Pentagon policy bars transgender troops using hormone therapy

A memorandum signed by the U.S. Department of Defense on Tuesday will effectively bar transgender service members who seek cross-sex hormone therapy or gender-confirming surgeries from military service, following a July announcement by President Donald Trump that has led to numerous legal challenges.

The policy, which takes effect April 12, has been criticized by endocrinologists, who have noted that gender-affirming treatments are medically necessary and do not result in a high cost burden for the military, as Trump has previously stated.

Joshua D. Safer

“It is surprising that the military ban on treating transgender service members is actually happening when medical treatment for transgender service members can be arranged easily for most in a way that will not interfere with them doing their job,” Joshua D. Safer, MD, medical director of the Center for Transgender Surgery and Medicine at the Mount Sinai Health System, told Endocrine Today. “I worry that this will force some transgender service members to avoid treatment in order to keep their positions in the military. That will not be good for either the transgender service members themselves or our military.”

The memo, signed by David L. Norquist, who is currently serving as the deputy defense secretary, states that a history or diagnosis of gender dysphoria is disqualifying for nonexempt individuals unless a licensed mental health provider certifies that the applicant demonstrated 36 consecutive months of “stability in the applicant’s biological sex ... without clinically significant distress,” and the provider has likewise determined that gender transition is not medically necessary.

The applicant must also be “willing and able to adhere to all applicable standards, including the standard associated with the applicant’s biological sex.” A history of cross-sex HT or a history of sex reassignment or genital reconstruction surgery is disqualifying, according to the memo.

“Individuals who are not exempt must adhere, like all other service members, to the standard associated with their biological sex,” the memo states. “These nonexempt service members may consult with a military medical provider, receive a diagnosis of gender dysphoria and receive mental health counseling, but may not obtain a gender marker change in [the Defense Enrollment Eligibility Reporting System] or serve in their preferred gender.”

Estimates vary on how many transgender individuals currently serve in the U.S. military. According to a 2016 report produced by the RAND National Defense Research Institute and reported by Endocrine Today, there are an estimated 1,320 to 6,630 active component service members who are transgender out of approximately 1.3 million overall. Of these, only a small subset will seek gender transition-related treatment, according to the report. Estimates from survey data and private health insurance claims data indicate that, each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy.

In a May article published in JAMA, researchers estimated that nearly 13,000 transgender individuals are currently serving, 200 of whom will seek gender dysphoria-related treatment each year.

Safer noted that a ban on transgender individuals serving in the military does not eliminate transgender members from the armed forces. Instead, he said, these individuals may forgo receiving medical care, including preventive services.

“As a physician, it is baffling to me what the logic pattern might be for limiting military service only to transgender troops who are not treated,” Safer said. “Certainly from a medical perspective, the logic would be to medically treat transgender troops as needed.” – by Regina Schaffer

References:

Schaefer AG, et al. Assessing the Implications of Allowing Transgender Personnel to Serve Openly. Santa Monica, California: RAND Corporation; 2016. Available at: http://www.rand.org/pubs/research_reports/RR1530.html. Accessed on March 15, 2019.

Schvey NA, et al. JAMA. 2017;doi:10.1001/jamainternmed.2017.0136.

For more information:

Joshua D. Safer, MD, can be reached at joshua.safer@mssm.edu.

Disclosure: Safer reports no relevant financial disclosures.

A memorandum signed by the U.S. Department of Defense on Tuesday will effectively bar transgender service members who seek cross-sex hormone therapy or gender-confirming surgeries from military service, following a July announcement by President Donald Trump that has led to numerous legal challenges.

The policy, which takes effect April 12, has been criticized by endocrinologists, who have noted that gender-affirming treatments are medically necessary and do not result in a high cost burden for the military, as Trump has previously stated.

Joshua D. Safer

“It is surprising that the military ban on treating transgender service members is actually happening when medical treatment for transgender service members can be arranged easily for most in a way that will not interfere with them doing their job,” Joshua D. Safer, MD, medical director of the Center for Transgender Surgery and Medicine at the Mount Sinai Health System, told Endocrine Today. “I worry that this will force some transgender service members to avoid treatment in order to keep their positions in the military. That will not be good for either the transgender service members themselves or our military.”

The memo, signed by David L. Norquist, who is currently serving as the deputy defense secretary, states that a history or diagnosis of gender dysphoria is disqualifying for nonexempt individuals unless a licensed mental health provider certifies that the applicant demonstrated 36 consecutive months of “stability in the applicant’s biological sex ... without clinically significant distress,” and the provider has likewise determined that gender transition is not medically necessary.

The applicant must also be “willing and able to adhere to all applicable standards, including the standard associated with the applicant’s biological sex.” A history of cross-sex HT or a history of sex reassignment or genital reconstruction surgery is disqualifying, according to the memo.

“Individuals who are not exempt must adhere, like all other service members, to the standard associated with their biological sex,” the memo states. “These nonexempt service members may consult with a military medical provider, receive a diagnosis of gender dysphoria and receive mental health counseling, but may not obtain a gender marker change in [the Defense Enrollment Eligibility Reporting System] or serve in their preferred gender.”

Estimates vary on how many transgender individuals currently serve in the U.S. military. According to a 2016 report produced by the RAND National Defense Research Institute and reported by Endocrine Today, there are an estimated 1,320 to 6,630 active component service members who are transgender out of approximately 1.3 million overall. Of these, only a small subset will seek gender transition-related treatment, according to the report. Estimates from survey data and private health insurance claims data indicate that, each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy.

PAGE BREAK

In a May article published in JAMA, researchers estimated that nearly 13,000 transgender individuals are currently serving, 200 of whom will seek gender dysphoria-related treatment each year.

Safer noted that a ban on transgender individuals serving in the military does not eliminate transgender members from the armed forces. Instead, he said, these individuals may forgo receiving medical care, including preventive services.

“As a physician, it is baffling to me what the logic pattern might be for limiting military service only to transgender troops who are not treated,” Safer said. “Certainly from a medical perspective, the logic would be to medically treat transgender troops as needed.” – by Regina Schaffer

References:

Schaefer AG, et al. Assessing the Implications of Allowing Transgender Personnel to Serve Openly. Santa Monica, California: RAND Corporation; 2016. Available at: http://www.rand.org/pubs/research_reports/RR1530.html. Accessed on March 15, 2019.

Schvey NA, et al. JAMA. 2017;doi:10.1001/jamainternmed.2017.0136.

For more information:

Joshua D. Safer, MD, can be reached at joshua.safer@mssm.edu.

Disclosure: Safer reports no relevant financial disclosures.