, Honduras, Costa Rica, Guatemala, Nicaragua, Panama, El Salvador, Grenada, Barbados, Bahamas, Dominican Republic, Haiti, Jamaica, Paraguay, Guyana, Dominica, Peru, Suriname, and Venezuela it is basically impossible to change the documents, because legally the gender identity which is not recognized.
In countries that are overseas departments of France, transgender people have the opportunity to change the documents in the court after sterilization. These countries are: French Guiana, Martinique and Guadeloupe.
Thanks to the work of Mariela Castro in Cuba and its national center for sexual education (CENESEX) since 2008. transgender people underwent surgery for surgical correction of sex (the SRS), may change the identity card (but not a birth certificate).
To obtain permission to hormone therapy and surgery, transgender person needs to be examined, part of which is the need to spend at least two years in the desired gender role. Surgery in Cuba are paid by the state.
Also in 2011, before the Cuban Parliament was presented a bill that would allow transgender people to change documents without surgery.