Chapter 24: Caring for Transgender and Gender Diverse Veterans

INTRODUCTION

Transgender and gender diverse (TGD) people have likely served in the U.S. armed forces for as long as the nation has had a military, although their presence and experiences within the military did not gain substantial attention until much later. Unfortunately, this later attention was mainly negative and stigmatizing of TGD identities both within the military and the larger culture. While in recent years visibility and social attitudes regarding TGD people have become more affirming in the broader culture, military policy has gone back and forth. The long history of prohibiting open military service by TGD people makes it difficult to compile accurate estimates of the number of TGD military personnel and examine their military service. Moreover, the shifting, inconsistent military policy on TGD service has complicated the environment of service for TGD service members. These policies present unique challenges for TGD veterans, particularly within the Veterans Health Administration (VHA). This chapter first discusses U.S. military culture and history as it relates to the experiences of TGD service members. Next, health disparities for TGD veterans are reviewed, followed by a discussion of the VHA policies related to TGD health care. Finally, two case studies of TGD veterans are presented.

HISTORY OF THE U.S. MILITARY AND TGD SERVICE MEMBERS

In the all-volunteer U.S. armed forces, fewer than 10% of Americans serve in the military.¹ A disproportionate number of TGD Americans join the military. Although the exact population prevalence is unknown, researchers estimate that TGD people make up 0.3% (700,000) of the U.S. population, and yet 0.6% (149,800) of military veterans are estimated to be TGD people.^2,3 In the 2015 U.S. Transgender Survey, a large online survey of 27,715 TGD Americans, 18% of participants reported serving in the military.⁴ These numbers suggest that TGD people have long served in the military and served largely undetected (Figure 24-1). From the 2015 U.S. Transgender Survey, more than half (52%) of respondents said no one else knew about their TGD identity.⁴ About one-third (34%) reported that a few or some people in the military knew about their TGD identity. Nearly 80% of survey respondents received an honorable discharge from the military. Of those who had left military service more than 10 years ago, about one-fifth (19%) believed their discharge was related to their TGD identity (Figure 24-1).

The military first issued a ban on service by TGD people in 1963, which was lifted briefly in June 2016. At first, the policy allowed TGD service members who were serving in secret to serve openly and receive transgender-related health care on military bases. This policy was then temporarily expanded to openly allow transgender people to join the military starting in January 2018. However, in July 2018, the military under the Trump Administration announced plans ...