On Wednesday, President Trump announced in a series of tweets that the US military will no longer accept openly transgender Americans.
His announcement signals a reversal of Barack Obama’s 2016 decision to allow transgender people to openly serve. After a trial period that ended July 1, Secretary of Defence James Mattis delayed the full implementation of that policy for six months.
“Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail,” Trump tweeted.
There are between 1,320 and 6,630 transgender personnel in the active component of the military (out of about 1.4 million) and about 1,510 in the reserves, according to a 2016 report from the think tank RAND Corporation. It is not yet clear whether those in the military who came out as transgender after Obama lifted the 2016 ban will be discharged.
Regardless of what happens on a policy level, Trump’s tweets have brought to light some common confusions and misconceptions about what it means to be transgender. Here’s what to know.
Sex versus gender
Transgender is an umbrella term that describes people whose gender identity is different from the one they were assigned at birth.
Sex and gender, while often used interchangeably, are not one in the same. A person’s sex refers to their biological classification of male or female — an assignment given at birth based on physical characteristics, including chromosomes and reproductive organs. A person’s gender, on the other hand, refers to their internal sense of gender, which can fall on a spectrum. Most people identify with the gender that matches their sex (male or female). This is called cisgender.
Some trans people, however, identify as neither male or female, or somewhere else on the gender spectrum, and typically describe themselves as non-binary or gender-queer.
Gender dysphoria is the distress that a person can experience when their assigned sex does not match their gender identity.
How someone knows they are trans
People can realise they are transgender at any point in their lives, according to the National Center for Transgender Equality (NCTE). Some make this distinction at puberty or earlier, while others take years to understand their gender identity, sometimes due to fear, shame, or confusion.
There is a consensus within the medical community that transgender identity should receive a medical, rather than psychiatric, diagnosis.
Healthcare for transgender people
Trump’s tweets suggest the president is concerned about “medical costs and disruption” from transgender people in the military. But it’s important to note that not all transgender people want or pursue gender-related medical treatment. If they do, the medical care a trans person seeks can depend on their individual level of dysphoria.
Procedures can include hormone replacement therapy and/or gender confirmation surgery, according to the American Medical Student Association (AMSM).
RAND Corporation’s analysis found that the financial costs of allowing trans soldiers to serve would be low considering the military’s overall healthcare costs. By their estimate, between 29 and 129 of the US military’s 1.4 million soldiers would likely seek gender confirmation surgery annually. The procedure, which can include a hormone process, anesthesia, and a hospital stay, can cost upward of $US100,000 without insurance.
On July 13, the House defeated a proposal that would have prevented the Pentagon from funding gender confirmation surgery and hormone therapy for service members. As a result, the RAND report said, military healthcare costs would have increased somewhere between $US2.4 million and $US8.4 million a year. At most, that would mean a 0.13% increase in medical spending by the DoD.
In the fiscal year of 2016, the Defence Department spent an approximate total of $US41.7 billion on healthcare for active members. The Department of Veterans Affairs, which has a separate budget, seeks to spend an additional $US69 billion on medical care in fiscal 2018.
Serving in the military as a transgender person
About one-fifth of all transgender adults are veterans, making transgender people approximately twice as likely as others to serve in the military, according to a 2014 survey by the NCTE and the National Gay and Lesbian Task Force.
A 2014 UCLA article published in the academic journal Medical Forces & Society concluded that transgender service members are just as deployable and medically ready as their cisgender peers, with few exceptions.
“As noted in other sections of this article, 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 researchers wrote.
Active transgender service members in the US forces have been able to seek gender-related care since 2016. But RAND found that less than 1% of the US military force has done so. The report also suggested that trans people have a “minimal likely impact” on force readiness, a measure that includes factors like unit cohesion and physical ability.
“We found that that transgender people serving in the military had a negligible impact overall,” RAND senior economist Radha Iyengar told Business Insider. “Australia, the UK, Israel, and Canada allow openly transgender people to serve. Looking at the factual numbers, we don’t think there’s any evidence that allowing open service would be costly or affect military readiness.”
Evan Young, the director of the Transgender American Veteran Association and a former army major, told BI that hiding his trans identity during his 14 years of military service was emotionally draining.
“The ban [on transgender people in the military] impacted me a lot,” he said. “I hid during ‘Don’t Ask, Don’t Tell. As soon as that was lifted, I realised I was transgender, and I stayed in the closet. For my entire military career, I had been closeted. It affected me severely mentally. I couldn’t bring my partner to any functions. And when I started taking testosterone, I could visibly see the changes, and I know my commander could too. I was a recluse. It was very tough.”
What happens now?
The Pentagon appears to not have known about Trump’s reversal on transgender military service before this morning.
“The tweet was the first we heard about it,” a defence official familiar with the matter told the Wall Street Journal.
Senior officials in each branch of the military had voiced opposition to integrating transgender people into troops in recent months, the Military Times reports. But many politicians and veterans strongly oppose Trump’s reversal of the Obama-era policy. Rep. Dan Kildee, vice chair of the LGBT Equality Caucus, called the decision a “slap in the face to the thousands of transgender Americans already serving in the military.”
Senator John McCain, a veteran himself, also denounced Trump’s decision.
“Any American who meets current medical and readiness standards should be allowed to continue serving,” McCain said in a statement. “There is no reason to force service members who are able to fight, train, and deploy to leave the military — regardless of their gender identity.”
When asked what will happen to currently deployed transgender military personnel around the world, White House press secretary Sarah Huckabee Sanders said it was “something that the Department of Defence and the White House will have to work together on as implementation takes place.”
Aaron Devor, the chair of transgender studies at the University of Victoria, does not believe that Trump’s ban on transgender people in the military will be upheld in court if it faces legal challenges.
“Trans military personnel serve bravely and loyally in 18 countries around the world,” he told Business Insider. “Trump’s rejection of trans troops in the US has no basis in objective evidence. This is bald faced and counterproductive reactionary bigotry. This ban will be overturned in the courts. Hatred will not win in the long run.”