Posted on Aug 12, 2015
How much will it cost the U.S. military to allow transgender service members to serve?
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How much will it cost us to let trans people serve openly? It's a valid question and I worked out some of the math down below. Some things to take into consideration before though, there are only around 15,000 trans people currently serving, we don't know how many veterans but it's probably around 75,000. Not all trans people get "the surgery" for various reasons, and the recovery time is typically 3 months. If half the current trans .mil population had sexual reassignment surgery, it would cost around $150,000,000 (assuming the cost for surgery remains around $20,000, which around North America is usually the case).
Now, the average length of enlisted service in the U.S. is around 7 years rounded up, and an average of 188,000 people join every year. Trans people make up .6% of the military population (rounded up), and therefore we could expect another 1,128 transgender recruits to join every year. Again, lets say half have SRS, the total estimated annual cost would be around $11,280,000. If we say 50,000 (66%) trans vets want the surgery (a very liberal estimate), that would be around $1,000,000,000. We might expect half the recently separated trans vets who didn't get it while in to get it through the VA while out.
Lets just assume for the sake of convenience that the same number of trans people that enter each year also leave (actually more people have been leaving than joining lately but w/e). So a quarter of those might want SRS (remember half would have already got it while in). That number is 282, and the cost would be $5,640,000 a year.
So to recap:
Initial wave of surgeries for active duty under Tricare - $150,000,000
Initial wave of surgeries for veterans/retired personnel - $1,000,000,000
Annual cost of surgeries for active duty under Tricare - $11,280,000
Annual cost of surgeries for veterans/retired personnel - $5,640,000
Sounds like allot of money, but how much will it increase our budget? In 2012, the DoD spent $52,000,000,000 on healthcare for service members. The Department of Veteran Affairs spends 42% of it's budget on healthcare, and it's budget was $168,800,000,000, with $70,896,000,000 spent directly on healthcare.
If we spend $150,000,000 more dollars in the initial wave of providing service members with SRS, it would reflect an overall budget increase of .3% (rounded up). The annual cost spent providing new recruits with SRS would be $11,280,000, which would reflect an overall annual budget increase of around .022% (rounded up).
If we spend $1,000,000,000 on the initial wave of surgeries for veterans (again a very very liberal estimate), it would reflect an overall budget increase of 1.4%. If we spend around $5,640,000 annually on surgeries for new veterans, it would reflect an increase of .008% (rounded up).
One more fun figure:
The total initial cost between both the DoD and DVA would be around $1,150,000,000. Out of the total amount of national debt, $18,342,202,555,158, this would reflect an overall increase of .0063% (rounded up).
My personal opinion is slanted on whether or not trans people should serve openly (I'm trans myself, left the service 4 days ago). So with the above numbers in mind, I'd love to hear from you. Do you support allowing transgender people to serve openly?
Now, the average length of enlisted service in the U.S. is around 7 years rounded up, and an average of 188,000 people join every year. Trans people make up .6% of the military population (rounded up), and therefore we could expect another 1,128 transgender recruits to join every year. Again, lets say half have SRS, the total estimated annual cost would be around $11,280,000. If we say 50,000 (66%) trans vets want the surgery (a very liberal estimate), that would be around $1,000,000,000. We might expect half the recently separated trans vets who didn't get it while in to get it through the VA while out.
Lets just assume for the sake of convenience that the same number of trans people that enter each year also leave (actually more people have been leaving than joining lately but w/e). So a quarter of those might want SRS (remember half would have already got it while in). That number is 282, and the cost would be $5,640,000 a year.
So to recap:
Initial wave of surgeries for active duty under Tricare - $150,000,000
Initial wave of surgeries for veterans/retired personnel - $1,000,000,000
Annual cost of surgeries for active duty under Tricare - $11,280,000
Annual cost of surgeries for veterans/retired personnel - $5,640,000
Sounds like allot of money, but how much will it increase our budget? In 2012, the DoD spent $52,000,000,000 on healthcare for service members. The Department of Veteran Affairs spends 42% of it's budget on healthcare, and it's budget was $168,800,000,000, with $70,896,000,000 spent directly on healthcare.
If we spend $150,000,000 more dollars in the initial wave of providing service members with SRS, it would reflect an overall budget increase of .3% (rounded up). The annual cost spent providing new recruits with SRS would be $11,280,000, which would reflect an overall annual budget increase of around .022% (rounded up).
If we spend $1,000,000,000 on the initial wave of surgeries for veterans (again a very very liberal estimate), it would reflect an overall budget increase of 1.4%. If we spend around $5,640,000 annually on surgeries for new veterans, it would reflect an increase of .008% (rounded up).
One more fun figure:
The total initial cost between both the DoD and DVA would be around $1,150,000,000. Out of the total amount of national debt, $18,342,202,555,158, this would reflect an overall increase of .0063% (rounded up).
My personal opinion is slanted on whether or not trans people should serve openly (I'm trans myself, left the service 4 days ago). So with the above numbers in mind, I'd love to hear from you. Do you support allowing transgender people to serve openly?
Posted in these groups: 
Transgender
Budget
Transgender Budget
Posted >1 y ago
Responses: 23
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SPC Angela Burnham - This should be considered "elective surgery" and disallowed. If a person enlisted as "male", that is what he should serve as. If he wants to change his body to resemble a female, he should bear the costs. If not having the surgery creates mental anguish that affects his ability to perform his duties, he should be discharged, not provided surgery. (Note - The same is true for female to male, since I was chastised once for only discussing "M2F" and not "F2M", as it was put to me.)
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Capt Jeff S.
I'd take it a step further and all you bleeding hearts can downvote me for being a "bigot" and telling it like it is. If someone enlists as a male, then they should be obligated to remain a male for the rest of their career. PERIOD. And nobody whose chromosomes are XX should be allowed to enlist as a male, and vice versa XY > female. The ONLY exception to that would be those rare unfortunates that have extra chromosomes and have the plumbing of both sexes at which point the doctor had to decide what sex they would be and this was done shortly after birth... But even in that case, their situation should be evaluated. Do they need a constant supply of drugs to maintain their health? If so, they're disqualified. Life isn't always fair, you have to deal with it. I know that sounds harsh but that's the reality of it. There are other places and other ways people can serve our country.
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SrA Michelle Black
Capt Jeff S. - EXACTLY! Fair and equal treatment across the board--disqualified as unfit just like anyone else who couldn't serve for mental illnesses (GID or comorbid depression, anxiety, etc...all mental illnesses, so UNFIT!) or other physical ailments.
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MSgt Kerry Lundy
Col Jean F Burleson I agree with you whole heartedly!! Born a boy you are a boy! Born a girl you are a girl. End of discussion. You want a change you pay for it and all follow up treatments! I and the rest of the tax payers are not responsible to pay for your dreams and desires. Who do you think should do your job while you under go surgery and three (3) months of follow ups and you do this before you enlist. THE COLONEL is right.
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That sounds like an awful lot of money to support an extreme minority of people while the DoD is cutting in all areas including troop numbers. IIRC some of us have been saying that TG's would join for no other reason than to get the surgery. Personally, I see this as a huge waste of defense dollars.
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MSG Mitch Dowler
TG people have a very, very high rate of STD's and also various mental health problems such as depression. It is not a valid assumption to blame TG suicide rates on discrimination when these suicide rates hold true across the nation even in very politically correct and accepting places such as Capitol Hill in Seattle. It is much more likely that the depression is linked to the same mental health issues that caused confusion the person's sexual plumbing and the promiscuity associated with the STD's. I have estimates as high as 50% for HIV transmission in studies of TG people.
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MSgt Kerry Lundy
SPC Angela Burnham - Explain so this old veteran can understand why gender reassignment surgery is a necessary medical treatment. Is this a medical or psycological problem when a man thinks he should be a woman and a woman thinks she should be a man.
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SPC Angela Burnham
MSgt Kerry Lundy -
Hello Master Sergeant, thanks for pulling me back to Rallypoint! I'll do my best to explain things to you from my perspective. From WebMD:
"People who have gender dysphoria feel strongly that their gender does not match their biology. Gender dysphoria used to be called 'gender identity disorder.' But the mismatch between body and internal sense of gender is not a mental illness. Instead, what needs to be addressed are the stress, anxiety, and depression that go along with it."
The above statement that gender dysphoria itself is not a mental disorder is backed up by the World Health Organization, the American Academy of Pediatrics, and the American Psychiatric Association (among others). Furthermore, there is substantial medical evidence that transgender people are transgender from birth, such as the below study with compared transgender brains to the brains of cisgender (normal) individuals:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953012/
So now that we've established that gender dysphoria itself isn't an illness, we can begin to treat the real problems, and their symptoms. Gender Confirmation Surgery often reduces dysphoria in transgender people by bringing their physical bodies in line with their gender identity, leading to less anxiety over the incongruency. However, it's important to note that many transgender people don't need or want surgery. The reasons can vary, but around 67% of transgender people are content with hormone replacement therapy, with replaces testosterone in the body with estrogen, or vice versa.
The second way we can eliminate the stress, anxiety, and depression associated with gender dysphoria is to reduce the social stigma associated with being transgender. Transgender people are subject to discrimination and violence on a nearly daily basis. When something as simple as using the bathroom can get you killed, you start to (understandably) stress the hell out.
At the end of the day, we can't throw all transgender people out of the military, it's just not feasibly going to happen. There are bare minimum 10,000 troops serving right now who are transgender, and maybe 10% of them are out and open. You can locate and throw out that ten percent, but it's literally just the tip of the iceburg. My opinion, which I recognize is biased, is that if these individuals can't be removed then we should at least do what we reasonably can to ensure that they can devote themselves to their missions instead of having to look over their own shoulders constantly.
Hello Master Sergeant, thanks for pulling me back to Rallypoint! I'll do my best to explain things to you from my perspective. From WebMD:
"People who have gender dysphoria feel strongly that their gender does not match their biology. Gender dysphoria used to be called 'gender identity disorder.' But the mismatch between body and internal sense of gender is not a mental illness. Instead, what needs to be addressed are the stress, anxiety, and depression that go along with it."
The above statement that gender dysphoria itself is not a mental disorder is backed up by the World Health Organization, the American Academy of Pediatrics, and the American Psychiatric Association (among others). Furthermore, there is substantial medical evidence that transgender people are transgender from birth, such as the below study with compared transgender brains to the brains of cisgender (normal) individuals:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953012/
So now that we've established that gender dysphoria itself isn't an illness, we can begin to treat the real problems, and their symptoms. Gender Confirmation Surgery often reduces dysphoria in transgender people by bringing their physical bodies in line with their gender identity, leading to less anxiety over the incongruency. However, it's important to note that many transgender people don't need or want surgery. The reasons can vary, but around 67% of transgender people are content with hormone replacement therapy, with replaces testosterone in the body with estrogen, or vice versa.
The second way we can eliminate the stress, anxiety, and depression associated with gender dysphoria is to reduce the social stigma associated with being transgender. Transgender people are subject to discrimination and violence on a nearly daily basis. When something as simple as using the bathroom can get you killed, you start to (understandably) stress the hell out.
At the end of the day, we can't throw all transgender people out of the military, it's just not feasibly going to happen. There are bare minimum 10,000 troops serving right now who are transgender, and maybe 10% of them are out and open. You can locate and throw out that ten percent, but it's literally just the tip of the iceburg. My opinion, which I recognize is biased, is that if these individuals can't be removed then we should at least do what we reasonably can to ensure that they can devote themselves to their missions instead of having to look over their own shoulders constantly.
Transsexualism: A Different Viewpoint to Brain Changes
Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria ...
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SGT Tim. Wilson
Cpl (Join to see) Talk about misuse of Military Budget ... What about taking part of the Military Budget to build a WALL????? That isn't complete, doesn't stay up AND has been proven that it can be climbed, tunneled under and through!!!!
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SPC Angela Burnham, there are not 15,500 Transgender persons serving in the US Armed Forces. I pulled the study that has been cited as showing that figure and debunked it on another thread for it's obviously flawed methodology. Short version is the sampled population were from LGBT Community Centers, and they filled out a survey that among other things asked them if they were current or prior service military and if they were discharged due to DADT. They then projected onto the general population based on survey responses and viola! Three whole aircraft carrier crew are transgender! Or three Army brigades. Or half of the entire US Coast Guard. On its face, this is preposterous. I would estimate the number as closer to 1000.
Having said that, I think that covering this surgery under Tricare would be a grievous mistake costing a fortune per Soldier with no benefit to the readiness of the armed forces. I can't think of a more compelling case than that for not doing it.
If people identifying as another gender want to serve, fine. Make the change on your own dime. I am supportive of you finding your own way and making a change like that is hugely important to you personally. But that is not why the military medical system exists.
I wish them well as I do any of my comrades in arms.
Having said that, I think that covering this surgery under Tricare would be a grievous mistake costing a fortune per Soldier with no benefit to the readiness of the armed forces. I can't think of a more compelling case than that for not doing it.
If people identifying as another gender want to serve, fine. Make the change on your own dime. I am supportive of you finding your own way and making a change like that is hugely important to you personally. But that is not why the military medical system exists.
I wish them well as I do any of my comrades in arms.
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SGT Tim. Wilson
LTJG (Join to see) I'm late to this discussion but wanted to thank you for posting this article. It was a very interesting and informative read!
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SGT Tim. Wilson
MSG Mitch Dowler Those thing's are authorized now, IF, they are a MEDICALLY necessary!
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SGT Tim. Wilson
Capt Jeff S. Right, the country that does such a great job taking care of it's Vets! Give me a break! If you were more accepting you wouldn't have a problem with this.
So tell me, if your son or daughter has gender dysphoria what will you say then? No you can't serve your country because I can't accept you?
So tell me, if your son or daughter has gender dysphoria what will you say then? No you can't serve your country because I can't accept you?
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MSgt Kerry Lundy
SGT Tim. Wilson - Can you explain to us how a sex change surgery is medically necessary as opposed to a personal choice? What makes it medically necessary? What percentage of those who are surgically sex changed seek a discharge after healing from the surgery?
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Why would the military or government pay for sexual reassignment surgery? This is elective and not a need. Should women get breast augmentation surgery covered because they do not feel womanly enough? Someone's mental health confusion over their own plumbing is not a problem of the American Citizen tax payers.
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SGT Tim. Wilson
That breast augmentation surgery is already being done, but only if you are a born female!
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It is not the governments responsibility too foot the bill for elective surgery. I understand that it is not your choice as a transgendered person to feel how you do however it is not a mission essential surgery. It doesn't help readiness. The military is not a place for experiment, it's a place to come in and get work done and do our job which is protecting the citizens of our great country. With that being said I hold no discrimination towards the people of the LGBT community and wish all of my brothers and sisters in arms the best in all of their endeavors
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We;ve spent a trillion on a fighter that still doesn't work. Enough said. lol
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I can't even begin to quote cost in any aspect of this, but I do have my 2 cent's worth. My thought process, when I say this, is from my experience and knowledge of AF Accessions and Physical Exams and Standards; slightly different from service to service, but basically the same. I think the current Trans personnel wishing to serve openly and/or have re-assignment accomplished electively should be able to do both, as long as that change does not adversely affect readiness, and, depending on the numbers at any given military installation and numbers in minimal specialties, the surgeries shouldn't be astronomical (no wave) with a waiting list that only so many can be done per quarter per year to manage numbers and the follow-up/management/maintenance care afterwards. This will ensure numbers for personnel readiness won't be an issue. It would have to be accomplished by military at a military facility only. As far as those wishing to come in, because they are assuming the title "Transgender" at entry with surgery completed, baring no complications, they can be accepted after X amount of time has passed since the surgery and with an additional medical review/evaluation to ensure military acceptability. For those who wish to join for the surgery, the answer would be no, and if they signed up anyway listing themselves as a male or a female, and then claimed Trans after entry, then those individual should be separated due to breach of contract. Now, that being said, I also won't claim to have any knowledge of the mental workings either, ie how/when they knew they were... But from most that I have heard from (family members included), this has been something they have known for quite a while. I'm not saying that approaching it this way is fair, but it is a good start for the military, as it's job is to wage war with bodies able to do that, and to reduce the number "broken at entry". Some selective/elective surgeries prior to enlistment also require a wait time and a specific evaluation before entry, and I see this as elective as it has no bearing on what the member can do physically as it pertains to the job. This would also alleviate any issues that may/would fall on to the military as responsible care as all bodies do not respond the same. This (process) is nothing new, and I foresee the military heading this way, or something similar, in the near future. Again, just my quick and brief two cents worth.
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Here is a question... would the military take (allow to enlist) a "cis-gendered" person that they knew in advance would need a $20K surgery (not to mention whatever hormone therapy costs)?
From what I remember when I was recruited the answer is "probably not". Most existing medical conditions were an automatic disqualifier. Need knee surgery? "Sorry, but no". You suffered depression 5 years ago? "Sorry, but no". You are currently taking medication for XYZ? "Sorry, no".
From what I remember when I was recruited the answer is "probably not". Most existing medical conditions were an automatic disqualifier. Need knee surgery? "Sorry, but no". You suffered depression 5 years ago? "Sorry, but no". You are currently taking medication for XYZ? "Sorry, no".
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I think you may have overstated the costs to the military by assuming the surgery would be made available to ADSM and veterans with VA medical care. I am only speaking from my experience with the VA and military medical systems so keep that dalt block handy.
The simpler error is including all transgender veterans as eligible for VA care. This is not currently the case as VA care is contingent upon a service connected medical condition or injury or indigence. Even retirees may not be eligible until eligible to receive retirement benefits. This eligibility requirement will likely shrink your numbers considerably. If and indigent veteran seeks VA care/it is on a means tested.scale with full access being difficult to achieve.
On the AD side, medical necessity will be one hurdle TGSM will face as will the preexisting ck dition determination. The military is loath to treat preexisting conditions or conditions that do not affect the SM's ability to fulfill their duties. This will further reduce your numbers.
To achieve your stated treatment rates, the DoD will need to determine that the surgery is necessary for all TGSM and veterans under either a specific waiver or under general treatment guidelines.
I would say your research has started a very worthwhile conversation and I look forward to its refinement as you refine your numbers at to the number of TGSM and whether the mitarybans VA medical systems will be available under the general treatment guidelines.
The simpler error is including all transgender veterans as eligible for VA care. This is not currently the case as VA care is contingent upon a service connected medical condition or injury or indigence. Even retirees may not be eligible until eligible to receive retirement benefits. This eligibility requirement will likely shrink your numbers considerably. If and indigent veteran seeks VA care/it is on a means tested.scale with full access being difficult to achieve.
On the AD side, medical necessity will be one hurdle TGSM will face as will the preexisting ck dition determination. The military is loath to treat preexisting conditions or conditions that do not affect the SM's ability to fulfill their duties. This will further reduce your numbers.
To achieve your stated treatment rates, the DoD will need to determine that the surgery is necessary for all TGSM and veterans under either a specific waiver or under general treatment guidelines.
I would say your research has started a very worthwhile conversation and I look forward to its refinement as you refine your numbers at to the number of TGSM and whether the mitarybans VA medical systems will be available under the general treatment guidelines.
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SPC Angela Burnham
This is a great point MSgt. As a disabled vet myself, I sometimes forget that not all veterans qualify for free outpatient or inpatient healthcare.
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Money aside, I am still wondering how this will work for housing/berthing? Just because you want to be a female but you have a penis, I am assuming that most real females will not want you in thier berthing area. I can also see that female who thinks they a male having issues in the male berthing when it comes time for showers after being in the bush for 2 weeks. Now I might be out of my simple infantry mind but how will this work?
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SPC Angela Burnham
Thanks for the response 1SG,
The way it worked for me was simple. I was asked which set of facilities I preferred to use, and was then allowed to use the women's facilities per my request. They all have cubicles these days anyways. Nobody ever freaked out, if anything the men would have been more uncomfortable having a person with boobs and long hair showering with them and using their bathroom. That's how it works for most other nations that allow trans people to serve, they choose which one to use and stick with it. If a person doesn't like the trans person using it, then that person can use alternate facilities most times. I know that may seem like we're ignoring the wishes of our comrades, but at the end of the day we're all professionals. The military can't always have gender neutral facilities, especially overseas. At the end of the day, everyone just has to suck it up and live and let live.
The way it worked for me was simple. I was asked which set of facilities I preferred to use, and was then allowed to use the women's facilities per my request. They all have cubicles these days anyways. Nobody ever freaked out, if anything the men would have been more uncomfortable having a person with boobs and long hair showering with them and using their bathroom. That's how it works for most other nations that allow trans people to serve, they choose which one to use and stick with it. If a person doesn't like the trans person using it, then that person can use alternate facilities most times. I know that may seem like we're ignoring the wishes of our comrades, but at the end of the day we're all professionals. The military can't always have gender neutral facilities, especially overseas. At the end of the day, everyone just has to suck it up and live and let live.
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1stSgt (Join to see)
Specialist, you have obviously never set foot aboard naval shipping or spent time with the infantry. There is no privacy. No cubicles. I don't see how this would work in my former environment without either you or everyone else having problems. Semper Fidelis.
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SPC Angela Burnham
1SG,
No, I was never stationed on a ship, but I have been deployed to forward operating bases (disaster response) that literally had no privacy in the showers. There were no issues there either.
No, I was never stationed on a ship, but I have been deployed to forward operating bases (disaster response) that literally had no privacy in the showers. There were no issues there either.
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