On Tuesday, a rash of extremely misleading headlines, from the New York Times to the Washington Post to ABC News, reported that Defense Secretary Jim Mattis had "frozen" Donald Trump's ban on transgender people serving in the military. This was misleading to the point of being a flat-out lie. As Mark Joseph Stern of Slate wrote:
This framing is an extreme mischaracterization of the facts. Mattis did not “freeze” the trans ban, and he is not “buy[ing] time” in some potentially insubordinate effort to buck Trump. In reality, the secretary is doing exactly what Trump directed him to do in a recent memo.
Mattis' claim that the issue needs more study is a lie designed to make a decision based in raw bigotry look more thoughtful than it is. The reason we know this is that the military has already studied this issue extensively, releasing a 2016 report that found “allowing transgender personnel to serve openly” would have “little or no impact on unit cohesion, operational effectiveness, or readiness.”
The excuse that Trump used when he first announced this ban on Twitter, and the excuse he will almost certainly continue to use, is that medical care for trans people, such as hormone therapy or gender confirmation surgery, is too expensive. Not only is this another lie — it was widely reported that the military spends five times as much on Viagra as it expects to spend on gender confirmation treatments — but this excuse is in itself a form of bigotry, a way to demonize transgender people by stigmatizing the health care they need.
“The only reason we’re even having this conversation is because the president and others don’t actually consider health care for trans people to be real health care," Chase Strangio, a staff attorney with the ACLU’s LGBT & AIDS Project, explained to Salon. “It’s only because we stigmatize this care and we don’t understand trans people that part of the conversation even comes up, because all of the evidence shows that the costs are negligible in a budget that’s billions and billions of dollars.”
Strangio, who helped Chelsea Manning with legal issues during her time in a military prison, is working on a suit that the ACLU filed against Trump and the Department of Defense on behalf of five active service members. The ban would not only bar trans people from enlisting and threaten the status of those currently serving, it would also forbid them from having equal access to health care.
“From a medical aspect, transgender care is regular health care," explained Dr. Jenn Conti, an ob-gyn who has helped trans men with their gender confirmation care and who is an advocate for Physicians for Reproductive Health. Trump's "statements and his tweets are truly not founded in medical science," she continued. "It’s a political issue, and it’s something that’s happening at the expense of an already stigmatized and underserved population.”
What Conti and Strangio both emphasized repeatedly is that there is no reason, morally or medically, to single out trans health care as any different from any other kind of medically necessary care.
“There are enormous medical and psychological consequences that stem from being forced to live in the wrong body," Conti explained. She has provided gender confirmation surgeries for trans men, including some veterans, and reports, "The relief they feel afterwards is indescribable.”
It's frustrating to even have to write about this, because people's right to private medical care that makes them healthy and whole should not be up for debate. Unfortunately, however, trans care — like contraception and abortion care — has been politicized by forces that wish to exploit these private health issues in interests of marginalizing entire classes of people.
“In all contexts, the data shows that not providing health care that’s necessary is more costly than providing it," Strangio said. He contrasted the $8 million the Pentagon estimates they will spend on trans medical care versus the $960 million bath that the military will take by trying to implement a ban on trans troops.
Beyond the money, however, there is a human cost involved in marginalizing trans health care from any system, military or otherwise. Conti has firsthand knowledge, because she's worked with patients who get health care through the Veterans Administration, which currently does not cover gender confirmation surgery or related trans medical treatments.
“These people, in addition to feeling really stigmatized, are tasked with this additional stressor of getting creative" in their pursuit of health care, Conti said. Some of her patients have been forced to claim "that they need these procedures for other indications, like abnormal uterine bleeding or heavy bleeding.”
As far as Conti is concerned, any uterine bleeding is abnormal in a trans man, because they "aren’t meant to have a uterus." However, the more humane and simpler solution is to simply treat health care for trans people as part of a regular health care system.
Banning trans service members adds another burden to the military medical care system by encouraging trans troops to hide their identity, Strangio added. Once inside the system, there are a number of situations, such as when getting sexual health or mental health care, that a closeted trans person may need to disclose his or her status to a doctor to get proper treatment. But doing so risks a discharged, creating an impossible and stressful choice that does no good for the patient, the doctor or the military.
Strangio expressed confidence that the ACLU's case against Trump and the Department of Defense would be successful. Pentagon-financed research backs the inclusion of trans troops and coverage of their health care needs. There's also "significant evidence," Strangio added, that the president's alleged concerns "are pretextual for animus that is driving the policy." Even if the plaintiffs win, he hastened to note, Trump's actions have done a tremendous amount of needless damage.
“Surgeries have been cancelled. People have been emboldened to act out their individual biases," he said. The president has sent a message, in Strangio's judgment that "the government doesn’t value our participation in public life, doesn’t take seriously our health needs."