Inside The Military’s Working Policies On Trans Service Members

Author’s note: This analysis is a review of the military’s transgender policy as it stands in November of 2016. It is unclear how the change in administration will impact the military’s new policy of transgender acceptance, especially as it pertains to insurance coverage and recruiting. On November 15th, the VA decided to scrap their plan to cover trans-related surgery for veterans, which appears to signal a possible reversal of the current policy.

A few years ago, it would have been tough to find someone who could speak with any education on what the word “transgender” means, let alone to find a real live trans person who lived openly and was willing to talk about their experience. As a recent Nobel Prize winner once sang, “The times, they are a changin,’” but up until recently, the fact that things are changing hasn’t been very obvious to the U.S. military.

Yet, finally, even the organization known for its rigid conformity to standards has moved away from stiff conservative beliefs on gender roles to a more inclusive model. Late last year, the military opened its doors to women in combat, enabling generations of women to contribute to their country in the same way their male counterparts can.

On Thursday June 30, 2016, U.S. Secretary of Defense Ash Carter announced another major change — this time concerning the U.S. military’s transgender members. The existing ban against transgender servicepeople was lifted: All branches of the U.S. military would begin accepting transgender candidates, as well as supporting those members seeking transition who were already serving.

As our national defense needs demand a range of people with different and unique skills, limiting the applicant pool based on the arbitrary condition of gender had made the job of national defense more difficult. Thus, this policy change constitutes a dramatic shift that promises to improve not only the conditions for transgender members of the military, but the broad defense capabilities of the U.S.

***

Major Keilyn Distefano joined the U.S. Army in 1998 as an M1A1 Abrams tank driver. She took the job believing that it would help her “grow up and be a man” — a common comment among closeted transgender service members. But after four years she didn’t find the work intellectually challenging enough for her. So she went to college, re-enlisted in the Army reserves, and then moved into computer networking. She’s been in the National Guard ever since.

“I was deployed to Afghanistan in 2009,” Keilyn told me. “Shortly before that, I’d realized what was going on with me, and just before that deployment, I realized that I was transgender and that I needed to see what I could do about transitioning. I found out that simply by being transgender I would be non-deployable, and I didn’t want to let my unit down. If I tried to change anything, I would be discharged. That would be very bad . . .”

Studies show that hundreds of thousands of transgender individuals are serving or have served in the military over the past decades, meaning it’s crucial that the policy groundwork be laid correctly.

So how exactly has the policy been implemented so far?

Lifting the ban on trans service members had been the spoils of a battle fought behind the scenes by activists since before the repeal of the military’s infamous Don’t Ask Don’t Tell (DADT) policy of the 1990s. Shifting existing policy away from exclusion of transgender service members to a more inclusive model was a similarly hard fight, especially during an election year. So far, it seems that the policymakers have done a decent job of building a comprehensive framework by which to adopt these changes. Luminaries in the transgender community (including Kristen Beck — a retired member of the Navy’s elite SEALs team most-recently known as Development Group or ‘DEVGRU’) have done a great deal of the legwork to ensure that this policy is comprehensive.

The policy, as written in the handbook for transgender service members released on October 1 of this year, begins by laying out the important differences between sex and gender — differences that are crucial to understand to provide effective treatment and support. It goes on to accentuate the importance of supporting not just the transitioning service member, but also everyone else under the same command.

But while the policy is very detailed in some areas, on other issues, the specifics of how service members will apply these changes has left some big questions.

One topic that had to be addressed with the new policy is how the military bureaucracy will manage in-service gender transition. Rigid conformity and discipline are the cornerstones of what makes any military successful in combat. Thus, it should come as no surprise that when it comes to transitioning, the military’s urge would be in working toward one unified Standard Operating Procedure that anyone suffering from gender dysphoria would need to go through. To anyone who’s undergone a gender transition, this may seem unintuitive, knowing how differently transitions manifest from person-to-person.

When undertaking a gender transition, it’s common for people to change their name and official gender marker to align with their true identity. As previous Pentagon policies outright banned transgender service members from military eligibility, these changes to the personnel record system, called the Defense Enrollment Eligibility Reporting System (DEERS), have had to be re-thought. Now that a new policy has been adopted, these simple changes should theoretically be possible. In practice, however, obtaining orders to pursue these changes can be cumbersome.

For some people, the application of gender transition policies in the military have fallen short of expectations — primarily by creating a vacuum for prejudice to manifest through vaguely certain worded protocols. This vacuum is prone to exploitation by commanders who may harbor prejudice. Per existing policies, such commanders could stall the progress of a subordinate at many different stages of transition by denying care on the basis of “minimizing impacts to the mission.”

Put differently: The military’s transgender policy is currently riddled with what trans people refer to as “gatekeeping.” Gatekeeping is the practice of setting unreasonable, and often erroneous, obstacles in the way of a person’s transition. It is a strategy that has been used by medical providers for decades — mainly by requiring patients to “prove” that they are transgender, and withholding treatment until a patient has run a gauntlet of unnecessary trials. One such trial, for instance, is a 1–2 year compulsory “real life experience” test, which requires people to live in the gender the individual is transitioning to — before receiving even simple treatments like Hormone Replacement Therapy (HRT).

Other antiquated barriers to transition dating back decades have included plans to move transgender parents away from their children and spouses. Divorce for these couples was an assumed part of transition, and care providers would expect their patients to seek heterosexual relationships regardless of their sexual orientation post-transition.

The purpose of this process has always been sold as a “protection for the patient,” but the efficacy of these measures, and the unnecessary emotional and psychological burden they place on the patients, has cast some doubt about who these steps truly protect.

While the military has banned outright discipline or direct reprisal from being used against a subordinate strictly on the basis of their trans status, there are still many ways that their transition may be overridden. Things like job assignments, security clearance revocation, and even waivers may be leveraged by spiteful or transphobic commanders.

And efforts to begin treatment at all can be thwarted by superiors. In order to begin transition in the service, one must seek the approval of direct supervisors and medical professionals. While it is necessary to have an expert support staff for the transitioning individual, it also leaves the door open for abuse and unnecessary complication, which can discourage the service member from pursuing transitioning. This is a practice the trans community often refers to as “desistance.”

***

To see what effect these changing policies have had on those they are meant to address, I spoke to a recently retired transgender service member.

Madie Babst enlisted in the U.S. Marine Corps in 2005, then went on to fly UH-60 “Black Hawk” helicopters for the U.S. Army during hazardous nighttime operations. Madie came out as transgender to her military physicians, but did not undergo treatment through the military. She retired in August of this year. Even after the announcement of the new policy in June, Madie had still faced the potential for career-ending discrimination.

She was, in fact, eventually barred from flying.

Emily Crose: Why exactly did your commander ground you from flying?

Madie Babst: By the time I had been diagnosed with gender dysphoria, I had already been grounded for Hashimotos Disease.

Emily: How did you go about getting an official diagnosis for gender dysphoria during your time in the service?

Madie: I had just been diagnosed with Hashimotos Disease, and was working on getting a waiver for that. My flight doctor said I really needed to see a behavioral health provider because I think he could see I wasn’t mentally right. Behavioral health then diagnosed me with depression and anxiety, and possible PTSD issues. My therapist knew something was up with me though and kept probing. Finally I admitted my gender dysphoria.

Under the old system of medical classification, gender dysphoria had been categorized under the umbrella term “sexual disorder” which includes “sexual aversion,” desire, arousal, pain, or orgasm disorders. This had been a rather heavy-handed standard in the medical community for sometime outside of military service. Unfortunately, it was an issue that would preclude an individual from military service.

Emily: Do you think they would have tried to kick you out if they had found an expedient way to do it?

Madie: Oh yeah, absolutely.

***

If Madie had stayed in the service, she could have expected that the ensuing military issue treatments would also have been a challenge to complete. Under the new policy, the military not only reserves the right to set a course of treatment, but also to determine if any treatment is necessary or even possible.

Given that transitioning in the service requires the approval of direct supervisors and medical professionals, an unfriendly flight doctor could have easily denied Madie care. If Madie had continued with her transition in the military — assuming of course, it had been granted — she could have expected medical coverage for her gender dysphoria, including HRT and Gender Confirming Surgeries (GCS — also referred to as Gender Reassignment Surgery, or GRS).

When deemed medically necessary, GCS have been approved by the military’s insurance provider, Tricare, which is consistent with the stated intention of the Secretary of Defense via Pentagon spokesman Maj. Ben Sakrisson. However, there are still many rules regulating if and how a member of the military may acquire this treatment. For instance, despite having a new policy of inclusion, Tricare will not cover veterans who transition after their time in the service. This is not, to say the least, consistent with the values of Tricare’s mission to provide coverage to all members of the military, which include retired military veterans and their families.

***

The Military’s policy on transgender service members has been a long time coming. It is far from perfect, but a massive step toward having a stronger, more innovative talent pool to provide critical defense services for the country. Transgender Americans have already been serving in the military silently and with honor for many years. Allowing them to continue their service is important for a stronger, more just union.

We fly our forces into extreme danger in helicopters, we develop code to support our common cyber-defense, and we are even represented in the most elite Special Operations Forces in the country. Americans have a stake in maintaining this talent instead of allowing it to be squandered by the fears a few short-sighted people have of something they don’t quite understand.

As the song goes, “Admit that the waters around you have grown and accept it that soon you’ll be drenched to the bone.” This is not the first challenge to inclusion that Americans will face, and it surely isn’t the last. It’s a welcome sign of the times that the military has opened its doors to transgender Americans who give their time for the defense of the nation not only for the sake of the country, but also for the sake of those who serve. With the risks of being maimed or killed in combat ever-present, the least we can do for them is make sure that their true name appears on their grave marker.

***

Lead image: flickr/David B. Gleason

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