LGBT activist organization Lambda Legal argued in front of the Ninth Circuit Court of Appeals on October 10 in an ongoing effort to challenge President Trump’s “transgender military ban.”
The issue began in 2017 when President Trump tweeted a statement that the Human Rights Campaign says meant “thousands of transgender service members and countless more potential recruits found their worlds turned upside down.” The tweets indicated transgender individuals would be banned from serving in the armed forces, reversing an Obama administration policy. This spurred multiple lawsuits and ongoing controversy.
For example, Sarah McBride, a HRC spokesperson, said this “is part of a broader effort to push transgender people back into the shadows and out of public life. From the bipartisan chorus of members of Congress to leading medical associations to several federal courts, every passing day we see further proof that this president’s policy is animus-fueled, dangerous and unconstitutional.”
But as has been often the case in these highly politicized debates, the reality does not quite reflect the narrative. The transgender policy is detailed in a 44-page memorandum to the president, written by Defense Secretary James Mattis on February 22, 2018. The document titled “Military Service by Transgender Individuals” is an exhaustive review of the concerns related to both aspiring service members who are transgender and transgender people already serving.
The Military Is Not a Social Justice Organization
The details are remarkable and staggering in complexity. The paper uses compassionate language and illustrates an underlying respect for transgender individuals and an appreciation of their unique struggles without compromising accuracy and honesty.
Mattis states firmly that “The purpose of the Armed Forces is to fight and win the nation’s wars.” So the determining factor in a person’s qualification for military service is whether that person can meet the standards of the armed services, which the paper distills as “qualified, effective and able-bodied.”
Mattis states clearly that any eligible individual who can meet the high standards for military service without the need for special accommodations should be allowed to serve. This, he states, is “no less true for transgender persons than for any other eligible individual.”
He notes that 71 percent of the nation’s 17- to 24-year-olds are ineligible to join the military due to medical, mental, or behavioral reasons. He confirms that transgender people suffering from gender dysphoria are “no less valued members of our Nation than all other categories of persons who are disqualified from military service.” Although many citizens wish to serve honorably in the military, Mattis concludes, the best interests of the armed forces must sometimes decline their wishes.
Why Transgenderism Has Disqualified People from Service
Historically, military standards did not allow transgender individuals who wished to serve as the opposite sex to do so. The military previously held that individuals with a history of psychosexual conditions such as voyeurism, exhibitionism, transsexualism, or transvestism were not permitted to join.
Mental health conditions, listed in the DoDI 6130.03 manual, have always been a barrier to joining the military, and with good reason. Service in the armed forces present a highly stressful and dangerous set of conditions that mental illness can directly interfere with. The standards also contain disqualifying conditions that include chest surgery, genital surgery or deformation, castration, a history of suicidal thoughts or tendencies, depression and anxiety disorders, and the use of certain medications including hormone therapies.
In recent years, service members were not automatically discharged if they demonstrated gender dysphoria after joining. The military generally holds current members to a less strict standard because of the expense taxpayers have put into training that individual and in respect to that individual’s service. Therefore, the condition had to be considered an impediment to the individual’s performance or mental health through formal counseling to process a separation. Typically, in related cases this meant those with concerns about depression, suicidal tendencies, or misconduct related to cross-dressing.
In 2015 this standard was revised under Obama Defense Secretary Ash Carter, and became known as the Carter Policy. This is what has been meant by saying the Obama administration “lifted the ban” on transgender service members. So it is partially accurate, because there were already transgender members serving, just those who became transgender during service and had not presented other reasons to be discharged.
What the Obama Administration Policy Did
On July 28, 2015 Carter sent out a memorandum stating service members would no longer be involuntarily separated due to gender identity or gender dysphoria. He created a working group tasked “to study the policy and readiness implications of welcoming transgender persons to serve openly.” The working group was directed to “start with the presumption that transgender persons can serve openly without adverse impact on military effectiveness and readiness.”
The review commissioned the RAND National Defense Research Institute to conduct a study to identify the health-care needs of transgender service members, associated costs, and health insurance options. The report estimated between 1,320 and 6,630 transgender service members were already serving and that transgender treatments would affect military health care costs only minimally.
The report also concluded that accepting new transgender people as soldiers would minimally affect unit cohesion. Essentially, the report recognized that the new policy would negatively affect all aspects studied, but said these effects would be minimal.
So Carter’s primary changes were allowing service members to transition into transgenderism openly. A service member diagnosed with gender dysphoria could fully transition, partially transition, or “socially transition,” meaning he could cross-dress but not engage in any medical intervention. Whichever path chosen, the individual would be officially recognized as the preferred sex in all areas and held to the same standards as their preferred sex. This included dress and grooming, fitness standards, and access to bathroom and shower facilities.
The policy did not automatically allow transgender applicants to join, however. A history of gender dysphoria was still disqualifying unless a medical professional confirmed the individual remained stable without distress or impairment for 18 months. If the applicant completed a gender transition or had been stable in his or her preferred gender for 18 months with cross-sex hormone therapy, he or she could join if otherwise eligible.
Finally, an individual who underwent surgery to transition would be disqualified unless a medical professional confirmed a period of 18 months had passed since the person’s last surgery and he or she did not suffer any physical limitations or complications and no further surgery was required.
The Trump Admin Decided to Review These Policies
On August 25, 2017, President Trump directed the secretaries of defense and homeland security to reinstate the original, long-standing policy that largely disqualified transgender individuals from joining the military. His memorandum stated this should be in place “until such time as a sufficient basis exists upon which to conclude that terminating the policy and practice” would not “hinder military effectiveness and lethality, disrupt unity cohesion, or tax military resources.”
Trump’s memorandum argued that further study was needed to address the negative consequences presented in the Carter Policy. He gave both secretaries authority to determine how to handle currently serving transgender individuals and did not dictate taking any action against them.
On September 14, 2017, Mattis organized a panel of experts to fully investigate the effects of transgender service members on military readiness, lethality, unit cohesion, and taxpayer expenditures. Here are several key factors determined in the extremely comprehensive examination.
- Transgender individuals with gender dysphoria experience extremely high rates of mental health conditions and suicidal tendencies. While the general population faces a 4.9 percent suicidal attempt rate, transgender individuals face a 41 percent rate. Due to the well-documented stress and dangers presented in military life, war zones, and extreme environments, there is a genuine concern that suicidal behavior would be increased in those suffering from gender dysphoria.
- Service members with gender dysphoria are eight times more likely to attempt suicide than their peers are.
- Service members with gender dysphoria are nine times more likely to have mental health concerns requiring medical intervention than the general military population does.
- In the first year of cross-sex hormone treatment, patients must receive bloodwork reviews every 90 days. If the individual pursues reassignment surgery, which only 2 percent of transmen (women presenting as men) and 10 percent of transwomen (men presenting as women) pursue, the individual would require up to a year or longer for a full recovery. Upwards of 20 percent of transwomen who receive bottom surgery experience serious complications. This all would create obstacles to service members actually serving in their military capacities.
The Centers for Medicare and Medicaid Services (CMS) studied more than 500 official sources to determine the effectiveness of gender reassignment surgery on positive health outcomes and found only 33 studies viable for review. Only six of those studies provided valuable information and all were considered limited by small sample sizes, a lack of validation, or subjectivity. CMS was unable to determine if reassignment surgery was “reasonable and necessary” for treating gender dysphoria, as there was simply not enough “quality evidence” to make a determination.
One of the most promising and well-organized studies came from Sweden and indicated that individuals who underwent reassignment surgery had a 19-fold greater mortality due to suicide than did the control group. Heart-related deaths increased 2 to 2.5 times the control group rate. The risk of psychiatric hospitalization was 2.8 times greater as well. In 2010, Mayo Clinic found that 28 primary studies on the effectiveness of cross-sex hormone therapy were very low quality.
For Other Conditions, Hormones Are Disqualifying
There were other significant concerns about the potential dangers of exposing transgender people to the military’s extremely harsh environments with high stress. Applicants who must take any synthetic hormone for the treatment of hypothyroidism, for example, are disqualified because it cannot be guaranteed the service member will have access to necessary medical treatment in war zones or other harsh, isolated environments. In the same way, transgender individuals who transition pose a higher risk of being unavailable for duty. Transitioning service members have an average of 159-167 days of limited duty out of one year.
Under the Carter Policy, a male who identified as female was entitled to full treatment as a female in all areas if that was part of his treatment plan for gender dysphoria. This presented significant obstacles to fairness, discrimination, and equality.
That’s because a male in this situation would be held to female fitness standards, body composition standards, and have access to female bathrooms and showers. As a male, he would hold an unfair advantage over females and be held to a lower fitness standard than other males. This creates inequality within the ranks and directly impacts unit cohesion and safety.
In contrast, female service members identifying as male would be expected to meet the higher physical standards of their male peers. Furthermore, as an anatomical male or female, their presence directly harms other service members’ privacy. The report indicates 424 service members currently hold approved treatment plans for gender dysphoria and 36 do not indicate any hormone or surgical transition. Only 22 have requested reassignment surgery with the majority requesting only cross-sex hormones.
Transgender Soldiers Are Still Serving
In light of the extensive research from Mattis’s panel of experts, the Trump administration has put into place a series of new recommendations. This is what LGBT activists are decrying as discriminatory and fighting in federal court. The divide is between those wishing to join and those who are already service members.
Transgender individuals who do not suffer from gender dysphoria and do not have a history of the diagnosis and are otherwise qualified for service are able to serve without limitation as long as they meet the standards of their biological sex. Essentially, Mattis carefully distinguishes between a person with a gender identity that differs from his or her biological sex and a person diagnosed with gender dysphoria, a serious medical condition recognized by the American Psychological Association featuring clinically significant distress and impairment.
Currently it is estimated that 8,980 service members identify as transgender but only 937 have been diagnosed with gender dysphoria, 10 percent of that population.
Transgender individuals with a history or diagnosis of gender dysphoria are disqualified with certain exceptions. Gender dysphoria diagnosed in childhood, for example, can have a persistence rate of 2 to 30 percent for male children and 12 to 50 percent in female children and therefore may resolve over time. As long as a person has demonstrated 36 months of stability and a lack of gender dysphoria, and otherwise qualifies, he or she can join the military. This is the same standard currently applied to individuals with a history of depression.
The Standards Apply Equally to Trans People
Transgender individuals who insist upon transition or who have already transitioned are disqualified from joining. This decision was determined based on the cumulative research demonstrating a concern for readiness, access to treatment, and the significant lack of scientific certainty concerning effectiveness of various treatment plans to remedy gender dysphoria.
As a rule, any DSM-5 psychiatric disorder that requires medication, has side effects or continual symptoms, and impairs performance limits the deployment of a service member and if deployed could significantly harm the individual. Due to the wide range of treatment options for gender dysphoria there is no fair and safe way to integrate all transitioned transgender individuals into sex-segregated environments.
For service members diagnosed with gender dysphoria, the condition is treated in a similar way to other conditions that would disqualify an applicant. For example, high blood pressure would exclude an applicant, but a service member later diagnosed is only required to treat the condition. In the same way, as long as a service member is willing to follow the standards of his or her biological sex and does not transition, his service is not in question.
The policy is a carefully constructed compromise on a highly volatile situation and, while it limits the physical expression of gender identity for transgender individuals, it does not discriminate against them for being transgender. As Mattis states, “military service requires sacrifice. The men and women who service voluntarily accept limitations on their personal liberties.”
This includes freedom of speech, political activity, and even of movement. Individuals in the military are not allowed to express their personal sense of style or individuality or deviate from standardized grooming and uniform requirements. In this way, a transgender person is treated equally to all other applicants.
The policy is also careful to honor the service of members who are transgender while recognizing the reality of sex-segregated limitations on people with fluid gender identity. Far from a document advocating bigotry or hatred, it goes to great lengths to ensure equal treatment of all applicants and service members. While being transgender in no way disqualifies an individual, some gender expression is simply not compatible with military standards.
Many qualified transgender applicants are likely discouraged from following their dream and honorably serving their country due to the LGBT left’s fear-mongering and inaccurate reporting. Hopefully, with more honest evaluation, most will recognize the military simply expects them to hold to the same standards as everyone else rather than receive special treatment. This is lesson all of LGBT people should consider following.