The Alteration of Sex Status and Sex Descriptor Act 49 of 2003, referred to simply as “Act 49”, allows South Africans to change their gender marker on their identity documents. Without the correct ID, it’s difficult or impossible to apply for jobs, access a hospital, obtain school results, open a bank account and withdraw money, obtain a driver’s licence, travel, vote, access social grants or shelters, or accomplish any number of other basic tasks. People using a name or presenting themselves as a gender that is not reflected in their ID book are regularly turned away from services, subject to humiliating delay and interrogation, and are at risk of verbal or physical violence because of that perceived discrepancy. Provisions of the Act 49 are regularly ignored or violated in practice by the Department of Home Affairs. We follow the plight of Nadia Swanepoel who, after a 3 year wait, embarked on a hunger strike in her struggle to get the Department of Home Affairs to issue her with the correct ID, and look at some of the core issues of this systemic problem.