By Rachel Sawicki

Transgender equality within the U.S. military may soon clear another hurdle thanks to the Department of Veterans Affairs.

The Veterans Health Administration currently provides care for transgender veterans and some transition-related medical care, but it is in the process of removing previous exclusions for transition-related surgical care.

Mara Keisling, executive director of the National Center for Transgender Equality, said the process is currently in a public-comment period and her organization is gathering input to relay to VA.

She said that 10 years ago, transgender veterans were “horribly disrespected” and couldn’t receive any care at all, whether or not it had anything to do with being transgender. “People shouldn’t think of them as ‘trans’ veterans. They’re just veterans,” Ms. Keisling said. “We’ve made a commitment as a nation that when people have risked their lives and when people have done their service, we take care of their care. And this is care that a lot of people need, their doctors want to give them, and there’s been this unfair and old-fashioned exclusion.”
A directive from 2011 changed those rules and opened access to transgender veterans’ health care.

“(The) VA provides care and treatment to Veterans that is compatible with generally accepted standards of medical practice and determined by appropriate health care professionals to promote, preserve, or restore the health of the individual,” the 2011 directive reads.

Other directives and amendments have since been made to include guidelines regarding the respect of transgender veterans and nondiscrimination policies.

“VHA does not discriminate based on (the) state of gender transition. … VHA will provide care to all transgender and intersex Veterans in a manner that is consistent with their self-identified gender identity,” reads Directive 1341, originally published in 2018 and last updated in 2020. “It is VHA policy that staff provide clinically appropriate, comprehensive, Veterancentered care with respect and dignity to enrolled or otherwise eligible transgender and intersex Veterans.”

Before the regulations prohibiting surgical care can be removed, experts will be weighing in. Ms. Keisling said she expects those testimonies to help move the process along.

“The state of the medical community and science is that they recognize that these are medically necessary treatments,” Ms. Keisling said. “Right now (at the VA), even when a doctor says, (a surgical procedure) is the right thing to do, they can’t do it. And that hurts that they can only go so far with the health care, which is all medically necessary and all recognized by the medical community as being appropriate. The doctors at the VA have not been able to properly serve the patients for the last 10 years.”

Surgical alterations are often one of the last steps in the process of treating gender dysphoria in transgender and gender-nonconforming individuals. Identifying as transgender or gender-nonconforming is not a mental disorder itself, but many of those individuals experience gender dysphoria, which is classified in the Diagnostic and Statistical Manual of Mental Disorders.

For a person to be diagnosed with gender dysphoria, they must show signs of distress related to the difference in their expressed gender and the gender they were assigned at birth and exhibit consistency in those feelings for at least six months, according to the American Psychiatric Association.

The World Professional Association for Transgender Health affirms that surgery is often medically necessary to alleviate gender dysphoria. WPATH also says that in some settings, surgery might reduce risk of harm from discriminatory beliefs in the event of arrest or search by police or other authorities.

As public comments are collected, Ms. Keisling said, “I assume there will be some people who don’t know anything about this who will weigh in against it just because it has to do with trans people.”

She added that the National Center for Transgender Equality will be submitting comments in favor of expanding VA health care and assisting anyone else who would like to do so.

For more information, call 202-642-4542 or email ncte@transequality.org.