Here are the new rules for transgender troops

Transgender people can serve openly in the U.S. military, effective immediately.

In an historic and controversial move, the Pentagon on Thursday lifted its longstanding ban on transgender troops and began outlining how the military will begin allowing — and paying for — service members to transition, medically and officially, from one gender to another.

Now transgender troops will no longer be considered “medically unfit” for military service. By October, transgender troops may begin an official process to change gender in the military personnel management systems.

The Pentagon will pay for health care support related to gender transition in cases where a military medical doctor determines that is necessary, according to the new policy.
Defense Secretary Ash Carter announced the new policy after a year of contentious debate inside the Pentagon as some senior military leaders questioned the impact on readiness.

Carter firmly rejected those readiness concerns and said the change will ultimately improve the quality of the force.

"The policies we’re issuing today will allow us to access talent of transgender service members to strengthen accomplishment of our mission," Carter said at a Pentagon press briefing.

“We have to have access to 100 percent of America’s population for our all-volunteer force to be able to recruit from among them the most highly qualified — and to retain them,” Carter said.

Many details remain unclear. Senior military leaders will have 90 days to draw up a detailed implementation plan that will address issues that include:


•How the military health system will provide care to transgender troops, to include medical support for gender transitions.
•When a transgender service member will begin adhering to a different gender’s grooming standards and uniform-wear rules.
•How and when a transgender service member will transition to new physical fitness standards.
•When a commander should consider moving transgender soldiers into alternative barracks or berthing quarters.
•How unit-level commanders should address a range of issues related to deployments, job assignments and training that may arise among troops undergoing gender transition.
•How troops can undergo the bureaucratic process for changing their gender marker in the official Defense Enrollment Eligibility Reporting System, known as DEERS.

The intent of the policy is that troops will undergo most or all of the changes simultaneously, but commanders will have discretion to grant exemptions. For example, a commander might allow a transgender service member to wear an alternative uniform before the official "gender marker" is changed in the military personnel system.

By early 2017, the services will begin conducting forcewide training about transgender service members for commanders, military doctors, recruiters and the rank-and-file force.

The new policy sets a deadline of one year, or July 2017, for the military to begin allowing transgender recruits to enlist or be commissioned into the officer corps.

Under the policy, the services can continue to reject prospective recruits who have been diagnosed with gender dysphoria — feeling that one's biological gender is the opposite of the one he or she identifies with emotionally and psychologically — unless a doctor certifies the individual has been treated and “stable” for at least 18 months and does not suffer from any significant distress or other impairment.

Prospective recruits who have undergone medical treatment associated with gender transition such as gender reassignment surgery or hormone therapy will require a doctor's approval to certify they have been stable in their preferred gender for at least 18 months.
Many transgender individuals choose not to seek gender reassignment surgery so there is no requirement that official gender and physical genitalia match for troops or recruits.

Defense officials estimate there are between 2,500 and 7,000 transgender troops in today’s active-duty force of 1.3 million people.

“Although relatively few in number, we’re talking about talented and trained Americans who are serving their country with honor and distinction,” Carter said Thursday.

“We invest hundreds of thousands of dollars to train and develop each individual, and we want to take the opportunity to retain people whose talent we’ve invested in and who have proven themselves," Carter said.

A year of change

One year ago, Carter announced plans to study the issue of transgender service and to update the Pentagon's policy. Since then, dozens of transgender troops have revealed their condition to their commanders, knowing they were putting their careers at risk.

“The reality is that we have transgender service members serving in uniform today, and I have a responsibility to them and their commanders to provide them both with clearer and more consistent guidance than is provided by current policies,” Carter said.

Minimal costs

Carter said the costs of the new policy would be minimal. He pointed to a recent study by the Rand Corp. that concluded there will be “minimal readiness impacts" and the health care costs would amount to “an exceedingly small proportion” of the overall military health care expenditures.

The overall the cost of providing health care to treat gender dysphoria will probably run between $40,000 and $50,000 over the lifetime of an individual service members, defense official say.

The Defense Department must weigh those costs against the costs of training individual service members, which often runs upward of $200,000 depending on the career field.

“Losing the benefit of that hundreds of thousands of dollars in training, for the savings of $40,000 to $50,000 in lifetime cost, it doesn’t seem like a very good trade off to us," said a senior defense official who asked not to be identified when speaking about the Pentagon’s internal deliberations.

In short, Carter is instructing the military health system to treat gender dysphoria like any other medical condition.

Transition plans

Transgender troops will have to have a personal transition plan approved by a military doctor, which is a standard requirement for major procedures for active-duty troops.

“There is concern that if you work outside the [military health] system and you have people who are not subject to our regulations, somebody could be venue shopping for doctors,” the defense official said.

When questions arise about what is really a medical necessity, defense officials say that military doctors will be explicitly instructed to follow the standard practice in the civilian medical community.

The most common treatment for gender dysphoria is hormone therapy.

“Breast implants may be medically necessary” for some individuals, said another defense official familiar with the medical aspects of transgender treatment.

Cosmetic surgery for gender transition, however, would in most cases be considered an elective procedure and not be covered by the military health system, defense officials said. Many transgender individuals do not opt for a full sex-change operation to include "bottom" surgery that changes genitalia.

“Particularly for female-to-male transgender people, they often times do not desire or medically need bottom surgery, so they may be stable and their medical needs are met by counseling” and hormones, said the defense official familiar with the medical aspects of the issue.

Rank-and-file opinion not sought

The Pentagon conducted no surveys to gauge the opinions of the rank-and-file force on this politically sensitive issue.

"The secretary determined was that this was medical treatment and a medical issue and you’re not going to defer to the force as to whether or not we’re going to provide treatment," said the defense official

“We are relying on our doctors very heavily throughout this process,” he said.

Commanders will have some say in the timing of medical treatment for transgender troops because transgender treatment is typically considered “medically necessary” but not “medically urgent.” For example, when a unit’s deployment is imminent, a commander can order treatment to be delayed until after the deployment.

Advocates for transgender troops applauded the policy change.

“Transgender troops have to be held to the same standards as everyone else, and gender dysphoria has to be treated like every other medical condition. As long as the military gets those two things right, everything else will fall into place,” said Aaron Belkin, an advocate with the Palm Center in California.