Medical Aspects of Transgender Military Service

• Author: M. Joycelyn Elders,George R. Brown,Alan M. Steinman,Thomas A. Kolditz,Eli Coleman
• Date: 01 April 2015
• DOI: 10.1177/0095327X14545625
• Published date: 01 April 2015
• Subject Matter: Special Section: Transgender Issues in the Military

Special Section Article

Medical Aspects

of Transgender

Military Service

M. Joycelyn Elders

1

, George R. Brown

2

,

Eli Coleman

3

, Thomas A. Kolditz

4

,

and Alan M. Steinman

5

Editor’s note: This is the first of three articles in this issue on transgender issues

in the military.

Abstract

At least eighteen countries allow transgender personnel to serve openly, but the

United Statesis not among them. In this article,we assess whether US militarypolicies

that ban transgenderservice members are based on medicallysound rationales. To do

so, we analyze Defense Department regulations and considera wide range of medical

data. Our conclusion is that there is no compelling medical reason for the ban on

service by transgender personnel,that the ban is an unnecessarybarrier to health care

access for transgender personnel, and that medical care for transgender individuals

should be managed using the same standards that apply to all others. Removal of the

military’s ban on transgender service would improve health outcomes, enable com-

manders to better care for their troops, and reflect the military’s commitment to

providing outstanding medical care for all military personnel.

Keywords

transgender service members, medical care, mental health, ‘‘don’t ask, don’t tell’’

1

University of Arkansas College of Medicine (Emeritus), Little Rock, AR, USA

2

East Tennessee State University, Johnson City, TN, USA

3

Department of Family Medicine and Community Health, University of Minnesota Medical School,

Duluth, MN, USA

4

Yale School of Management, New Haven, CT, USA

5

US Coast Guard (Retired), Olympia, WA, USA

Corresponding Author:

Thomas A. Kolditz, Yale School of Management, P.O. Box 208200, New Haven, CT 06520-8200, USA.

Email: thomas.kolditz@yale.edu

Armed Forces & Society

2015, Vol. 41(2) 199-220

ªThe Author(s) 2014

Reprints and permission:

sagepub.com/journalsPermissions.nav

DOI: 10.1177/0095327X14545625

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Introduction

At least eighteen countries allow transgender personnel to serve openly, but the

United States is not among them.

1

When ‘‘don’t ask, don’t tell’’ was overturned

in 2011, gay, lesbian, and bisexual personnel were allowed to serve openly, but

regulations banning transgender military service remained in place. Unlike the

rationales that justified excluding gays, lesbians, and bisexuals, and that empha-

sized operational issues including readiness, cohesion, recruitment and morale,

the rules barring transgender military service are, for the most part, embedded

in medical regulations, and are premised on assumptions about the medical fitness

of transgender personnel.

2

Despite the repeal of ‘‘don’t ask, don’t tell,’’ and the

fact that the Veterans Health Administration (VHA) enacted a 2011 policy man-

dating the provision of health care benefits to transgender veterans, medical reg-

ulations that bar the service of transgender personnel have not been updated.

3

In

this article, we conduct the first-ever analysis of the plausibility of rationales that

justify regulations prohibiting transgender service.

4

After a brief introduction, we

discuss Defense Department regulations barring transgender service as well as the

four medical rationales that justify them. Then, we assess the plausibility of each

rationale.

The term transgender is a broad, umbrella term that refers to individuals

who do not identify with the physical gender that they were assigned at birth.

5

There are an estimated 700,000 transgender American adults, representing 0.3

percent of the nation’s adult population. While some military regulations and

legal cases that we discuss refer to transsexuals, and while some transgender

people use the term transsexual to describe someone who lives permanently

with a gender different from their sex at birth, many view the term as out-

dated and no longer use it, which is why we use the term transgender in this

article.

There is no single medical treatment for transgender individuals who undergo

gender transition. Surgical transition refers to the use of gender-confirming surgery

to change one’s gender while medical transition refers to the use of surgery and/or

cross-sex hormone therapy (CSH) to do so. Survey data indicate that 76 percent of

transgender individuals have had cross-sex hormone therapy and that only a small

minority have had genital reconstructive surgery.

6

The transition period for most

people lasts between one and six months.

7

Scholars estimate that 15,500 transgender individuals serve in the US armed

forces, including 8,800 in the active component and 6,700 in the National Guard

and Reserve components, and that 134,000 veterans are transgender.

8

Transgender

adult citizens are more than twice as likely as non-transgender Americans (2.2

percent transgender vs. 0.9 percent non-transgender) to serve currently in the

military.

9

We are only aware, however, of approximately two dozen service

members who have been discharged because of their transgender identity in

recent years.

10

200 Armed Forces & Society 41(2)