The following article by Zack Ford was posted on the ThinkProgress website May 2, 2018:
It just doesn’t add up.
The process that led to the implementation of President Trump’s transgender military ban in March is becoming clearer, thanks to a trove of new documents that shed some light on the otherwise murky closed-door dealings.
Four different lawsuits are currently challenging the ban, which was first announced in a tweet last summer and then re-issued on March 23. A ThinkProgress review of several documents included in discovery finds a massive disconnect between what was discussed in the meetings and what was ultimately recommended, reinforcing concerns that the process was rigged from the beginning — in favor of a ban.
The documents offer a limited glimpse into the military panel that convened between October and January to study the potential consequences of such a ban, but they do nothing to help justify it. They include agendas from all 13 panel meetings, minutes from the first five of those meetings, and some other supplementary documents that guided the discussion.
Many of the details from the documents are redacted to block anything that might convey the panel’s “deliberative process,” i.e. the ways in which the panel used the information provided to make their determinations. The names of every guest who spoke at the meetings, as well as the “other attendees” present, were also blacked out.
What was left unredacted, however, is still revealing. Discussion at the first meeting (October 13, 2017) suggests that the military panel was divided on whether to allow trans service. Some offered positive comments about trans service members, but others expressed concerns about how “individual desires” might dictate what treatment they might receive. They seemed to believe that there should be a clear line as to what transition steps are “medically necessary” and which aren’t that could be objectively applied.
A “vast majority” of the panelists also expressed their belief that transition plans would make service members non-deployable for upwards of two years, counting hormone therapy and surgeries. It’s unclear where they came up with these estimates. The RAND study that informed the decision to lift the ban on trans service under President Obama rejected concerns that hormone therapy would have any impact on deployability and measured impacts from various surgeries in weeks — not years. It’s possible that unrealistic estimates offered by conservative groups to justify the ban had shaped their thinking.
At the four meetings that followed, the panel heard from various guests, including a group of nine current transgender service members, a panel of military medical experts, and a panel of civilian medical experts. Two of the trans service members who presented at the October 19 meeting, Navy Lieutenant Commander Blake Dremann and Army Staff Sergeant Patricia King, spoke to ThinkProgress about their experiences talking with the panel.
According to Dremann, each service member shared their personal story, and the panel’s subsequent questions focused primarily on medical care and deployability. None of the speakers had missed any deployments nor had any concerns with their units. Dremann noted that many panel members had been part of the group that previously decided to end the ban, with the exception of the new undersecretaries.
“There were a lot of head nods,” he said, suggesting that the panel was already familiar with the experiences of trans service members. “I didn’t get a sense that anyone took away that [letting transgender people serve] was a horrible idea.”
King described to the panel in detail how easily she was able to manage each of her surgeries, all within the course of one year. She had undergone the Defense Department’s first voice feminization surgery, which went very well and was managed entirely during the previous Christmas break. She’d undergone breast augmentation surgery, which she paid for herself, requiring only a four-day weekend. An Army surgeon completed her facial feminization surgery during her summer break, again having minimal impact on her service. She had also been scheduled for a gender reassignment surgery, which ended up taking place over Thanksgiving.
Combined with the Christmas break, King only missed three weeks of work.
In anticipation of her need to take light duty after that, King said she had also arranged with her unit to attend classes at an Army school. “This is what happens when a soldier supports their unit and a unit supports their soldier,” she explained. “We figured out the best time to have the surgery and the best way to use the time. They sent me to a school and I learned.”
Still, some of the panel members wrestled with understanding transgender identity, with one of the military leaders asking, “When are you not transgender anymore?” According to King, he was trying to figure out whether a person no longer needs that label if they completed all necessary medical interventions. As documented in the minutes, one of the trans service members replied, “I am no longer transgender when it is no longer relevant.”
Both Dremann and King left the meeting feeling very optimistic about the direction the panel was headed. King said that, from her perspective, there wasn’t any question about whether they would continue to allow trans military members to serve. It simply sounded like the panel was simply asking how they might revise the policy to improve trans service.
“They wanted to know how trans service was being received and if they got it right,” she said. “That’s how I walked away from it. They were leaders dedicated to their service members.”
“We were as surprised by what was said in the [final] recommendations, as a lot of other people were, because that was not our experience talking to the panel members,” Dremann said. “They seemed to realize that we had not caused any problems with the units or with our medical care.”
Other experts’ remarks at subsequent panel meetings likewise only spoke to letting transgender people serve.
On October 26, the panel heard from three military medical experts. The experts voiced concerns they had about how trans service members are currently treated, but none broached the subject of them serving.
For instance, with the ban looming, some experts said they were worried that service members may “[rush] to surgery” before being kicked out. They also expressed concern about how current policy for changing a service member’s gender marker is burdensome because it requires “completion of the medical treatment plan,” whatever that treatment plan is. And while they noted that suicide risk is high for individuals with untreated gender dysphoria, they said that suicidal ideation significantly decreases with treatment.
The military medical experts also addressed questions about how beginning cross-sex hormones would impact deployability. Ideally, a patient should receive lab work every 90 days until there is six months of hormonal stability. The experts suggested that there could be some side effects to hormone withdrawal, but also said that “it would be unlikely that an individual would be unable to take cross-sex hormones anywhere in the world.” The endocrinologist also noted that “roughly three times more cisgender men want testosterone supplements than transgender patients,” so hormone treatment is not a concern unique to transgender service members.
Two meetings later, on November 9, a group of three civilian medical experts refuted the previous experts’ concerns about hormonal withdrawal. They also explained that it wouldn’t matter if a service member missed a blood test because of deployment, because it would just freeze their current progress. “From an endocrinologist’s perspective,” the minutes recount, “there is no reason why a transgender [s]ervice member on cross-sex hormones could not deploy — it would just restrict the ability of the individual to have their dosages adjusted because that requires routine monitoring.”
Questions from the panel still suggested a lack of understanding among some of its members. For example, one member asked the civilian medical experts “if transgenderism could be cured.” One of the experts confirmed, “Gender dysphoria is a consequence of a failure to treat gender incongruence and relief can be achieved in numerous ways.”
Both groups of medical experts conveyed that allowing transgender service was the right call. Implementing a ban would hurt trans people who continue to serve in silence as well as civilians stigmatized by the ban. One medical expert also confirmed that allowing transgender transitions would “increase the lethality and readiness of the force” by “providing health care to an unserved population.”
Without minutes for the subsequent meetings, only a few other clues about the outcome are available from the remaining documents.
For example, a compilation of the administrative data presented during the panels offers an insight from the sixth meeting, where the panel heard from a “Retention and Non-deployable workgroup.” According to that group, “Mature theaters (Korea, Afghanistan) would likely be able to support transgender Service members with mental health and medical support.” This confirms what the medical experts said about deployability not being a concern.
Another “Data Extracts” document suggests that medical costs for service members with gender dysphoria (GD) have risen “nearly 3 times compared to a non-GD service member.” But the accompanying chart shows that the overall costs to the military have been as minuscule as the RAND study predicted. RAND estimated that the military would spend between $2.4 million and $8.4 million per year covering trans service members’ health needs — about a 00.1 percent increase in military health expenditures. In 2017, the first full year of open trans service, the military only spent about $2.2 million on transgender health needs.
The only other possible clue to the panel’s deliberations was a change of leadership. In early December, Robert Wilkie took over the panel following his confirmation as Under Secretary of Defense for Personnel and Readiness. Trump had nominated Wilkie for the position back in July — just one week before he tweeted out the ban on trans military service. Wilkie has not spoken publicly about his views on the issue of trans service, but he previously worked for Sen. Thom Tillis (R-NC), whose anti-LGBTQ views included defending HB2, North Carolina’s 2016 law allowing open discrimination against transgender people. Tillis did, however, oppose Trump’s ban.
Wilkie’s first meeting overseeing the panel was on December 7. Unless he was one of the redacted attendees at the earlier meetings, this means he only participated in the last five of the panel’s meetings. On January 11, Wilkie issued an action memo to Mattis with recommendations to reinstate the ban that mirror what Mattis later recommended to Trump.
Contrary to previous assumptions, this memo is the only final work product from the committee. Wilkie’s recommendations include:
- Transgender people can only join the military if they serve “in their biological sex.” In other words, if they took any steps to transition (or plan to), they are forbidden from joining.
- Transgender people who are already serving may serve openly, “but only in their biological sex and without receiving cross-sex hormone therapy or surgical transition support.” In other words, for trans people to continue serving, they have to forego transitioning and any related medical treatment.
- A diagnosis of gender dysphoria (past or present) is disqualifying, except for those service members who came out as transgender when the ban was originally lifted.
Substantiation for these recommendations is found nowhere in the documents currently available.
As both ThinkProgress and Slate previously reported, Vice President Pence created his own separate “working group,” which included anti-LGBTQ activists like Tony Perkins of the Family Research Council and Ryan T. Anderson of the Heritage Foundation. Despite rumors that the military panel and Mattis himself favored allowing transgender people to serve, it was Pence’s recommendation to ban service, sources claim, that “effectively overruled” the panel’s work. Indeed, the final recommendations directly mirror the anti-transgender talking points those conservative groups regularly use.
The court record suggests, then, that Pence’s influence was already at work when Wilkie submitted his action memo. While questions remain, that continues to be the only explanation for how a panel that only heard information affirming transgender military service arrived at the opposite conclusion.
In the weeks since the new policy was issued, the White House has stood by the panel’s inexplicable decision to ban trans service members from the military, despite mounting criticism from major medical organizations, all of whom have provided evidence disproving the administration’s rationale, and all of the arguments presented in the panel experts’ presentations. All four service chiefshave also admitted under oath they have no knowledge of unit cohesion concerns — one of the primary justifications for the ban — related to trans people serving, once again mirroring the information presented by those who addressed the military panel.
Additionally, six former U.S. surgeons general have rejected the Trump administration’s medical justifications for the ban.
This past week, a group of 49 senators also wrote a letter condemning Defense Secretary James Mattis for “establishing a new ‘Don’t Ask, Don’t Tell,’” calling it a “discriminatory” policy that will “harm our nation’s military.”