The transgender troop ban will be like a door slamming shut.
When the policy goes into effect on April 12, openly transgender people won’t be able to get into the military—and many who are already inside will have to hide who they are, forced to pick between seeking medical treatment for gender dysphoria and keeping their jobs.
Mental health experts warn that will be a terrible double bind for transgender troops.
“We certainly have data to suggest that living with gender dysphoria or any kind of distress—just the day in, day out chronic stress of having an incongruence between one’s identity and one’s biological sex at birth—causes a range of physical and mental health problems,” Dr. Ashli Owen-Smith, a behavioral scientist at Georgia State University’s School of Public Health, told The Daily Beast.
Those problems include depression, anxiety, and increased suicidal ideation. As for treatment, the evidence is clear: transition-related medical care can have a positive impact on transgender mental health, as several studies have shown, and having that care withheld can have a negative impact, exacerbating other mental health problems.
As Dr. Owen-Smith explained: “It makes sense that if [treatment] is something that you want and that you feel that you need but you can’t access, then that creates even more distress than the distress you’re already experiencing just living with gender dysphoria.”
Now that all of the preliminary injunctions against the troop ban have been dissolved in accordance with a January Supreme Court ruling, the new policy on transgender military service will go into effect in a little over a week.
Many transgender service members, as The Daily Beast has previously reported, are currently scrambling to get a gender dysphoria diagnosis in time so that they can remain in the military under the policy’s grandfather clause.
But others already know they won’t be able to meet the deadline.
That means they’ll have to suppress their transgender identity if they want to stay in the service. Under the guidelines distributed by the Pentagon, transgender service members will be required to serve according to “the standards associated with their biological sex” and cannot “serve in their preferred gender.”
Receiving a diagnosis of gender dysphoria, while technically permissible, could very well mean discharge: If a military doctor says that a service member needs to transition “to protect the health of the individual”—and medical associations have said that transition-related health care is indeed necessary in many cases—that service member cannot stay.
One transgender male West Point cadet, who spoke to The Daily Beast on condition of anonymity because he could lose his commission if he comes out, wants to keep his identity hidden from military medical providers for precisely this reason.
This cadet might have been able to secure a gender dysphoria diagnosis before April 12, but because there will be a break in service between his forthcoming graduation from West Point and his commission, he wasn’t entirely certain that it would be safe to do so.
“If there’s any chance that I’d be denied my commission, I wouldn’t want to take it because my main goal right now is commission,” he told The Daily Beast.
That means he will continue serving, not knowing when or if it will be possible for him to one day serve openly. He wanted to make a career out of military service. Now, he’s not so sure.
“If nothing ends up changing and the ban does go into effect, then I probably won’t be able to stay in a whole 20 [years] because I will need to transition at some point, just for my own mental state,” he said.
Forced to weigh his need to transition against his desire to serve, this West Point cadet says that he has found some comfort in friendship with other cadets, who “don’t really care” if anyone is transgender “if you can do your job or if you can accomplish the mission.”
Indeed, studies have found that social support can be beneficial for transgender people. But that support can only carry him so far.
“They’re supportive and all,” the West Point cadet said of his friends, “and that helps get me through the rough patches, but I don’t know how long I can do that for, so that might be the difference between me serving five years and serving 20.”
Dr. Jamison Green, chair of the ethics committee for the World Professional Association of Transgender Health, believes that this policy will have a chilling effect on transgender service members who have yet to transition and will now be barred from doing so.
“The impact of this policy is not medically or ethically benign,” he told The Daily Beast.
For one, Dr. Green noted, closeted transgender service members may be afraid to discuss a wide array of mental health issues with military providers for fear of being diagnosed with gender dysphoria and potentially discharged.
“No doubt there are other medical conditions that service members may wish to conceal from their command staff because reporting the condition might lead to discharge,” said Green.
The West Point cadet who spoke with The Daily Beast said that he will have to “figure out what I can and can’t say to certain people”—a strategy that recalls the era of Don’t Ask, Don’t Tell for cisgender gay, lesbian, and bisexual service members. But he also sympathizes with those service members who need more urgent help, and now may be dissuaded from seeking it.
“I think for some people it might be difficult because they don’t want to risk getting kicked out but they still do need help—and it’s important to get that help if you need it,” he said. “It’s sad that people probably will be deterred from getting the help that they need because they don’t want to get kicked out on accident.”
In a statement to The Daily Beast, a Department of Defense spokesperson reiterated the details of the policy and said, “We encourage all service members to consult a military medical provider for any medical issue they may have,” adding that “the military provides all necessary medical care to protect the health of our service members, including those who are in the process of being separated.”
In his initial tweets on the subject of transgender military service in July 2017, President Trump implied that there would be “tremendous medical costs involved.”
But not only is the cost of providing transition-related care minuscule relative to the military’s medical budget, the cost of forcing troops to stay in the closet could be much greater, experts warn, considering that a lack of treatment can exacerbate other conditions.
“Providing care for individuals who need care is about much more than dollars and cents,” Owen-Smith said, “but I suspect that if we were to conduct a more rigorous cost-effectiveness or cost-benefit analysis, we would probably see that preventing these conditions is cost savings, rather than trying to treat them after they’ve already occurred.”
In the absence of conclusive data to that effect, though, Owen-Smith stressed that under a “moral and ethical framework,” providing medical treatment to transgender troops is “about taking care of one another and making sure that all of our citizens have access to the health care that they need.”
Indeed, the core issue, as Green noted, is that transgender service members who receive a diagnosis after April 12 will face “overt denial of care on the basis of a diagnosis that has not been proven to—and in fact does in no way—limit their capacity to serve.”
“This policy singles out a medical condition for discrimination on no basis other than animus and its imposition is antithetical to its stated purpose of maintaining military cohesion and readiness,” he said.
For at least one West Point cadet surrounded by supportive peers, the cruelty of that policy is baffling. “Other cadets and other soldiers don’t really care as long as the mission gets accomplished and everyone’s safe doing it,” he told The Daily Beast. “I don’t know why it’s such a big deal when it’s just people being themselves.”