By Diane H. Mazur
Download the full 52 page report HERE.
The March 2014 Report of the Transgender Military Service Commission concluded “there is no compelling medical rationale for banning transgender military service.” The Commission, chaired by former U.S. Surgeon General Joycelyn Elders, M.D., and retired Rear Admiral Alan M. Steinman, M.D., found that the military did not have medically sound reasons for refusing enlistment to or requiring discharge of transgender individuals.
This study builds on the Commission’s findings by comparing military regulations governing four sets of representative medical conditions with regulations governing service by transgender individuals. It finds that medical regulations affecting transgender personnel are inconsistent with the regulation of medical conditions in general:
(1) Two different standards can apply to comparable medical care, or even the same medical care, depending on whether the service member is transgender or not.
(2) Medical regulations governing non-transgender-related conditions strike a careful balance in retaining service members whose medical conditions do not significantly impair fitness for duty while avoiding undue burden on doctors, commanders, and the military healthcare system. In contrast, rules that apply to transgender personnel make no attempt to balance these aims and instead require the exclusion of all transgender service members, regardless of fitness for duty or burden of care.
(3) Medical regulations governing non-transgender-related conditions assess medical risk based on individual medical evaluation and generally rely on ability to perform military duty in making retention decisions. In contrast, military regulations governing gender identity presume all transgender personnel are unfit and render their duty performance irrelevant.
(4) Medical regulations governing non-transgender-related conditions are designed to maintain and restore health. They refer service members for fitness evaluation and possible separation only after medical treatment and a reasonable period of time for recovery. In contrast, regulations governing gender identity prohibit military doctors from providing safe, effective, and medically necessary treatment and require separation without an opportunity to demonstrate fitness.
(5) Medical regulations governing non-transgender-related conditions are updated on a regular basis to reflect current scientific consensus and best medical practices. In contrast, military rules governing gender identity are decades out of date and reflect assumptions that were repudiated a generation ago.
(6) Medical regulations governing non-transgender-related conditions do not stigmatize personnel who have those conditions. In contrast, transgender personnel are stigmatized by medical regulations that classify transgender identity within a category of “inherent defects” that includes sexual deviance and mental illness.
Inconsistencies in military regulations between medical treatment of transgender and non-transgender personnel remain unexplained. For example, the military has defended its transgender policies in court by contending that assignment of transgender personnel to remote geographic areas “would be equivalent to placing an individual with known coronary artery disease in a remote location without readily available coronary care.” However, military medical guidance expressly permits deployment by individuals who have had heart attacks or coronary artery bypass grafts, provided the cardiac events occurred at least a year before deployment. Similarly, the military contends that hormone replacement treatment requires a level of monitoring and expertise beyond the capability of deployed medical facilities, yet it permits deployment by diabetic personnel who require much more intensive monitoring.