All the right-wing lies about Trump’s transgender military ban, debunked

All the right-wing lies about Trump’s transgender military ban, debunked

››› ››› REBECCA DAMANTE

Right-wing media figures have helped promote a series of myths about transgender service members in the U.S. military in response to President Donald Trump’s announcement that he would ban them from serving. These debunked myths include the claim that the cost of medically necessary health care for transgender service members would be in the billions, that allowing transgender members to serve would interfere with military readiness and cohesion, that a majority of transgender people are unable to be deployed due to their health care needs, and that being transgender is a mental illness that makes people unfit to be in the military.


Sarah Wasko / Media Matters

FACT: The Pentagon-commissioned Rand Corp. study estimates costs of $2.4 to $8.4 million annually, and it was supported by other findings

FACT: Transgender military members do not negatively affect military cohesion or readiness

FACT: Transgender people and service members do not all undergo surgery, and other medical treatments such as hormones do not affect deployability

FACT: Being transgender is not a mental illness

MYTH: Allowing transgender people to serve in the military creates billions in additional costs

Family Research Council: Over the next 10 years, allowing transgender people to serve in the military could cost “as much as $1.9 to $3.7 billion.” Peter Sprigg, a senior policy fellow at the anti-LGBTQ hate group Family Research Council (FRC), published a July “issue brief” that dubiously claimed the cost of allowing transgender people to serve in the military would be up to 10 times higher than estimates done by the Pentagon-commissioned Rand Corp. FRC admitted it had “undertaken its own analysis” of the costs and estimated that “they could total as much as $1.9 to $3.7 billion (not million, as in the RAND study) over the next ten years.” From the brief (citations removed):

The RAND Corporation undertook an analysis of this question in 2016, and came up with a broad-range estimate that the health-related costs of gender transition would total between $2.4 million and $8.4 million annually (i.e., between $24 million and $84 million over ten years). However, these estimates were drawn from actuarial data based on the estimated increase in insurance premiums for private employers who adopted coverage for gender transition. Since the military pays for the health care of active duty service members directly, it is more logical to look at the direct costs of such procedures. In addition, the RAND study made estimates of lost time due to recovery from gender reassignment surgery, but placed no dollar value on this indirect, but very real cost to the armed forces.

Family Research Council has now undertaken its own analysis of the potential costs of permitting people who identify as transgender to serve in the military, and has concluded they could total as much as $1.9 to $3.7 billion (not million, as in the RAND study) over the next ten years. This total includes both direct medical costs and the cost of potential lost time of deployable service. (The additional administrative costs of preparing and overseeing individualized care plans for each service member who identifies as transgender, the costs of training the entire force regarding the new policy, and the loss of time associated with that training, have not been included in these estimates.) [Family Research Council, July 2017; Southern Poverty Law Center, accessed 9/7/17]

FRC’s Tony Perkins: The cost of allowing transgender people to serve in the military is “anywhere from $1.9 billion to $3.7 billion over 10 years.” On July 27, FRC President Tony Perkins published an op-ed in The Hill supporting Trump’s transgender military ban and repeating FRC’s dubious estimates. In the post, Perkins cited Trump’s tweet that transgender military members would lead to “tremendous medical costs” and said that FRC’s “own analysis” “showed that the direct medical costs (surgery and hormones) could be nearly $1 billion dollars over 10 years. Meanwhile, the lost time due to service members not being deployable or taking special leave could drive the total cost to anywhere from $1.9 billion to $3.7 billion over 10 years.” From the op-ed:

The service chiefs reportedly requested a longer delay of two years, and Air Force General Paul Selva, vice chairman of the Joint Chiefs of Staff, told Congress there was “disagreement on the science.” Perhaps they realized that “gender reassignment surgery” — at a cost to taxpayers of up to $110,000 per person — could not be deemed “medically necessary” when even President Obama’s Department of Health and Human Services had concluded that “the clinical evidence is inconclusive” on this point. In any case, President Trump’s “consultation with . . . Generals and military experts” resulted in the right decision.

[...]

President Trump was right to be concerned about “the tremendous medical costs and disruption” caused by allowing those who identify as transgender to serve in the military. The Family Research Council’s own analysis of the potential costs — showed that the direct medical costs (surgery and hormones) could be nearly $1 billion dollars over 10 years. Meanwhile, the lost time due to service members not being deployable or taking special leave could drive the total cost to anywhere from $1.9 billion to $3.7 billion over 10 years. [The Hill, 7/27/17]

Right-wing media outlets amplified FRC’s exaggerated projections on the cost of allowing transgender people to openly serve in the military. Right-wing media outlets including Barbwire, CBN News, and Newsmax provided a platform for FRC representatives to spread FRC’s misinformation and to help bolster the organization’s claims. [Barbwire, 7/23/17; CBN News, 7/24/17; Newsmax, 7/25/17]

Fox’s Oliver North: “Why would we spend $1.5 billion” on transgender service members? On July 27, Fox News’ Oliver North appeared on Hannity, where he promoted dubious estimates that the government would “spend $1.5 billion” on treatment for transgender military members. From the July 27 segment:

OLIVER NORTH: There is an estimate in the press that it cost $250,000 for transgender surgery and hormone treatment. Why would we spend that? If indeed some of those reports [are] right, then we have 6,000 people that are transgender in the military and want to come in to get transgendered surgery and the like, why would we spend $1.5 billion on that when for the same amount of money, we could build another USS Wasp, a landing helicopter delivery vessel for Marine amphibious assaults? [Fox News, Hannity, 7/27/17 via FoxNews.com]

Wash. Free Beacon’s Elizabeth Harrington: “There's only .7 percent of active duty military population that is transgender, but the cost would be $1.3 billion over 10 years.” Washington Free Beacon’s Elizabeth Harrington appeared on Fox News’ Tucker Carlson Tonight, where she claimed that “the cost would be $1.3 billion over 10 years” to include transgender service members in the military. Harrington claimed the numbers, which she said came from Rep. Vicky Hartzler (R-MO), provide a more “accurate picture” than the Pentagon-commissioned Rand Corp. study. From the July 28 segment:

ELIZABETH HARRINGTON: This would cost -- it’s striking because the numbers in fact are there's only .7 percent of the active duty military population are transgender, but the cost is actually $1.3 billion over 10 years, and these numbers come from the [Republican] Congresswoman Vicky Hartzler, from Missouri, and I think they provide a much far accurate picture than the Rand Corporation study, which was commissioned by the Obama administration, had very low numbers estimating the actual amount of transgenders in active duty. They excluded the Reserves, they excluded the [National] Guard, and they only assumed that 5 percent would get transgender surgeries.

But the fact is, a more accurate number is 30 percent, and it’s really a conservative estimate that 30 percent would get the surgeries because actually, in fact, a much higher percentage of transgender individuals express the desire to get a surgical transition in the future someday. And if they're taxpayer-funded -- look, sex changes aren’t cheap, and if they’re taxpayer-funded and they’re free, I think it’ll incentivize a lot of more transgender individuals to utilize taxpayer funding for these high-cost surgeries. [Fox News, Tucker Carlson Tonight, 7/28/17]

FACT: The Pentagon-commissioned Rand Corp. study estimates costs of $2.4 to $8.4 million annually, and it was supported by other findings

Rand Corp.: Allowing transgender people to serve openly in the military would result in “relatively low” additional health care costs “between $2.4 and $8.4 million annually.” The Pentagon commissioned the Rand Corp. to conduct a 2016 review and economic analysis of the potential impact of allowing transgender people to openly serve in the military. The study estimated that increases to annual health care costs would fall between $2.4 and $8.4 million annually, accounting for only a “0.04- to 0.13-percent increase in active-component health care expenditures.” The report noted that the impact on the budget was “relatively low” and that “even in the most extreme scenario that we were able to identify using the private health insurance data, we expect only a 0.13-percent ($8.4 million out of $6.2 billion) increase in AC health care spending.” From the report’s key findings (emphasis original):

The Costs of Gender Transition–Related Health Care Treatment Are Relatively Low

  • Using private health insurance claims data to estimate the cost of extending gender transition–related health care coverage to transgender personnel indicated that active-component health care costs would increase by between $2.4 million and $8.4 million annually, representing a 0.04- to 0.13-percent increase in active-component health care expenditures.

  • Even upper-bound estimates indicate that less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy. [Rand Corp., accessed 9/7/17]

Palm Center Director Aaron Belkin: “The cost amounts to little more than a rounding error in the military's” budget: In The New England Journal of Medicine, Palm Center Director Aaron Belkin estimated “that the provision of transition-related care will cost the military $5.6 million annually, or 22 cents per member per month.” He also said that after his analysis, he was “convinced” that costs are “too low to warrant consideration in the current policy debate.” Belkin noted that “under any plausible estimation method, the cost amounts to little more than a rounding error in the military’s $47.8 billion annual health care budget.” From the September 17, 2015, report (citations removed):

Having analyzed the cost that the military will incur by providing transition-related care, I am convinced that it is too low to warrant consideration in the current policy debate. Specifically, I estimate that the provision of transition-related care will cost the military $5.6 million annually, or 22 cents per member per month. Of course, the cost will depend on how many transgender personnel serve and utilize care, and estimates are sensitive to certain assumptions, such as the expectation that the military will not become a “magnet” employer for transgender people seeking health care benefits. Though my utilization and cost estimates are quite close to actual data provided by an allied military force, it seems clear that under any plausible estimation method, the cost amounts to little more than a rounding error in the military's $47.8 billion annual health care budget.

My calculations are as follows. In 2014, scholars estimated that 15,500 transgender personnel served in the military out of a total force of 2,581,000, but they included troops who were ineligible for health benefits. Moreover, the military has become smaller in recent years: as of May 31, 2015, a total of 2,136,779 troops served in the Active and Selected Reserve components and were thus eligible for health benefits. Assuming that the number of transgender personnel has declined along with the overall force size, and excluding those serving in Reserve components whose members are ineligible for medical benefits, I estimate that 12,800 transgender troops serve currently and are eligible for health care. [The New England Journal of Medicine, 9/17/15]

Palm Center: “Fully implementing President Trump’s ban would cost $960 million in pursuit of savings of $8.4 million per year.” On August 8, the Palm Center think tank published research on the cost of “discharging transgender troops,” as proposed by Trump. The center estimated that “fully implementing President Trump’s ban would cost $960 million in pursuit of savings of $8.4 million per year,” calling that figure “more than 100 times the cost of trans healthcare.” The report came to its estimation by “multiplying the number of service members who will be discharged by the cost of recruiting and training a replacement,” as the military would have to “recruit and train a replacement for each service member discharged.” The report added that its authors “used conservative figures to derive their cost projection” and noted that its estimates “did not include administrative costs and lost time for personnel tasked with rounding up transgender personnel and overseeing their separation, or of legal costs that are sure to mount as service members challenge the Pentagon’s effort to purge their ranks in the military.” From the report:

A new report co-authored by current and retired professors at the Naval Postgraduate School in Monterey has projected the cost of discharging the military’s transgender troops at $960 million. The report was released in response to the recent announcement by President Trump, on Twitter, that the military would no longer “allow Transgender individuals to serve in any capacity in the U.S. Military,” citing what the president called the “tremendous medical costs” of providing adequate care.

But the new report shows that discharging and replacing the estimated 12,800 transgender service members who are already serving would cost over 100 times more than providing medically necessary health care to the military’s transgender troops. “Fully implementing President Trump’s ban would cost $960 million in pursuit of savings of $8.4 million per year,” the report concludes. The $8.4 million figure is the upper-bound estimate calculated by the RAND Corporation for providing health care to transgender troops each year.

[...]

The new report uses a “replacement-cost method” to calculate the overall cost of ousting transgender troops. Since the military has to recruit and train a replacement for each service member discharged, the authors explain, the total price of a ban was derived by multiplying the number of service members who will be discharged by the cost of recruiting and training a replacement.

The authors used conservative figures to derive their cost projection. While some media reports have cited an estimate that 15,500 transgender troops are currently serving, the authors used a lower figure published in the New England Journal of Medicine estimating that there are 12,800 transgender service members. (RAND’s estimate included a range that dipped even lower; the current report uses the middle figure). Since RAND’s $8.4 million figure for health care spending was an upper-bound estimate, the actual cost of purging the military of its transgender troops may be far more than 100 times higher. And the current report did not include administrative costs and lost time for personnel tasked with rounding up transgender personnel and overseeing their separation, or of legal costs that are sure to mount as service members challenge the Pentagon’s effort to purge their ranks in the military. [Palm Center, 8/8/17]

MYTH: Transgender service members undermine military readiness and cohesion

Fox’s Mollie Hemingway: “Transgender ideology is just one of many social justice issues that have caused a lot of problems for troop cohesion.” On July 26, Fox News’ Mollie Hemingway appeared on Special Report with Bret Baier and claimed that “transgender ideology” had “caused a lot of problems for troop cohesion and ability to fight wars.” Hemingway continued that “this is something that is frustrating to a lot of enlisted people and a lot of generals.” From the segment:

MOLLIE HEMINGWAY: I totally agree that there is an arbitrary and capricious angle to the way this was done. At the same time, there is maxim in politics about never giving a bureaucrat a chance to say no, and sometimes just providing some leadership, making some change, actually turning back a bit of this unending attack on certain values that have been happening in the military. I mean, transgender ideology is just one of many social justices that have caused a lot problems for troop cohesion and ability to fight wars, and this is something that is frustrating to a lot of enlisted people and a lot of generals. [Fox News, Special Report with Bret Baier, 7/26/17 via FoxNews.com]

National Review: “The only issue in determining who serves in the military should be military fitness, readiness, and loyalty. Any deviation from those priorities gets people killed.” On July 26, National Review posted an article on the implications of the transgender military ban. The article claimed, “The military is no place for social experiments, or really any other social-policy battles, from the Left or the Right. The stakes are too high. The only issue in determining who serves in the military should be military fitness, readiness, and loyalty. Any deviation from those priorities gets people killed.” [National Review, 7/26/17]

The Federalist: Trump's "transgender policy simply enforces the military’s uniform combat readiness standards that apply to all servicemen and women.” A July 31 post by a veteran of the war in Afghanistan in The Federalist, headlined “Military Service Is A Privilege That Transgender People Aren’t Qualified For,” defended Trump’s transgender military ban as a “readiness issue.” The post argued that Trump’s “transgender policy simply enforces the military’s uniform combat readiness standards that apply to all servicemen and women.” Author James Hasson went on to outline “three readiness issues at play in the transgender context,” which he said included “physical fitness standards,” mental health considerations, and “logistical problems” such as taking hormone treatments. From the post (emphasis original):

The transgender policy simply enforces the military’s uniform combat readiness standards that apply to all servicemen and women. There are three readiness issues at play in the transgender context. The first issue is the physical readiness problem caused by a system that evaluates transgender troops’ physical fitness for duty under the standard of whichever sex they identify with internally—male or female—instead of the physical fitness standards that were intentionally designed for individuals who share their biological characteristics.

The Physical and Mental Health Needs Are Unsustainable

The second argument, made forcefully by J.R. Salzman, is that combat is a uniquely stressful environment that can break even the most mentally and emotionally grounded soldiers. Nearly half of transgender individuals suffer from depression or anxiety. More than one in five have considered suicide within the last 30 days, and 41 percent do attempt suicide.

These statistics are awful, and they merit greater attention and examination, but they are simply not compatible with the realities of combat. Deployments, a close friend observed while we were in Afghanistan, “are like an echo chamber of your own emotions.” They are not good for anyone’s blood pressure, and can be catastrophic for those who bring outside stressors overseas with them. The military routinely screens out recruits who have histories of depression and anxiety, even though their intentions are no less admirable than the intentions of transgendered individuals who want to serve, under the very principle that “everyone who is qualified to serve should be allowed to serve.”

Finally, there are logistical problems caused by deploying soldiers who require a steady, if not daily, regimen of hormone treatments to stay healthy. Soldiers in basic training are not even allowed to keep personal bottles of Advil, because the military is designed to create warriors who can function independently in austere and primitive environments and to weed out those cannot do so.

[...]

This is not a culture war issue. I am not making any claim about the broader culture wars, nor do I intend to. This is a readiness issue. Everyone who is qualified to serve should be allowed to serve. Unfortunately, that excludes nearly half of the U.S. population in various ways. But that is the reality of the mission and purpose of our armed forces. [The Federalist, 7/31/17]

FACT: Transgender military members do not negatively affect military cohesion or readiness

Department of Defense: “Open service by transgender Service members while being subject to the same standards and procedures as other members … is consistent with military readiness.” On June 30, 2016, Defense Secretary Ash Carter announced in a memorandum that “transgender individuals shall be allowed to serve in the military,” saying that transgender service members would be “subject to the same standards and procedures as other members with regard to their medical fitness for duty, physical fitness, uniform and grooming, deployability and retention” and that the policy was “consistent with military readiness.” The announcement added that transgender service members “whose ability to serve is adversely affected by a medical condition or medical treatment related to their gender identity should be treated ... in a manner consistent with a Service member whose ability to serve is similarly affected for reasons unrelated to gender identity or gender transition.” It also said that transgender service members with a history of gender dysphoria must have been “stable without clinically significant distress or impairment in social, occupational, or other important areas of functioning for 18 months.” From the memorandum (emphasis original):

  • The policy of the Department of Defense is that service in the United States military should be open to all who can meet the rigorous standards for military service and readiness. Consistent with the policies and procedures set forth in this memorandum, transgender individuals shall be allowed to serve in the military.

  • These policies and procedures are premised on my conclusion that open service by transgender Service members while being subject to the same standards and procedures as other members with regard to their medical fitness for duty, physical fitness, uniform and grooming, deployability, and retention, is consistent with military readiness and with strength through diversity.

[...]

1. SEPARATION AND RETENTION

[...]

b. Transgender Service members will be subject to the same standards as any other Service member of the same gender; they may be separated, discharged, or denied reenlistment or continuation of service under existing processes and basis, but not due solely to their gender identity or an expressed intent to transition genders.

c. A Service member whose ability to serve is adversely affected by a medical condition or medical treatment related to their gender identity should be treated, for purposes of separation and retention, in a manner consistent with a Service member whose ability to serve is similarly affected for reasons unrelated to gender identity or gender transition.

[...]

1. A history of gender dysphoria is disqualifying, unless, as certified by a licensed medical provider, the applicant has been stable without clinically significant distress or impairment in social, occupational, or other important areas of functioning for 18 months. [Department of Defense, 6/30/16]

Rand Corp.: Allowing transgender people to openly serve in the military would have “minimal likely impact” on military readiness. Based on evidence from foreign militaries, the Rand Corp.’s 2016 study found that transgender-inclusive military service would have “little or no impact on unit cohesion, operational effectiveness, or readiness. Commanders noted that the policies had benefits for all service members by creating a more inclusive and diverse force.” Its key findings compared accepting transgender service members to policy changes that opened “more roles to women” and allowed “gay and lesbian personnel to serve openly,” adding that they “similarly had no significant effect on unit cohesion, operational effectiveness, or readiness.” From the report:

Previous Integration Efforts and the Experiences of Foreign Militaries Indicate a Minimal Likely Impact on Force Readiness

  • The limited research on the effects of foreign military policies indicates little or no impact on unit cohesion, operational effectiveness, or readiness. Commanders noted that the policies had benefits for all service members by creating a more inclusive and diverse force.

  • Policy changes to open more roles to women and to allow gay and lesbian personnel to serve openly in the U.S. military have similarly had no significant effect on unit cohesion, operational effectiveness, or readiness. [Rand Corp., accessed 9/7/17]

Fifty-six retired generals and admirals on Trump’s ban: “This proposed ban, if implemented, would cause significant disruptions” and “degrade readiness.” On August 1, 56 retired generals and admirals provided a statement to the Palm Center denouncing Trump’s proposed transgender military ban. The cohort of veterans said, “This proposed ban, if implemented, would cause significant disruptions, deprive the military of mission-critical talent, and compromise the integrity of transgender troops who would be forced to live a lie, as well as non-transgender peers who would be forced to choose between reporting their comrades or disobeying policy.” It also said that “the proposed ban would degrade readiness even more than the failed ‘don’t ask, don’t tell’ policy” and that transgender service members “must not be dismissed, deprived of medically necessary health care, or forced to compromise their integrity or hide their identity.” The letter added that 18 foreign nations “allow transgender troops to serve, and none has reported any detriment to readiness” and that transgender U.S. troops “have been serving honorably and openly for the past year, and have been widely praised by commanders.” The retired generals and admirals agreed that “inclusive policy for transgender troops promotes readiness.” From the August 1 statement:

Fifty-six* retired General and Flag Officers provided the following statement to the Palm Center today:

“The Commander in Chief has tweeted a total ban of honorably serving transgender troops. This proposed ban, if implemented, would cause significant disruptions, deprive the military of mission-critical talent, and compromise the integrity of transgender troops who would be forced to live a lie, as well as non-transgender peers who would be forced to choose between reporting their comrades or disobeying policy. As a result, the proposed ban would degrade readiness even more than the failed ‘don’t ask, don’t tell’ policy. Patriotic transgender Americans who are serving—and who want to serve—must not be dismissed, deprived of medically necessary health care, or forced to compromise their integrity or hide their identity.

[...]

“As for ostensible disruptions, transgender troops have been serving honorably and openly for the past year, and have been widely praised by commanders. Eighteen foreign nations, including the UK and Israel, allow transgender troops to serve, and none has reported any detriment to readiness.

[...]

“And Admiral Mike Mullen stated that, ‘I led our armed forces under the flawed ‘don’t ask, don’t tell’ policy and saw firsthand the harm to readiness and morale when we fail to treat all service members according to the same standards. Thousands of transgender Americans are currently serving in uniform and there is no reason to single out these brave men and women and deny them the medical care that they require. The military conducted a thorough research process on this issue and concluded that inclusive policy for transgender troops promotes readiness.’ Admiral Mullen urged civilian leaders ‘to respect the military’s judgment and not to breach the faith of service members who defend our freedoms.’ We could not agree more.” [Palm Center Blueprints for Sound Public Policy, 8/1/17]

MYTH: Large numbers of transgender service members will seek surgical procedures that prevent deployability

Wash. Free Beacon cited a study claiming that transgender troops “seeking basic sex-change operations would be nondeployable for 238 days.” On August 24, Washington Free Beacon’s Harrington published a post that argued, “On average, transgender troops seeking basic sex-change operations would be nondeployable for 238 days, or 34 weeks out of a year.” Harrington also claimed that the recovery time for male-to-female transitions “would cost 210 days of nondeployability” and that female-to-male transitions result in “on average 267 days where they cannot be deployed.” Harrington added, “By taking the low estimate from the RAND study of nondeployable time of 210 days, the 8,213 surgical transitions would lead to a total 1,724,730 days of nondeployable time, or 4,725 years.” From the post:

The [Rand Corp.] study found that, on average, transgender troops seeking basic sex-change operations would be nondeployable for 238 days, or 34 weeks out of a year. The figure amounts to 65 percent of one year.

"These constraints typically include a postoperative recovery period that would prevent any work and a period of restricted physical activity that would prevent deployment," the RAND study states.

"We note that these estimates do not account for any additional time required to determine medical fitness to deploy," the RAND study added. "Army guidelines, for example, do not permit deployment within six weeks of surgery."

The RAND study reported that male-to-female surgeries would cost 210 days of nondeployability, including medical leave and medical disability periods.

[...]

RAND found female-to-male transitions on average take longer recovery times, on average 267 days where they cannot be deployed.

By taking the low estimate from the RAND study of nondeployable time of 210 days, the 8,213 surgical transitions would lead to a total 1,724,730 days of nondeployable time, or 4,725 years. [Washington Free Beacon, 8/24/17]

Harrington on Fox: “The average transgender soldier will spend 238 days recovering from sex change surgeries and unavailable to deploy.” On July 28, Harrington manipulated numbers from Rand Corp. estimates to claim on Fox News that “every transgender soldier who goes through transition will be out an estimated 238 days. So that is 238 days that they’re not going to be deployed overseas in active duty.” From the July 28 segment of Tucker Carlson Tonight:

ELIZABETH HARRINGTON: It’s striking because even the Rand Corp. admits that every transgender soldier who goes through transition will be out an estimated 238 days. So that is 238 days that they’re not going to be deployed overseas in active duty, and someone else will have to go in their place. So when the White House says this is about cost but it’s also about readiness, they’re absolutely right because they’re taking the place of someone else. And they’re get to have the taxpayer-funded surgery, and then they’re not available to be deployed because these surgeries are extensive, and it’s 238 days. That’s most of a full year, so it’s really striking. [Fox News, Tucker Carlson Tonight, 7/28/17]

FACT: Transgender people and service members do not all undergo surgery, and other medical treatments such as hormones do not affect deployability

Harrington’s numbers do not appear in the Rand report. Harrington’s manufactured figure of 238 days that “every transgender soldier who goes through transition will be out” for does not appear in the Rand report. It appears to be extrapolated from the report’s data on “estimated nondeployable days” for various gender transition-related surgeries. The largest number of estimated nondeployable days for any single transition-related procedure in the report is 135 days, but adding up the nondeployable days for all surgeries for both male-to-female and female-to-male transitions, which would be 210 and 267, respectively, and averaging the two totals results in 238. This would imply that each transitioning service member would be seeking consecutive surgeries during service and be seeking the maximum surgical treatment. The Rand report also noted that “it is possible that transgender service members would time their medical treatments to minimize the effect on their eligibility to deploy” and that undergoing hormone therapy would have no effect on deployability. From the report:

[Rand Corp., 2016

Rand Corp.: “Less than 0.1% of the total force would seek transition related care that could disrupt their ability to deploy,” estimated to be “between 29 and 129 service members.” Rand Corp.’s 2016 analysis of the potential impact of allowing transgender people to openly serve in the military found that not all transgender service members “will seek gender transition-related treatment,” particularly treatment that would disrupt deployment. The study said that “even at upper-bound estimates, less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy” and estimated that “each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy. From the report (emphasis original):

There Are an Estimated 1,320–6,630 Transgender Service Members in the Active Component, but Not All Will Seek Gender Transition–Related Treatment

  • It is difficult to estimate the number of transgender personnel in the military due to current policies and a lack of empirical data. Applying a range of prevalence estimates, combining data from multiple surveys, and adjusting for the male/female distribution in the military provided a midrange estimate of around 2,450 transgender personnel in the active component (out of a total number of approximately 1.3 million active-component service members) and 1,510 in the Selected Reserve.

  • Only a subset will seek gender transition–related treatment. Estimates derived from survey data and private health insurance claims data indicate that, each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy.

[...]

  • Even upper-bound estimates indicate that less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy. [Rand Corporation, accessed 9/7/17]

Palm Center: “Transgender service members are deployable and medically ready,” and “cross-sex hormone treatment and mental health considerations do not, in general, impede the deployability of transgender service members.” According to the Palm Center’s 2014 study on the deployability of transgender service members, “With few exceptions, transgender service members are deployable and medically ready.” The report added that “cross-sex hormone treatment and mental health considerations do not, in general, impede the deployability of transgender service members, and the public record includes instances in which transgender individuals deployed after having undergone transition.” The report also said that “arguments invoked to oppose transgender service” on the grounds of deployability “do not withstand scrutiny.” The Palm Center’s report estimated that “fewer than 2 percent of transgender service members … would seek gender-confirming surgery each year,” saying that “the number of service members undergoing surgical transition in any given period would be low, both in relative and absolute terms, either because they would have already transitioned prior to joining the military, would prefer to wait until the end of military service to transition, or would not want to surgically transition, regardless of the timing.” From the March 2014 report:

In explaining the military’s ban on transgender service, and as noted above, spokespersons have emphasized non-deployability, medical readiness and constraints on fitness for duty as reasons why transgender service members should not be allowed to serve. While personnel policy must of course be designed to promote deployability and medical readiness, arguments invoked to oppose transgender service on these grounds do not withstand scrutiny. With few exceptions, transgender service members are deployable and medically ready. As noted in other sections of this report, cross-sex hormone treatment and mental health considerations do not, in general, impede the deployability of transgender service members, and the public record includes instances in which transgender individuals deployed after having undergone transition. With two exceptions, all transgender service members who are otherwise fit would be as deployable as their non-transgender peers. The first exception is post-operative transgender service members whose genital surgeries result in long-term complications. Using conservative assumptions, as noted earlier, an estimated 16 post-operative service members (ten MTF transgender women and six FTM transgender men) would become permanently undeployable each year as a result of ongoing post-operative medical complications following genital surgery.

The second exception would be those undergoing surgical transition while in service. But the number of service members undergoing surgical transition in any given period would be low, both in relative and absolute terms, either because they would have already transitioned prior to joining the military, would prefer to wait until the end of military service to transition, or would not want to surgically transition, regardless of the timing. As discussed above, if the military’s health care program paid for transition-related coverage, fewer than 2 percent of transgender service members, a total of 230 individuals, would seek gender-confirming surgery each year. With very few exceptions, transgender service members would be deployable and medically ready on a continuous basis. [Palm Center, March 2014]

New England Journal of Medicine: “The Pentagon could expect 192 service members to undergo gender transition annually.” Writing in The New England Journal Medicine, Belkin gave a range of estimates for the number of transgender service members who would “undergo gender transition annually.” Through various methods of estimation, Belkin said that the military could expect between 94 and 192 service members to transition each year out of a population that he estimated to be around 12,800. From the September 17, 2015, report (citations removed):

Assuming that the number of transgender personnel has declined along with the overall force size, and excluding those serving in Reserve components whose members are ineligible for medical benefits, I estimate that 12,800 transgender troops serve currently and are eligible for health care.

As for the expected utilization of transition-related care, the latest research suggests that among large civilian employers whose insurance plans offer transition-related care including surgery and hormones, an average of 0.044 per thousand employees (one of every 22,727) file claims for such care annually. On the basis of this utilization rate, the military could expect that 94 transgender service members will require transition-related care annually. However, transgender persons are overrepresented in the military by a factor of two — possibly in part because, before attaining self-acceptance, many transgender women (people born biologically male who identify as female) seek to prove to themselves that they are not transgender by joining the military and trying to fit into its hypermasculine culture.

If transgender people are twice as likely to serve in the military as to work for the civilian firms from which the 0.044 figure was derived, then an estimated 188 transgender service members would be expected to require some type of transition-related care annually. It is not possible, on the basis of the available data, to estimate how many will require hormones only, surgery only, or hormones plus surgery.

As an accuracy check, consider the Australian military, which covers the cost of transition-related care: over a 30-month period, 13 Australian troops out of a full-time force of 58,000 underwent gender transition — an average of 1 service member out of 11,154 per year. If the Australian rate were applicable to the U.S. military, the Pentagon could expect 192 service members to undergo gender transition annually. [The New England Journal of Medicine, September 2015]

MYTH: Being transgender is a mental illness, and therefore trans people are unfit to be in the military

FRC’s Jerry Boykin: The military “shouldn't recruit people with any kind of physical or mental illness that would require them to go through some kind of surgery or some kind of major rehabilitation program.” On August 24, retired Gen. Jerry Boykin of the anti-LGBTQ hate group Family Research Council (FRC) claimed on Fox News’ The Story with Martha MacCallum, “We don’t recruit people and shouldn't recruit people with any kind of physical or mental illness that would require them to go through some kind of surgery or some kind of major rehabilitation program.” From the segment:

MARTHA MACCALLUM (HOST): Gen. Boykin, let me start with you. You have called this decision by President Trump "bold and courageous." Why?

GEN. JERRY BOYKIN: Well, I think that first of all, we need to remember that this is something that he pledged to do. He talked to a group of us veterans, many of which were retired flag officers back in October of last year and this was one of the issues that came up and he pledged to make this decision. So, following through on this decision was very bold because he took on the entire LGBT community in doing so. But he did it because it's a common sense decision to make and we applaud him for doing it.

[...]

BOYKIN: I'm very passionate about this for a couple of reasons. One of which is because we've used our military as a test bed for nothing but social experiments and it's time to stop and focus on readiness. The second thing is we don't recruit people and shouldn't recruit people with any kind of physical or mental illness that would require them to go through some kind of surgery or some kind of major rehabilitation program. [Fox News, The Story with Martha MacCallum, 8/24/17]

Daily Wire’s Ben Shapiro: “No one has the ‘right’ to serve in the military. People are 4F [unfit to serve] for a variety of reasons. Mental illness can be such a reason.”

[Twitter, 7/26/17]

Shapiro: “The military should not accept mentally ill soldiers,” but Trump’s announcement “should not have been done by tweet.”

[Twitter, 7/26/17]

FACT: Being transgender is not a mental illness

The American Psychiatric Association eliminated the term “gender identity disorder” from the DSM and replaced it with “gender dysphoria,” which applies to those who suffer from significant distress. In December 2012, the American Psychiatric Association revised its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to eliminate the term “gender identity disorder,” which previously described people who are transgender. According to CNN, the outdated diagnosis meant that transgender people were “considered mentally ill” at that time. The new version of the DSM does not list identifying as transgender as a mental illness. It does, however, use the term “gender dysphoria” to describe the “conflict between a person’s physical or assigned gender and the gender with which he/she/they identify,” which may cause “significant distress and/or problems functioning with this conflict between the way they feel and think of themselves … and their physical or assigned gender.” Thus, it is the distress caused by not being able to present as the gender that one identifies with that can be diagnosed as a mental illness rather than identifying as transgender. The American Psychiatric Association suggests allowing people who have gender dysphoria to be allowed to transition in the way that best fits their individual needs, whether “counseling, cross-sex hormones, puberty suppression, [or] gender reassignment surgery.” It also notes that some adults “may have a strong desire to be of a different gender and to be treated as a different gender without seeking medical treatment or altering their body.” [CNN, 12/27/12; American Psychiatric Association, February 2016]

American Psychological Association: “Identifying as transgender does not constitute a mental disorder.” According to the American Psychological Association, being transgender is not a mental illness. The association explained, “A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder.” The American Psychological Association added that the diagnosis of gender dysphoria has detractors, with some saying “that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated” while “others argue that it is essential to retain the diagnosis to ensure access to care.” It also noted that there “may be changes to its current classification.” From the American Psychological Association:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder." [American Psychological Association, accessed 9/7/17]

American Psychological Association: “We ask that transgender individuals continue to be allowed to serve their country.” On July 26, the American Psychological Association, which is the “largest scientific and professional organization representing psychology in the United States,” released a press release opposing Trump’s decision to ban transgender people from the military. The statement asked “that transgender individuals continue to be allowed to serve their country” and noted that research shows “no scientific evidence that allowing transgender people to serve in the armed forces has had an adverse impact on our military readiness or unit cohesion.” [American Psychological Association, 7/26/17]

NCTE: “Not all transgender people have gender dysphoria,” and “being transgender is not considered a medical condition.” The National Center for Transgender Equality (NCTE) explained that “not all transgender people have gender dysphoria” and that “on its own, being transgender is not considered a medical condition.” NCTE continued, “Many transgender people do not experience serious anxiety or stress associated with the difference between their gender identity and their gender of birth, and so may not have gender dysphoria.” For those who do experience gender dysphoria, NCTE said, “All major medical organizations in the United States recognize that living according to one’s gender identity is an effective, safe and medically necessary treatment for many people who have gender dysphoria.” NCTE also added that “anxiety disorders, depression, and other mental health conditions” that may result from gender dysphoria “are not caused by having a transgender identity: they’re a result of the intolerance many transgender people have to deal with.” From NCTE:

Not all transgender people have gender dysphoria. On its own, being transgender is not considered a medical condition. Many transgender people do not experience serious anxiety or stress associated with the difference between their gender identity and their gender of birth, and so may not have gender dysphoria.

Gender dysphoria can often be relieved by expressing one’s gender in a way that the person is comfortable with. That can include dressing and grooming in a way that reflects who one knows they are, using a different name or pronoun, and, for some, taking medical steps to physically change their body. All major medical organizations in the United States recognize that living according to one’s gender identity is an effective, safe and medically necessary treatment for many people who have gender dysphoria.

It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Many transgender people live in a society that tells them that their deeply held identity is wrong or deviant. Some transgender people have lost their families, their jobs, their homes, and their support, and some experience harassment and even violence. Transgender children may experience rejection or even emotional or physical abuse at home, at school, or in their communities. These kinds of experiences can be challenging for anyone, and for some people, it can lead to anxiety disorders, depression, and other mental health conditions. But these conditions are not caused by having a transgender identity: they're a result of the intolerance many transgender people have to deal with. Many transgender people – especially transgender people who are accepted and valued in their communities – are able to live healthy and fulfilling lives. [National Center for Transgender Equality, July 2016]

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