Nevada will issue a gender marker of M, F, or X on a driver's license or state ID, with no medical documentation required.
In order to update the name on a Nevada ID, an applicant must first change their name with the Social Security Administration, and then submit a court order certifying the name change to the Department of Motor Vehicles.
In order to update the gender marker on a Nevada ID, no documentation is needed. NAC 483-070. Applicants may select M, F, or X on the application form regardless of the gender on other documents submitted. An applicant must appear in person to make this change and is not limited in the number of times the change is made.
The DMV addresses name and gender marker changes here.