Will the military see a surge in transgender troops? Not likely.

There were big fears inside the Pentagon throughout the past year: Transgender teens will be lining up outside recruiting stations; the military services will see an influx of first-term enlistees seeking sex-change operations; the new policy offering health care for gender dysphoria would make the U.S. military the most popular employer among transgender people.

But none of that is likely to happen, according to experts inside and outside the military.

The new policy unveiled Thursday by Defense Secretary Ash Carter promises to provide health care for transgender troops, which could in some cases include gender reassignment surgery. But that same policy includes a several key provisions that will restrict coverage for first-term enlistees and discourage young transgender people from joining the military if they are primarily motivated by the new coverage.
There were big fears inside the Pentagon throughout the past year: Transgender teens will be lining up outside recruiting stations; the military services will see an influx of first-term enlistees seeking sex-change operations; the new policy offering health care for gender dysphoria would make the U.S. military the most popular employer among transgender people.

But none of that is likely to happen, according to experts inside and outside the military.

The new policy unveiled Thursday by Defense Secretary Ash Carter promises to provide health care for transgender troops, which could in some cases include gender reassignment surgery. But that same policy includes a several key provisions that will restrict coverage for first-term enlistees and discourage young transgender people from joining the military if they are primarily motivated by the new coverage.
The Pentagon policy aims for consistency across the force and will discourage commanders from mounting overly aggressive investigations of people who lodge new claims of gender dysphoria. Commanders can consult with their medical advisers, legal advisers and the special “coordination cells” that will be set up to clarify transgender policy issues.

“We expect our commanders to deal with tough issues all the time, and this is another circumstance where they are going to deal with tough issues and make judgment calls. This is no different,” the defense official said.

Estimating the real impact

The number of troops seeking care is likely to be very small. A study published in the New England Journal of Medicine estimates it will be fewer than 200 each year from a total force of 1.3 million active duty troops.

Pentagon officials estimate the total cost of that health care coverage to be between $4 and $14 million, a small sliver of the Defense Department’s total health care budget of about $60 billion.

In the private-sector, some insurance companies extend coverage for gender transition care at no additional cost. Studies show transgender coverage actually reduces insurance companies' overall expense by reducing the need for other treatments, such as metal health care or substance abuse treatment.

Transgender advocates note, too, the military's compensation package and enlistment standards will be the same for all prospective recruits.

"We use health care benefits to entice people to join the military all the time," Belkin said.

"If they are not good candidates for military service, they are going to get weeded out in the accessions process."