Is the the military transgender ban transphobic?

Is there a case for banning transgender people from serving in the U.S military?

In 2016, the pentagon announced it was lifting the ban preventing transgender people from serving in the U.S military. The then current transgender people would have access to the same medical coverage as any other military members in addition to hormone therapy and gender reassignment surgery if these procedures were deemed necessary by doctors. In the case of incoming service members, they would have to be “stable” in gender identity for 18 months before enlisting.

Roughly a year after Obama lifted the ban, Trump has announced in a series of tweets that the Military would be reinstating the ban on transgender people.

After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you
— President Donald J. Trump

A media outpour of support for transgenders ensue with many labelling the move as thinly-disguised, baseless, bigoted and transphobic attack against an already marginalized community. Some took a step further and attempted to illicit a yet bigger emotional reaction by brazenly stating Trump’s tweets are a direct permission to freely abuse, discriminate and physically harm transgender individuals. But is the move really a direct attack against the rights of a marginalized community or is there a case for a ban on transgender people from serving in the U.S military?

Admittedly, Trump's economic argument for reinstating the ban is not very convincing, though completely reasonable from a libertarian and conservative perspective as these two groups tent to be fiscally conservatives.

Despite that, I believe the President would have been better off tackling this from a health perspective rather than an economic one, which is what I am going to attempt to do.

The argument from a health perspective

First, let's look at the medical conditions that may prevent civilians from joining the military — focusing on mental health, then let's look at the evidence regarding the mental health of the transgender community.

The Standard of Medical Fitness from the U.S Military has myriad of seemingly arbitrary and sometimes unfair health conditions that prevent individuals from joining the military. See below

Application and responsibilities
a. Purpose. The purpose of the standards contained in this chapter is to ensure that individuals medically qualified are —
(1) Free of contagious diseases that would likely endanger the health of other personnel. 
(2) Free of medical conditions or physical defects that would require excessive time lost from duty for necessary treatment or hospitalization or would likely result in separation from the Army for medical unfitness. 
(3) Medically capable of satisfactorily completing required training. 
(4) Medically adaptable to the military environment without the necessity of geographical area limitations. 
(5) Medically capable of performing duties without aggravation of existing physical defects or medical conditions.

More specific examples

2–27. Learning, psychiatric and behavioral disorders
d. Current mood disorders including, but not limited to, major depression (296.2–3), bipolar (296.4–7), affective psychoses (296.8–9), depressive not otherwise specified (311), are disqualifying.
….
j . History of suicidal behaviour, including gestures (s) or attempt (s) (300.9) or history of self-mutilation, is disqualifying.
k. Current or history of anxiety disorders (anxiety (300.01) or panic (300.2)), agoraphobia (300.21), social phobia (300.23), simple phobias (300.29), obsessive-compulsive (300.3), other acute reactions to stress (308), and post-traumatic stress disorder (309.81) are disqualifying.
….
p. Current or history of other mental disorders (all 290–319 not listed above) that in the opinion of the civilian or military provider will interfere with, or prevent satisfactory performance of military duty, are disqualifying.

Now, let's look at what the body of literature has to say regarding the mental health of transgender individuals.

Dhejne et all. (2005) carried out a literature review to investigate the prevalence of psychiatric disorders among trans individuals and identified elevated rates of psychopathology.

Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. The research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.

Additionally, Grotzke et all. (2016) looked at the prevalence of Co-Morbid Mental Health Diagnoses in Transgender Military Veterans at the Salt Lake City Veterans Affairs Medical Center, and found that

Among military veterans identifying as transgender, 90 percent have at least one mental health diagnosis, such as post-traumatic stress disorder (PTSD) or depression, and nearly 50 percent had a hospitalization after a suicide attempt or suicidal thoughts.

Further complicating the situation

Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria.

From this, it is clear that the transgender community is by large more susceptible to mental health issues than the overall population. Further, transgender individuals serving in the military have an even higher rate of gender dysphoria and thus, even higher chance of developing other mental health issues as a result. All of this, is in addition to the fact that non-transgender veterans already have a 15% higher rate of PTSD than the general population.

So, to sum up

  1. Non-transgender veterans already have a 15% higher rate of PTSD than the general population.
  2. Transgender individuals not serving in the military already represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality.
  3. Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria.
  4. Among military veterans identifying as transgender, 90 percent have at least one mental health diagnosis, such as post-traumatic stress disorder (PTSD) or depression, and nearly 50 percent had a hospitalization after a suicide attempt or suicidal thoughts.

By allowing transgender individuals in the military we are putting a group with high risk of developing gender dysphoria and other mental health conditions, into situations that are already harmful and present negative mental health outcomes in seemingly healthy individuals.

It's undeniable that there may be transgender individuals who are not depressed, anxious or in eminent risk of developing mental health problems. Nonetheless, to mitigate the likelihood of future negative health outcomes of an already vulnerable group, it is understandable that the military would also account for future risks and therefore leave out an entire group that is at risk from enlisting.

Lastly, many transgender individuals who choose to transition will undergo hormone treatment for the rest of their lives. The military, however, is expected to perform in situations where supply of resources may be scarce or cut off entirely. Medication weakens the supply line. Other medical conditions exist that are easily treated with appropriate medication such as thyroid or diabetes but that still make one unfit for service. There are probably people suffering from these conditions that are otherwise in perfectly good fitness and have plenty of gun handling experience and are still not be eligible to join. The reason is rather simple, making exception to many medical cases , regardless of how small they are, increases liabilities and gradually weakens the military by small degrees.

I believe this is a perfectly valid position and a far cry from a transphobic, bigoted position to have.