If you were born in BC, you can now change the gender on your birth certificate to match your gender identity without having had surgery! Way to go, BC!
After several false starts, the government has sorted out the issues regarding changing gender markers on all BCID.
It is currently not possible to get the new BC ID and Care Card Combo without a gender marker. Furthermore, that gender marker will be the same as your birth certificate, which cannot be changed until after you have had gender-related surgery. This is because there are two separate databases involved. One is ICBC's, and the other belongs to the Ministry of Health. ICBC can change the gender mark in their own database, but they can't change the gender recorded in the Ministry of Health's database. However, you can get your BCID with the appropriate gender marker, and have your Care Card separate. If you don't like carrying a Care Card around with the wrong gender marker, just write down the number on a piece of paper and carry it in your wallet. So let's say thank you to ICBC for their willingness to help transgender people obtain appropriate identification documents. Here's hoping that the Ministry of Health will figure out a way to manage their part in the near future.
On another note, some trans people have found that when they go to a hospital emergency or medical clinic, the information on their records may still have the wrong gender listed, as each place has its own records. Unfortunately, people may need to request a gender marker change anytime they revisit a health care clinic/hospital that has records from before their transition.