For many people, one of the most surprising facts about transgender people is how frequently they serve in the military.
Transgender people are twice as likely to be veterans as the rest of the US population. According to the 2015 US Transgender Survey, one in five transgender people have either served in the military or are currently enlisted in the military. It’s one reason why President Trump’s attempt to ban transgender people was so absurd and insulting.
That ban — announced via tweet just over a year ago — is locked in federal courts, with court after court ruling it discriminatory and baseless. But the administration could soon have another chance to strike at the 134,000 veterans who are transgender.
In response to a lawsuit, the Department of Veteran Affairs is being forced to review its outdated exclusion on surgical care for transgender veterans, which has been in place since the 1970s. Since that time, the medical community at large has overwhelmingly embraced medical treatments for gender transition as medically necessary for many patients.
But advocates and veterans are concerned that the Trump Administration will simply use this process to justify maintaining or even expanding their discriminatory policy demanding the VA remove this discriminatory exclusion.
In asking for public comments on the ban, the VA invoked the administration’s recent report attempting to justify Trump’s ban on transgender troops. That report’s lead author was reportedly none other than Robert Wilkie, who was just confirmed as Secretary of Veterans Affairs.
While that report that was thoroughly debunked by American Medical Association, the American Psychological Association, and the leadership of the entire medical community, advocates and allies fear the Trump administration will try to defend this senseless exclusion.
According to Cynthia DeVille, a transgender veteran who served in the Air Force from 1981 to 2001, the VA’s exclusion forces many veterans to choose between paying out of pocket for the care they should be entitled to, and living without medically necessary care.
“Most common is they don’t get whatever procedure they need,” said Deville. “Some find employment and have other insurance, some take on loans, but most decline to have the procedure. It’s strictly financial.”
The exclusion prevents the VA from providing procedures to transgender veterans even if the VA’s own medical professionals deem them medically necessary. For over a decade, groups like the American Medical Association and the American Psychological Association have widely supported surgical treatments for transgender patients, and since 2016, 95 percent of private insurance plans have removed exclusions preventing patients from getting those same treatments.
But transgender veterans are still often forced to take on the costs themselves or simply deny themselves medically-necessary care.
According to DeVille, this hits transgender veterans particularly hard because of the barriers to employment they already face. Transgender people face rampant discrimination when looking for work, and any veteran eligible for care at a VA clinic has a disability that likewise complicates a job search.
“I think that’s when you see suicide attempts come in,” said Deville. “They feel that desperation of not being able to feel whole. A lot of friends feel the fix is surgical and that’s the only answer for them. They become desperate, they become depressed.”
Because gender dysphoria can be a serious medical condition, this puts veterans at greater risk for suffering from depression, substance use disorders, and stress-related diseases — risk factors already common among all veterans. Indeed, by denying transgender people the care that could avoid many of these complications, the VA is likely paying more than it would if simply provided the care these veterans need.
Lara Americo, another transgender veteran of the Air Force, told NCTE she was forced to relocate from North Carolina to New York City in 2012 just to find affirming healthcare.
“It was hard to find a doctor who was willing to see a transgender patient” in North Carolina, said Lara. Her VA doctor sent her to an outside clinic just to get a prescription for hormone medications that are commonly prescribed to cisgender people every day.
“Our fate is really in the hands of providers and how much they care.”
According to Lara, her doctor was frustrated by the exclusion that prevented VA providers from recommending surgery. “HRT saved my life, but my transition isn’t finished,” said Americo. “I haven’t been able to get all the treatment I need from the VA.”
Joe Whimple, a transgender veteran living in New York City, spoke positively of the care he received at his local clinic, but noted many in more rural parts of the country likely struggle.
“I feel like veterans in Louisana, Texas, Tennessee, and states like that will suffer because they don’t have affirming providers,” said Whimple. A transgender man, Whimple had a hysterectomy that was done at a VA clinic — but only once the procedure was coded to be related to a different health issue Whimple was experiencing.
“If I was living in Alabama or Kentucky, it would have been much harder.” said Whimple. “I was siloed into an accepting situation because I had a progressive doctor. Our fate is really in the hands of providers and how much they care.”
Under the Affordable Care Act, any provider that receives federal funds must treat transgender patients with the same respect and dignity as any other patient. Just this week, a judge ordered the state of Wisconsin to remove its own exclusion against transition-related care in that state’s Medicaid program.
Whether the Department of Veterans Affairs will follow suit is still yet to be seen. The VA is accepting public comment on the rule, and many transgender veterans and health care providers have already spoken out against the exclusion.
If you want to support the health care of transgender veterans like Cynthia, Lara, and Joe, visit NCTE’s Action Page and tell the administration to that no veteran should be denied the medical care they have earned, simply because of who they are.