Medical Help for Transgender Military: Call to Action

| Feb 1, 2016
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Secretary of Defense Ashton Carter.

Secretary of Defense Ashton Carter.

On July 16, 2015 the Secretary of Defense issued two directives regarding transgender people in the military.The first was to form a task force to study policy and readiness considerations of welcoming transgender people to serve openly. The second was to kick up all decisions regarding expulsion from the military to a high official in the Pentagon which essentially freezes all such expulsions.

No matter the outcome of the task force, the cat is out of the bag. DOD has recognized that it has transgender people in its ranks and more willing to join. This means there is no going back. There would be “h@*l to pay” (I will be using some other colorful military phrases in this piece.) We would be out of step with several of our NATO allies. Already, local rules permit transgender expression outside of duty hours and there is no threat of being expelled. No way to take that back.

DOD recognition means that the military medical establishment is responsible for providing treatment for transgender people. There is no way to avoid it. While the policy debate appears to be over with regard to “openly serving” it does not appear to me that the Department of Defense medical establishment is taking prompt, effective action. (I was in Army medical establishment during my active duty.) To me they seem to have ignored or greatly underestimated the challenge of providing for transgender people based on several scientific and practical facts. If I were still in the military medical establishment and in a leadership position, some of these facts would be enough to “set my hair on fire.”

The first fact is that the numbers of transgender and transsexual people in the US military is significant. Transgender people join up at a rate 20 times that of non-trans volunteers. From my population frequency “rules-of-thumb” based on existing estimates and surveys, I believe that a conservative estimate is that there are at least 20,000 transgender MtF with 2000 of these being MtF transsexuals. Other estimates I have seen put the number of transgender people in the U.S. military at 15,000 which is in the same ballpark. These estimates may not include the numbers of gender queer individuals which are on the increase, particularly in younger populations.

The second fact is that transgender people have additional treatment needs compared to GLB people. The task force planned to follow the same process as was used in the aftermath of the repeal of “don’t ask, don’t tell.” Using this GLB integration model exclusively may overlook the particular mental health and medical needs of transgender people.

The third fact is that I do not see officials in the military medical community exerting leadership. For example, I do not see the head of the Uniformed Service Medical School saying that they are going to add transgender science to their curriculum or the head of the Uniformed Service Graduate School expressing urgency to expand transgender science knowledge. Both are happening in civilian medical schools. It is the same for the Army, Navy and USAF medical establishments and training schools. It would be easy for me to say that the military medical establishment is not a responsible organization but the facts are otherwise. When you want a cure for yellow fever, or need organization to treat Ebola, or Katrina strikes, as they say, “who you gonna call?” Civilian emergency treatment and technology have especially benefitted from military medical trauma research and development.

The fourth fact is that I only see a trickle of providers beginning to get prepared. Competent mental health and medical providers are rare in the civilian world and apparently non-existent in the US military establishment. (There is Dr. George Brown but he is now in the VA. He recently published a paper on the frequency of breast cancer in transsexuals.)

I recently attended a WPATH training course here in Atlanta for providers that included some from the military. Only a handful of them were in uniform but the ones who were told me that there were more in the audience. But such CEU courses are not enough. WPATH recommends that providers “intern” with experienced providers for several months to a year before they are ready to go it alone. As far as I can tell, there is no process set up to do this. Is there precedent for this? Down the road from me is Grady Hospital that is the preeminent trauma hospital in the area. Right now there are military medics doing rotations through Grady in order to get experience for combat treatment. Because Grady gets all of the gunshot wounds, knifings and other trauma in the area, they get lots of practice that is similar to combat.

The fifth fact is that the military medical establishment cannot count on “contracting it out” as they frequently do for specialized services. As I pointed out above, there are very few qualified providers in the civilian world and none in many areas where the military might need them. The civilian providers are already scurrying to deal with the increase in transgender people.

I am getting the feeling that there is some cultural resistance to treating transgender people in the military arena, just as there is in the civilian world. Many transgender people report that doctors have refused to treat them for various bogus reasons. A couple of months ago, I was rejected for an appointment at Emory Healthcare which is supposed to be one of the best in the South. This happens even though both the ACA and Medicare say this is illegal. (But this is the South where cultural rejection runs deep.) In other posts I have already covered the fact that transgender people often have to educate their providers on the required treatment.

I have a great doctor but even he asks me technical questions.

This means that “sensitivity diversity training” is needed for providers (as well as all the military personnel). While some claim that the military is no place to do social experimentation, they have led the way in facilitating acceptance of diverse people. When I was on active duty, I had such diversity training every six months or so. The military is actually quite good at it.

The military medical establishment may suddenly realize that they are “behind the power curve” in providing needed help for transgender people. Being “behind the power curve” is a military term referring to piloting an aircraft in a dive and not having enough engine power to turn up and avoid the ground. Lets hope they start exerting leadership and turn the situation around.

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Category: Transgender Body & Soul, Transgender Opinion

danabevan

About the Author ()

Dana Jennett Bevan holds a Ph.D. from Princeton University and a Bachelors degree from Dartmouth College both in experimental psychology. She is the author of The Transsexual Scientist which combines biology with autobiography as she came to learn about transgenderism throughout her life. Her second book The Psychobiology of Transsexualism and Transgenderism is a comprehensive analysis of TSTG research and was published in 2014 by Praeger under the pen name Thomas E. Bevan. Her third book Being Transgender was released by Praeger in November 2016. She can be reached at [email protected].

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