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Military Medical Standards: Health Care in Serious Need of Reform

Next month we celebrate the first anniversary of the end of "Don’t Ask, Don’t Tell" (DADT). Amidst the joy, one group of patriots has nothing to celebrate. Transgender Americans remain unwanted warriors. Our military medical regulations pertaining to transgender individuals, written almost a half century ago and essentially unchanged since, reflect the same narrow perspective that historically excluded other unwanted groups from military service. Qualified individuals, even those who may differ from the status quo, should be allowed to serve the country they love and contribute to the military's mission.

As medicine is evolving in the 21st century, more emphasis is being placed on medical care based on evidence and implementing the best practices. Unfortunately, our current medical standards are not evidence-based; there is no medical support for a permanent ban on transgender individuals from ever being able to serve. To the contrary, forty years of evidence show that gender reassignment treatment provides positive benefits to individuals, improves their quality of life, and reduces or eliminates their gender dysphoria.

The American Psychiatric Association (APA) last week stated that being transgender does not impair one’s “judgment, stability, reliability, or general social or vocational capabilities…” This is something that ten allies, including Great Britain, Canada, Australia, and Israel, have already known for some time. Perhaps more importantly, they also recognize that, in military terms, transgender service members do not harm good order, discipline, and morale simply by being themselves.

The only three articles in the medical literature that address transsexuals in the US military in any manner were written during the Reagan era by then-serving medical officers. They are instructive because they show the true rationale behind the regulations: the real reasons for barring transsexuals were “similar to those excluding homosexuals (effects on unit morale).” George Brown, an Air Force psychiatrist, writing in 1989 was also as stark in his assessment of the situation:

[There] is a clear message that the military environment will not tolerate identified transsexuals in its ranks, irrespective of the quality of duty performance. [Emphasis added – Doesn’t this sound familiar?] Transsexualism continues to be viewed as a nonmedical defect requiring administrative separation, analogous to cases of homosexuality . . . in spite of ample medical evidence to the contrary.

In 2012, nothing has changed in the military.

However the world is rapidly changing and it is time for the military to catch up. There is a worldwide recognized standard of care established by the World Professional Association for Transgender Health (WPATH) - one the military refuses to accept despite its acceptance in 2008 by the American Medical Association (AMA). (Dr. Brown, mentioned above, serves on the WPATH board of directors.) The recent statement by the APA condemning discrimination against transgender and gender non-conforming individuals specifically cited the military’s policy in justifying its stance.

Adding further momentum for change in the military’s medical standards is the reported forthcoming change to the APA’s Diagnostic and Statistics Manual (DSM). The fifth version will remove gender identity disorder and remove the stigma of mental illness from those who are gender non-conforming in a similar manner as it did in 1973 when it removed homosexuality as a mental disease. Gender dysphoria, the condition which is treated by gender reassignment, will remain. The APA, AMA, and WPATH also call for the proper access to treatment for gender dysphoria – now denied to military members and veterans. (The law barring the VA from providing gender reassignment surgery is a cynical basis for the military’s process of administratively discharging transgender members with gender dysphoria rather than medically discharging them.)

Admiral Mike Mullen, the former Chairman of the Joint Chiefs of Staff, stated repeal of DADT was a matter of integrity. The military’s use of medical regulations to bar transgender service, not for medical reasons but for unsubstantiated concerns about good order and morale, is no less an affront to the Core Values. It is time to admit that the medical standards completely barring all transgender service are nothing more than an echo of the same prejudices and pretextual arguments familiar from the DADT fight. The APA's welcome step forward gives us an opportunity to review our standards, ensuring they are evidence-based, reflecting the best medical practices, supporting the health care our men and women in uniform deserve, and providing for the best fighting force our nation can produce.

By Paula M. Neira RN, CEN, Esq. - Lieutenant, United States Navy / Naval Reserve (1985-1991) |