“There is no medically valid reason to exclude transgender individuals from service in the U.S. military,” the American Medical Association (AMA) announced in its June 8 resolution on “Military Medical Policies Affecting Transgender Individuals.”
Currently, there are an estimated 700,000 transgender persons in the U.S., about 15,500 of whom are serving in the U.S. military. Yet according to military medical regulations, doctors are prohibited from providing medically necessary treatment for gender dysphoria, the diagnostic term for individuals who see and feel themselves to be a different gender than that which they were assigned at birth.
Among its many conclusions, AMA notes that a commission cochaired by Major General (Ret) Gale S. Pollock, former acting U.S. Army Surgeon General, determined that “providing transgender personnel with medically necessary health care would not be excessively burdensome.”
So far this year, both the Army and Air Force have revised their procedures for involuntary discharge of transgender service members. In March, the Army issued a directive that protects transgender soldiers from being dismissed by mid-level officers. Under the directive, officers must explain to a high-ranking civilian leader their decision to discharge a transgender solider.
Army Regulation 40-501, Standards of Medical Fitness, has remained unchanged since its 2011 revision to accommodate the Don’t Ask, Don’t Tell Repeal Act of 2010, with chapter 3 outlining the various medical conditions and physical defects that may render a soldier unfit for further military service. Section 3-35 states that certain disorders, as defined by the Army, including transsexual and the outdated term of gender identity disorder, “render an individual administratively unfit.” Despite the revised procedures, this policy remains in effect.
The Air Force’s revised procedures are similar to that of the Army’s, elevating decision-making authority from field commanders to the Air Force Review Boards Agency director. This will ensure “the ability to consistently apply the existing policy,” according to Daniel Sitterly, the principal deputy assistant secretary of the Air Force for Manpower and Reserve Affairs, in a June 4 Air Force press release.
The Air Force also stated in the release that a service member’s identification as transgender, absent a record of poor duty performance, misconduct, or a medically disqualifying condition, is not a basis for involuntary separation.
“Discrimination of any kind has no place in America’s armed forces,” said Defense Secretary Ash Carter, keynote speaker at the Pentagon’s annual Gay, Lesbian, Bisexual and Transgender Pride event Tuesday.
The U.S. military has previously faced similar scrutiny for its discriminatory policies regarding race, gender, and sexual orientation, all of which have been revised. The most recent policy revision came in 2011 when the Pentagon rescinded the Don’t Ask, Don’t Tell policy, whereby homosexual men and women serving in the military were not permitted to talk about their sexual orientation or engage in sexual activity, and commanding officers were not allowed to question service members about their sexual orientation.
The DoD isn’t the only government agency rethinking its treatment of transgendered individuals—VA is also experiencing a learning curve for transgendered care. The VHA Office of Patient Care Services and the Office of Health Equity updated its Lesbian, Gay, Bisexual & Transgender (LGBT) Veteran Health Care Fact Sheet, which covers some of the most common challenges LGBT veterans are likely to face, policies that promote high-quality LGBT health care experience, and what VHA is doing to provide information, guidance, and education to its providers about LGBT health issues.
Cecile A. Unger, MD, spoke on the gynecologist’s role in transgender patient care at the 2015 Annual Clinical Meeting of the American College of Obstetricians and Gynecologists. In a follow-up interview with OBG Management, Dr. Unger discussed pertinent terminology, including gender dysphoria, and important clinical aspects of examining and treating a transgender patient. Dr. Unger also offered clinical guidance on screening transgender patients and how to accomplish patient-provider trust. Click here for the complete interview.