How the Military Discriminates Against Transgender Individuals


When I joined the U.S. Navy back in 1980, I knew I was transgender. I didn’t know the word transgender, but I knew deep down that’s what I was.

Prior to joining the Navy, in 1979, my pentecostal parents considered transgender identities and transgender expressions to be sinful, and made going to “conversion therapy” a condition of living at home. Due to my own internalized transphobia, I thought I was sinful too, so I underwent the therapy, which had the goal of having me become “ex-transgender.”

A goal of both gay and transgender conversion therapy is to embrace societal gender role norms, so in my case embracing masculine norms was the goal. It should come as no surprise then that when I enlisted in the Navy in 1980, it was in part an attempt to be the man I wasn’t.

Chelsea Manning, who enlisted under the name Bradley Manning—and who in August received a 35-year prison sentence for releasing classified government documents to WikiLeaks—recently gave that same explanation as to why she enlisted.

If either of us had admitted to being transgender before we joined the military, we wouldn’t have been allowed to join. This is because Department of Defense Instruction 6130.03, the Medical Standards for Appointment, Enlistment, or Induction in the Military Services, states that “[c]urrent or history of psychosexual conditions, including but not limited to transsexualism, exhibitionism, transvestism, voyeurism, and other paraphilias” precludes induction.

Department of Defense (DOD) policy also discharges currently serving personnel if they admit to, or are discovered to be, transgender. For enlisted service members, Department of Defense Instruction 1332.14 (the Enlisted Administrative Separations) is the controlling regulation. The Army’s applicable regulation is Army Regulation 40–501, the Standards of Medical Fitness, which states:

A history of, or current manifestations of, personality disorders, disorders of impulse control not elsewhere classified, transvestism, voyeurism, other paraphilias, or factitious disorders, psychosexual conditions, transsexual, gender identity disorder to include major abnormalities or defects of the genitalia such as change of sex or a current attempt to change sex, hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis or dysfunctional residuals from surgical correction of these conditions render an individual administratively unfit [to serve].

This transgender exclusion is backed by case law. The first such case in which such exclusion was discussed is 1981′s Doe v. Alexander. Tarynn M. Witten wrote about the case in a 2007 whitepaper entitled “Gender Identity and the Military – Transgender, Transsexual, and Intersex Identified Individuals in the U.S. Armed Forces,” saying:

[T]he Army defended its policy of denying enlistment to transsexual persons, arguing that transsexual persons presented a medical problem in that their requirements for hormone supplementation might not be available at some location where they could be assigned.

The 2007 DeGroat v. Townsend decision by the U.S. Southern District Court in Ohio, Western Division, echoed the decision in Doe v. Alexander, finding Joanne E. Degroat, a member of the U.S. Armed Forces (USAF) from 1974 to 1989, medically unfit to serve. In the decision, the court stated that “USAF medical staff encouraged and counseled her to dress in female street clothing when off-base and off-duty” as part of the treatment plan for her gender dysphoria. Major DeGroat was seen attending church in female clothing, and then “was notified that she had to show cause for retention on active duty for substandard performance due to a failure to show acceptable qualities of leadership required by an officer of her grade, based on her wearing female clothing on two instances and subjecting herself to public view.” Her separation for service was upheld.

The Leyland v. Orr decision is also on point. Jane Anne Leyland was honorably discharged from the Air Force Reserves as being found mentally and physically unfit to serve due to being transsexual and receiving trans-related medical treatment. As Witten wrote in her paper, “Leyland’s fitness for duty recommended discharge on the grounds of psychological unsuitability, the Air Force Board for Correction of Military Records affirmed the discharge on grounds of psychological unsuitability and physical unfitness.”

From the Ninth Circuit Court of Appeals ruling, Dr. Donald Novicki, a urology consultant to the Air Force surgeon general, stated that the known and potential long-term effects of a sex change constitute a risk significant enough to restrict the individual’s performance of Air Force duties, especially when remote geographic assignments are involved. Dr. Novicki stated that assigning such a person to such places “would be equivalent to placing an individual with known coronary artery disease in a remote location without readily available coronary care.” He added, “It has been and remains the policy of the Surgeon General that such abnormalities be identified and that such individuals be denied entry or continued active duty for their benefit and for the benefit of the United States Air Force.”

Lastly, in 1988′s United States v. Davis, the appellant was charged under Article 134 of the Uniform Code of Military Justice after having several Navy psychiatrists diagnose her with what the DSM-V refers to as “gender dysphoria,” and was recommended for continued treatment of the condition. The U.S. Court of Military Appeals ruling on the case stated that expressing gender as one’s target sex while on base in a manner as required by the relevant standard of care “virtually always would be prejudicial to good order and discipline and discrediting to the Armed Forces.”

The military services have not in recent years criminalized treatment of gender dysphoria as was done in United States v. Davis, but as these court rulings indicate, being diagnosed for gender dysphoria—and being treated for gender dysphoria while serving in the military—are reasons for denying entry to transgender people, as well as initiating their separation from the military services. This is settled law.

The prohibition against medical treatment for transgender people extends beyond active service members. TRICARE, the DOD’s health-care insurance program for dependents and retirees, has insurance exclusions for gender dysphoria related health-care treatment. The TRICARE policy manual includes in the program’s exclusions “[s]ervices and supplies related to transsexualism or such other conditions as gender dysphoria (including, but not limited, to intersex surgery, psychotherapy, and prescription drugs), except as specifically provided in 32 [Code of Federal Regulations].”

The American Psychiatric Association, the American Psychological Association, the American Medical Association, and the World Professional Association for Transgender Health (WPATH) all support removing exclusions for treatment connected to gender dysphoria. For example, the American Medical Association stated in 2008′s Resolution 122:

[I]f left untreated, [gender dysphoria] can result in clinically significant psychological distress, dysfunction, debilitating depression … An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with [gender dysphoria.]

Health experts in [gender dysphoria], including WPATH, have rejected the myth that such treatments are ‘cosmetic’ or ‘experimental’ and have recognized that these treatments can provide safe and effective treatment for a serious health condition[.]

Physicians treating persons with [gender dysphoria] must be able to provide the correct treatment necessary for a patient in order to achieve genuine and lasting comfort with his or her gender, based on the person’s individual needs and medical history[.]

To put all of this in perspective regarding appropriate medical treatment for Chelsea Manning, if by court order it’s required that her gender dysphoria be treated in accordance with the standards of care, she’d be the only military patient diagnosed with gender dysphoria to legally receive appropriate treatment for that condition. That’s not an argument against Manning receiving such treatment—rather, it highlights just how outmoded the DOD’s policies are.

Chelsea Manning’s request for medical treatment in Army custody is precipitating discussions about what is appropriate medical treatment for transgender people, and what transgender-related health care should be made available by the DOD for service members and by TRICARE for dependents and retirees. It’s also spurred a discussion of whether U.S. government health-care exclusions for gender dysphoria are ethically defensible.

In thinking of what are ethical and appropriate health-care treatments for transgender people, we need to consider that the American Psychiatric Association has strongly questioned the efficacy of conversion therapy. In addition, the Ninth Circuit Court of Appeals affirmed  last week the right to prohibit therapy for minors that has the goal of making patients “ex-gay” or “ex-transgender.” Because of the real harm such therapy can cause, one can safely state that the federal government shouldn’t be in the business of engaging in conversion therapy with their transgender prisoners.

And beyond the medical considerations, the public transitions of Kristin Beck—the former Navy seal who recently came out as transgender on CNN’s Anderson Cooper 360—and Chelsea Manning are generating a national discussion on open military service for transgender people.

Chelsea Manning’s now public transition highlights the needs of a vulnerable population. And how we treat the most vulnerable individuals in our society is a discussion we certainly should be having.

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  • Arachne646

    It’s a good point that those who call transgender persons “sick, delusional” and so forth, must address–conversion therapy has been thoroughly discredited, so: “one can safely state that the federal government shouldn’t be in the business of engaging in conversion therapy with their transgender prisoners.” Or their veterans, and other dependents who they cover for health insurance purposes! The federal Bureau of Prisons, by the way, has just had a judgement against them that they must provide medical treatment to transgender inmates, so hopefully that will be implemented without problems!

  • ArmyGal

    Being born in the Air Force, Joining the Active Army, and
    the Alabama National Guard, Supporting my fellow veterans as a Government
    contractor, and finally as a Department of Army Civilian. I must say that I had
    always believed in the Equal Employment
    Opportunity (EEO) complaint process system. That After being a victim or a both
    a hostile work environment, Sexual Discrimination as defined by Title VII of
    the civil rights act, and a pervasive hostile work environment I filed a
    complaint. Because I believed as I was
    trained in the Army that a regulation is the gospel for accomplishing anything;
    I believed the process would work as I had believed it would have worked for the
    few instances where a Soldier had confided to me as an NCO of the United States
    Army.

    Sad to say, the Initial informal complaint was filed with
    little or no response from the EEO office until well past 180 days even after
    several emails and enquires, I went to the IG office and then the formal
    complaint was taken. Now on to the next
    180 days, the EEO office only kept me informed if I contacted them to get a
    status, often taking two or more weeks to get a response.

    Then next 180 days found in Investigative reporting
    Davison personnel, at Redstone and he limited the scope when the potential
    impact the army would have been increased or additional charges could have been
    brought forward. Within two weeks the
    transcript was to have been made available to me, it did not come, nor did the
    Report Of Investigation folder until almost 3 months later. A decision was made to have a Final Agency
    Decision, based upon the belief that the right thing would be done.

    Eight months later the Department of the Army Office of
    the Assistant Secretary Manpower and Reserve Affairs, issued a Final Agency
    decision after working on the case for only about a week to review all of the
    documentation.

    They provided a determination that harassment, and a
    hostile work environment in their opinion was not persistent and pervasive
    enough to substantiate a claim. I ask
    how can something that went on almost 11 months with multiple incidents not be
    considered. How could they overstep the determination of the EEOC on Title VII,
    OPM Guidance, and even the Pride Proclamation made by the Secretary of defense.
    This when the defense arena is in its darkest hour rampant with sexual
    harassment, sexual assault, and sexual discrimination.

    I am sad that after more than 4 decades around the military
    that doing the right thing to protect all employee should also be doing what is
    right for the entire workforce, is instead in reviews of information by an
    Final Agency geared not toward currently EEOC Legislation, guidance, and
    against the code of Federal Regulations where an employee should not be
    discriminated against, or judged for anything other than their work
    performance.

    It is a sad day at Redstone Arsenal when we fail those
    who have not only served in to protect their country but as a disabled veteran also continue to uphold
    the values of the constitution, and support or current soldiers in the field
    and in harm’s way. I will continue to
    work, I will preserves, with continues MST, and counseling. I will continue to
    see that our troops get everything they need.

    I WILL NEVER EVER EVER place my trust in the Internal
    policies, procedures, and regulations, that seem to be applicable only to the
    complainant and not the investigating team that took over 700 days to even come
    to a decision that the harassment, and discrimination was there but not
    pervasive enough to have a finding.

    I guess on Redstone Arsenal, AMC, and AMRDEC you can
    sexually harass, sexual discriminate so at least once to any person so long as
    you do not do it pervasively to the same person, or the same person does not do
    it enough times to make it a valid complaint.

    Signed

    A transgendered Disabled Veteran Civil service Employee

  • Ophelia13

    It’s a well intentioned article, but I can’t agree with what’s being stated in it as fact. The author claims the military’s health care insurance, Tricare, won’t pay for HRT (hormone replacement therapy) for retirees or dependents. I’m a retiree and they’re never said a word and always pay for mine. The fact that DADT and DOMA has been repealed even causes that to fail the common sense test. If I’m a beneficiary and I marry a trans person, how could they deny my spouse basic medical care such as HRT?

    The article also fails to mention that the Veterans’s Administration both offers and picks up the tab for HRT for any veteran eligible for care in their health system that has GID (gender identity disorder).