Should Transgender Persons Serve?

In response to the 25 August 2017 presidential memorandum “Military Service by Transgender Individuals,” the Department of Defense is developing an implementation plan that will address transgender individuals currently serving in the U.S. military, as well as the accession of transgender individuals into the military. With Secretary of Defense James Mattis’s recommendation to the White House expected in the next few months, the department is rightly focused on developing a plan that will “promote military readiness, lethality, and unit cohesion, with due regard for budgetary constraints and consistent with applicable law.”¹

The topic of transgender service sparks a wide array of passionate responses. For many people, who may never have (knowingly) interacted with a transgender person, this may be new and unfamiliar territory. Unfortunately, there are numerous myths, stereotypes, and even lies about transgender individuals intermingled with the facts, which can make this topic confusing. What information is accurate and what is “fake news”? What does it mean to be transgender? Are transgender members fit to serve? How does transition affect military service? What are the costs? How will this affect nontransgender members in a unit? Add the various cultural, social, political, media, and religious perspectives and the ability to make an impartial, fact-based assessment of the situation has become extremely difficult. This article aims to separate fact from fiction to assess whether transgender members should be allowed to serve in the military.

“T” Primer

“Trans” gender (meaning “across” gender) refers to persons who do not identify with the sex they are assigned at birth—for example, an individual who physically looks female and is assigned the gender of female at birth but identifies as male. The American Psychiatric Association notes that “gender nonconformity is not in itself a mental disorder.” In fact, scientists have discovered that transgender brains more closely resemble the brains of the gender identified with than the gender assigned at birth.2 The body does not match the brain. Transgender individuals were born into the incorrect bodies.

The term “identify” is used, but this is not a choice. Mentally, transgender persons are their identified gender, only their physical bodies do not match. Though often lumped together in the term “LGBT” (with lesbian, gay, and bisexual), transgender has nothing to do with a person’s sexual orientation. The gender you identify with has no relation to whom you are attracted to.

Closeted transgender persons work extremely hard to keep their condition hidden. Imagine waking up in a body of the opposite gender. It would take effort to get dressed, act appropriately, and somehow make it through the day playing the part. Then you would go to sleep and start over again the next day, and the next, for the rest of your life. Over time, this creates stress, which is medically diagnosed as Gender Dysphoria (GD).³ A diagnosis of GD means the person is debilitated by their dissatisfaction with their physical body and the label they were assigned at birth. Some with GD manage to live with a mismatched body their entire lives, others become depressed, and for some it is so bad they become suicidal.⁴ Each person’s response is unique.

The treatment for GD is to “transition” to the sex with which one identifies. For individuals who are transitioning—“coming out” to live openly as their gender identity—this typically means changing hair, grooming, and clothing styles. Most, but not all, pursue a variety of medical options to make their physical features match their gender identities, including laser hair removal, hormone replacement therapy, and surgical intervention.

 

Fitness to Serve

Where do transgender persons fall related to “fitness to serve”? Any person with a male body must meet male service standards; anyone with a female body must meet female standards. Transgender persons who can meet the standards of their physical body are fit for service. The standards remain unchanged. Those who meet the standards can serve; those who do not cannot. Transgender personnel are medically and physically fit to serve; they meet standards and serve today. The only new issue involves transitioning, which is the most poorly understood aspect of whether transgender persons are fit to serve.

Culturally, we routinely alter our bodies to correct what we perceive to be a defect or simply for aesthetic preference—everything from cleft lip or palate surgery to laser eye surgery to cosmetic surgery. When physical issues are noticed at birth, they often are corrected while the child is young. However, there is no scan or test to know if individuals are transgender. It takes time, as they grow, for them to fully understand why they feel different. The mismatch of body with gender identity cannot be detected for many years, at which time societal pressures can keep individuals from addressing the mismatch until later in life.

Many types of physical “defects” can be corrected and meet military standards. A service member who is injured in combat, a car accident, or while playing sports on the weekend is provided medical treatment and allowed time to recover. Members who may temporarily be unfit for deployment because of injury, illness, medical condition, or mental health issues routinely are treated with medication, surgery, therapy, or other intervention and brought back to full fitness for duty. Having GD is no different; it is correctable through treatment by transitioning.

Service members have a wide array of health-care issues the military treats to ensure fitness for duty, including high blood pressure, cancer, musculoskeletal injuries, high cholesterol, concussions, and mental health issues. For a few members, their medical issue is GD. Treatment generally includes counseling, changes to grooming, clothing, and lifestyle, medication to alter hormone levels, and a variety of surgical procedures to make permanent alterations to the body. Depending on the nature of the deployment and the severity of the GD diagnosis, members may be able to complete some of their transition while deployed and take care of other aspects between deployments.

What if someone could not get their prescription medication while deployed? Would it hinder their readiness? Military members deploy worldwide every day while taking the same medications transgender persons use, just for different reasons. Transgender members can still operate and function without their medication, the same as women who are unable to get birth control pills refilled while deployed. While the situation is not ideal, it would not limit a person’s ability to perform their duties.

The cost of transgender surgery often is cited as a reason transgender members should not serve. First, not all transgender people get surgeries, but for those who do, let’s examine the costs. If a transgender person chooses to have sex reassignment surgery, estimated costs range between $20,000 and $30,000.⁵ In Canada, 19 service members completed sex reassignment surgery between 2008 and 2015 for a total cost of $319,000, according to a Canadian broadcast news service.⁶ Other surgeries to refine the person’s appearance—face lifts, body contouring, hair removal, etc.—are paid for by the member. Hormone replacement drugs costs around $30 per month and doctor visits about $100 per month, about the same for other medications. Total costs are estimated at $2.4 million to $8.4 million, or .04 percent to .14 percent of an annual military health-care budget of more than $6 billion.⁷ Knee replacement surgery costs on average $49,500 per knee, and recovery time is 7 to 12 weeks.⁸ The recovery time for the most extensive transgender surgery is 6 to 8 weeks. The down time for many less invasive procedures may be a week or less. Also, people who opt for surgical interventions require less medication or are eligible for longer term solutions, such as subdermal inserts or patches.

The medical costs to return highly trained military members to duty pale in comparison to the time, money, and effort required to replace them, which is why the military works to get personnel back into a medically fit status rather than simply discharging everyone who gets sick or injured. So why not provide treatment to cure a medical diagnosis such as GD? The difference is many people are not educated about transgender health needs, and social stigmas get in the way.

The key issue for transgender members related to fitness for service is the transition period, which is about 12 to 18 months—similar to the time required for shoulder rotator cuff surgery or to bring a pregnancy to term. Within that time frame, there will be periods when they are not fit for full duty if pursuing surgeries, but working with commands when scheduling these procedures can minimize disruption to the unit. Once the transition is complete, which includes meeting fitness standards for the new physical gender, the gender marker would be changed in the Defense Enrollment Eligibility Reporting System and the person would be available for worldwide deployment.

If a transgender person meets standards, wants to join, and already has transitioned, there is no down time for transition and no costs for surgical interventions.

Willingness to Serve

History is rich with people who demonstrated behaviors that did not conform to gender norms. In the early 1400s, Joan of Arc wore men’s clothing and armor and led a military campaign. She was tried for heresy and burned at the stake. One of the charges was cross dressing. Today she is considered a heroine of France. Admiral Zheng He was a Muslim eunuch who fought numerous battles for the Chinese emperor and was renowned for his military ability and leadership. Today he is honored every year on China’s national maritime day. There are other examples of people who varied from stereotypical gender behavior who were valued for their character and achievements, not their appearance or the status of their genitalia. It was their ability to do their jobs that mattered.

The same is true today. The military has invested millions of dollars to train transgender members, and many have served proudly or are serving in every field: intelligence experts, administrative specialists, war zone linguists, combat infantry, health service professionals, and commanding officers.

The “Real” Issue

If transgender persons meet service standards, currently serve with honor, and the costs to transition are comparable (or less) than many other medical issues the military covers, why should they be removed from service or not be allowed to join? Why has accepting transitioning or post-transition members been so divisive?

Many do not understand what it means to be transgender. They think it is a mental illness (it is not). They think it is a choice (it is not). They think the costs are exorbitant (they are not). They worry transgender persons will flood into the military for a taxpayer-funded sex change (not realistic). Once the myths are debunked and the facts established, what is left?

Transphobia is the intense dislike of or prejudice against transgender people. No matter the facts, some people simply do not like the idea of serving with someone who does not fit their definition of “normal.” People who argue against transgender service often say it disrupts good order and discipline, arguing that service members are uncomfortable with the presence of transgender people. Whether for bathrooms, barracks, or showers, this argument has been used before—to keep African Americans, women, and LGB members out of the service. Before each of these groups was allowed into the military, there were many who cried that doing so would erode morale, unit cohesion, esprit de corps, and effectiveness. Yet, when they were allowed in, the sky did not fall and units did not lose their effectiveness. Instead, the military gained more warfighters. Imagine our military today if we had listened to those fears and barred any of these groups from service.

National acceptance is growing. A recent Pew poll found nearly 90 percent of Americans know someone who is LGB.9 According to a 2016 Harris poll, while only 16 percent of adults know a transgender person, that number is higher among millennials. In addition, the Harris study found that 1 in 5 millennials self-identify with the LGBT community.¹⁰ Nearly half of U.S. military members are 25 years old or younger, and nearly three-fourths are under 30, or basically millennials.¹¹ The future of the military is our young recruits, and data shows they are more open and accepting of LGBT members. And as more transgender persons feel comfortable coming out, more people will know a transgender person and their attitudes likely will change, which is what happened when LGB members started coming out in larger numbers.

If you want to know how a transgender person will affect a unit, ask the members of a unit that has a transgender member. They likely will tell you this is a non-issue. There is no impact on readiness or unit morale. And the issue of bathrooms, showers, etc., can be easily resolved with unit-level solutions. While new and awkward at first, open, honest conversation with command leadership quickly dispels the matter. Many have opinions as to how this will affect units, but only those who serve with transgender persons truly know.

There also is discussion of a “compromise” that would allow transgender persons currently in the military to continue to serve but not cover the medical costs for transitions or post-transition sustainment. Nor would new transgender members be allowed to enter the service. This will not work. We learned from “Don’t Ask, Don’t Tell” that this type of “it’s okay so long as we don’t know about it” policy does not work. First, the service always will have transgender members. Many may not realize or accept they are transgender until years after they join; others initially will be content joining based on their gender assignment. The stress of living in a body that is not “right” will take its toll, however, and many of these individuals will be diagnosed with GD. Do we kick them out? Worse, do they fail to seek help for fear of discharge and end up in severe depression or even commit suicide, as happens now? How would that affect unit readiness? We cannot “closet” transgender persons to allow them to serve, just as “closeting” LGB members did not work.

We must remain focused on investing in our warfighters and not be distracted by society’s transition through familiar phases that eventually will result in acceptance and integration of the transgender community. Removing transgender service members will break a bond with the service members and their families, just to support a goal of making a few soldiers, sailors, Marines, airmen, and Coast Guardsmen “comfortable.” This is a waste of taxpayers’ investment in otherwise skilled warfighters. Let’s learn from history and skip the part of this societal cycle where we fall victim to the “doom and gloom” of the naysayers. Our workforce has proven time again they grow stronger through diversity and inclusion.

The Nation Needs Transgender Service

Being “comfortable” is not a luxury the nation can afford. The world is full of dark and terrible things: cyber attacks, hurricanes, depleted food resources, terrorists, and threat of nuclear war. To ensure it can defend the nation, the military needs eligible, willing Americans to fill its ranks. Unfortunately, the number of people eligible for military service is shrinking. More than 70 percent of the population between 17 and 24 years of age is unable to meet eligibility requirements.12 Of those eligible to join, many are recruited by other employers or simply are not interested in serving.

Transgender persons are ready, willing, and able. Not counting the United States, 18 countries today allow transgender persons to serve.¹³ They are a normal part of society and have played critical roles throughout history, whether we knew it or not. Many have served or are currently serving; future generations similarly will step up and want to serve. The military values diversity, not for demographics themselves, but for diversity of thought. Different perspectives, backgrounds, and experience, including those unique to transgender members, all contribute to an ability to see problems differently and devise creative solutions. The nation needs the best, strongest, most lethal military possible, and transgender service fully supports that goal. Arguments about costs, bathrooms, unit cohesion, and social engineering are red herrings.

History is rich with people who demonstrated behaviors that did not conform to gender norms. It was their ability to do their jobs that mattered. Shouldn’t the same be true for transgender service members? Secretary Mattis summed this up nicely during his January 2017 confirmation hearing: “We need to open the door to all who are eligible and wish to serve.”¹⁴