Right now, you’re able to select the appropriate gender marker on your passport without a note from a medical professional (and a passport can be used in the vast majority of situations you’d use a birth certificate) but because the self select gender marker was done by executive action, it’s extremely likely to be reversed when Trump takes office.
Also, having one might be a good idea in general.
Honestly, I doubt they’d mess with the cards. They’re extremely common and useful for people who live in border states - Minnesota encourages them at our DMVs, and if you know about the northwest angle it’s likely a big part of why.