Some of the FAQs:
Q: Does being transgender mean an individual is psychologically unstable?
A: It does not. In May 2013, the most recent (fifth) edition of Diagnostic and Statistical
Manual of the American Psychiatric Association (DSM-5) was released, which depathologized
gender nonconforming behavior and identities, removed the earlier
Gender Identity Disorder (GID) diagnosis, and placed gender dysphoria in its own
distinct category. The APA states in this document, “It is important to note that gender
nonconformity is not in itself a mental disorder.”7 In the past few years, most major
medical and psychological organizations have adopted positions opposing
discrimination against transgender individuals, including the withholding of medically
necessary care.8
Q: What types of medical care do transgender service members require?
A: Courses of treatment vary from person to person. As with many conditions, the
individual selects treatment options based on the recommendations of his or her doctor
and other consulting specialists.
Treatment typically begins with counseling or psychotherapy to confirm a diagnosis of
gender dysphoria. Counseling also provides the individual with the opportunity to better
understand his or her gender identity, address the negative impact of gender dysphoria
and stigma on mental wellness, enhance social and peer support, and build resilience in
preparation for transition. As part of this process, internationally recognized standards of
care recommend in most cases that the individual begin living part-time or full-time in
the gender role more consistent with their gender identity. This shift is typically made
prior to any further medical intervention and, often, as an eligibility requirement for
receiving such intervention.9
Medical interventions often associated with transition include the following:
• Hormone Replacement Therapy (HRT) administered via pills, intramuscular
injections, or transdermal patches or gels;
• Surgery to change primary and/or secondary sex characteristics (e.g.,
breasts/chest, external and/or internal genitalia, facial features).10
Standards of Care and Ethical Guidelines for treatment are published and maintained
by the World Professional Organization for Transgender Health (WPATH), an
international professional organization established in 1979.11
Q: What are the projected costs of providing appropriate medical care for
transgender service members?
A: A recent study by the Williams Institute of UCLA showed that in civilian contexts, the
cost to employers of providing transgender individuals with appropriate health care
raised gross premium costs by no more than a four tenths of a percent for large
companies, and as little as four one-hundredths for smaller organizations.12 Applied to
the military context, providing appropriate health care is significantly more cost effective
than discharging transgender service members without cause. For example, it cost over
half a million dollars to train CT3 Landon Wilson13, a U.S. Navy Cryptologic Technician
discharged in 2014 for being transgender, yet the average total lifetime costs of
transition-related claims per individual is less than $30,000.14
Q: Will the DoD be able to provide the medical expertise necessary to care for
transgender service members?
A: Most of the care transgender service members require can be handled by a general
practitioner.15 DoD doctors already perform some of the surgical procedures
transgender service members may need, such as breast reconstruction, augmentation,
reduction, and hysterectomy.16 In those few cases where DoD medical professionals
lack proper expertise or DoD medical facilities are not properly equipped, there are
already administrative systems in place, such as TriCare, to allow service members to
obtain access to appropriate specialists outside DoD.17
Q: Don’t transgender individuals require a lot of extra, specialized medical care
after transition?
A: No. Post-transition, most transgender individuals who are otherwise healthy see a
general practitioner once or twice a year for routine blood work and prescription
renewal.18, 19
Q: Are transgender people deployable to forward locations and other austere
environments?
A: Yes. In fact, DoD has been deploying transgender individuals for over a decade as
civilians and contractors to Afghanistan, Iraq, and the Persian Gulf and embedding them
with US forces there.20, 21, 22 In this capacity, transgender Americans have served openly
in forward locations such as Camp Anaconda and Balad Air Base in Iraq, New Kabul
Compound and Kandahar Air Base in Afghanistan, and aboard US Navy ships
operating in the Persian Gulf. Additionally, our allies have successfully deployed
transgender service members for more than 20 years and into every theater of the war
on terror.23 There are no special medical requirements that would prevent a transgender
service member from deploying to any location where US troops serve today.24
Q: Will providing transgender service members access to necessary medications
place an additional burden on the military health care system?
A: No. The military health care system already provides the medications commonly
used for HRT to non-transgender service members as treatment for other conditions.
HRT for transgender service members would not require new pharmaceuticals,
logistics, or significant cost.25
Q: What if a transgender service member is prevented from accessing their
medications due to logistical or tactical circumstances?
A: Such a situation is highly unlikely. Allied militaries in which transgender individuals
serve openly have found the rate of such occurrences to be extremely low. In those
circumstances where temporary loss of access to HRT medications is truly unavoidable,
the effects are neither debilitating nor life threatening.26, 27
I was on oral HRT from day one as this was prescribed by my NHS
endocrinologist, and simply stocked up from my medical center before
deployment. When I suddenly found myself extended for 2 months in the
Falklands in 2011, I ordered more through the medical center there.28
– Flight Lieutenant Ayla Holdom, RAF
Q: Will transgender service members spend a lot of time in a non-deployable
status?
A: No. Transgender service members in other countries report spending less than six
months total in a medically non-deployable status. Typically, the medical elements of
transition that might affect readiness are scheduled so as not to impact unit readiness
(i.e. while the unit is on a home cycle).
I was kept at G1 A1 Z1 [physically fit for flying and ground deployment
without any restriction] and retained my flying category throughout, with
the exceptions of having a month off flying duties when I began my HRT
(which is the standard time-period for any long-term medication) and 6
months off flying in total, following my Gender Reassignment Surgery
(GRS), during which time I was medically downgraded to P7 (nondeployable)…
Shortly after I began HRT though, before my public
transition, I was deployed for 7 weeks to the Falkland Islands in a flying
role and again for 9 weeks towards the end of my transition, a few months
before my GRS.
I am now A1 P2, which means there’s no restriction to my flying or my
deploying and is simply a marker to show I am on long-term medication.29
– Flight Lieutenant Ayla Holdom, RAF