No medically valid reason for a ban on transgender military service

Last week the American Medical Association (AMA) passed a resolution that has the potential to transform the debate over one of the last remaining policies of government discrimination. The 220,000-member AMA voted to affirm that “there is no medically valid reason to exclude transgender individuals from service in the U.S. military.” 

The armed forces generally strive to ensure that Pentagon policies reflect the most up-to-date medical science, including routine reviews of all personnel policies. Unfortunately, the military’s current rules on transgender service—which remain intact despite the 2011 lifting of the “don’t ask, don’t tell” policy banning openly gay service members—are based on assumptions and attitudes that are decades out of date.                                    

{mosads}The transgender service ban is contained in military medical regulations that govern physical and mental health standards for entering and remaining in the military. Among other exclusions, the rules prohibit what the military refers to as “transsexualism,” a diagnosis that was eliminated by the American Psychiatric Association (APA) more than twenty years ago. Last year, the APA removed “gender identity disorder” and replaced it with a diagnosis that focuses on the distress that often accompanies feeling at odds with the gender one was assigned at birth.  

When asked why the military continues to impose transgender restrictions that are unsupported by medical science, Pentagon spokespeople have claimed it would be difficult to provide adequate medical treatment to transgender troops in the “austere environments” of combat.  

Yet that rationale has been repeatedly discredited by the increasing visibility of many of the estimated 15,500 currently-serving transgender troops, as well as by the experiences of the 18 allied nations that allow transgender service, including Britain, Canada and Australia. Research supports the case that the policy is outdated and unnecessary. Last year, a peer-reviewed study that I co-authored with former Surgeon General Joycelyn Elders and other experts found that “there is no compelling medical rationale for banning transgender military service, and that eliminating the ban would advance a number of military interests, including enabling commanders to better care for their service members.”  

Another study authored by Professor Diane Mazur, a legal scholar at the Palm Center, which studies sexual minorities in the military, found that “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.” While the military seeks to retain and support non-transgender personnel with a variety of medical conditions, it automatically excludes transgender personnel with medical needs no more difficult to meet—irrespective of their fitness for duty. 

The AMA resolution echoes these research conclusions, effectively eliminating the last remaining argument for banning transgender service. The AMA cites data showing that transgender individuals require no more specialized, risky or burdensome medical care than any other military members. It concludes that the military’s regulations “are out of date with respect to the medical consensus about gender identity,” noting that, by contrast, regulations governing non-transgender conditions “are updated regularly based on current scientific consensus and best practices.” Finally, the AMA resolution calls for the provision of medical care to transgender personnel “as determined by patient and physician according to the same medical standards that apply to non-transgender personnel.”  

The government’s inconsistent treatment of sexual minorities in the military has a long history that, fortunately, seems to be coming to an end. That history highlights both similarities and differences between the transgender ban and the now-defunct policy on service by gay, lesbian and bisexual service members. “Don’t ask, don’t tell” was similar to the transgender ban in that both policies excluded sexual minorities for reasons that had nothing to do with their ability to perform, and forced military members to compromise their integrity and even lie about who they are. But unlike the transgender ban, “don’t ask, don’t tell” was not rooted in a medical rationale. Instead it rested on the assumption—since proven false—that the reaction of straight service members to serving with openly gay colleagues would undermine the cohesion and effectiveness of fighting units. 

The significance of last week’s AMA resolution, therefore, cannot be overstated. The fact that the oldest and largest association of physicians in the country has now endorsed the conclusion that the transgender exclusion policy has no factual basis to support it signals an indisputable medical consensus on the matter. The military is rightly proud that—in most cases—its policies aim to reflect both the latest scientific knowledge and the values of freedom, fairness and equality that its troops fight to protect. The policy on transgender troops should be no different.

Steinman is the former Coast Guard Director of Health and Safety (equivalent to the Surgeon General of other military branches), who testified at the AMA meetings in support of the resolution.