Assessing the Implications of Allowing Transgender Personnel to Serve Openly

"Recent U.S. Department of Defense (DoD) policy banned transgender personnel from serving openly in the military. Potential changes to this policy raised questions regarding access to gender transition and related health care, the range of transition-related treatments that DoD will need to provide, the potential costs associated with these treatments, and the impact of these health care needs on force readiness and the deployability of transgender service members. A RAND study identified the health care needs of the transgender population and transgender service members in particular. It also examined the costs of covering transition-related treatments, assessed the potential readiness implications of a policy change, and reviewed the experiences of foreign militaries that permit transgender personnel to serve openly"--Publisher's description Cover......Page 1 Title Page......Page 2 Copyright......Page 3 Preface......Page 4 Contents......Page 6 Figures and Tables......Page 8 Summary......Page 10 Acknowledgments......Page 18 Abbreviations......Page 20 Study Approach......Page 22 Organization of This Report......Page 25 Definitions of Key Terms and Concepts......Page 26 Health Care Needs of the Transgender Population......Page 27 Military Health System Capacity and Gender Transition–Related Treatment......Page 28 Potential Consequences of Not Providing Necessary Gender Transition–Related Care......Page 30 General Population Estimates of Transgender Prevalence......Page 32 Prevalence-Based Approach to Estimating the Number of Transgender Service Members in the U.S. Military......Page 35 CHAPTER FOUR: How Many Transgender Service Members Are Likely to Seek Gender Transition–Related Medical Treatment?......Page 40 Prevalence-Based Approach to Estimating the Number of Gender Transition–Related Treatments in the U.S. Military......Page 41 Utilization-Based Approach to Estimating the Number of Gender Transition–Related Treatments in the U.S. Military......Page 43 Summarizing the Estimates......Page 51 Private Health Insurance Cost Estimates......Page 54 Sensitivity Analyses......Page 56 Summarizing the Estimates......Page 57 Impact on Ability to Deploy......Page 60 Impact on Unit Cohesion......Page 65 Costs of Separation Requirements Related to Transgender Service Members......Page 67 CHAPTER SEVEN: What Lessons Can Be Learned from Foreign Militaries That Permit Transgender Personnel to Serve Openly?......Page 70 Policies on Transgender Personnel in Foreign Militaries......Page 71 Effects on Cohesion and Readiness......Page 81 Best Practices from Foreign Militaries......Page 82 Lessons Learned and Issues to Consider for U.S. Military Policy......Page 83 CHAPTER EIGHT: Which DoD Policies Would Need to Be Changed if Transgender Service Members Are Allowed to Serve Openly?......Page 86 Retention Policy......Page 87 Deployment Policy......Page 88 CHAPTER NINE: Conclusion......Page 90 A. Terminology......Page 94 B. History of DSM Terminology and Diagnoses......Page 98 C. Treatments for Gender Dysphoria......Page 100 D. Review of Accession, Retention, and Separation Regulations......Page 104 References......Page 106 Preface -- Figures and Tables -- Summary -- Acknowledgments -- Abbreviations -- -- Chapter 1. Introduction : Study Approach -- Organization of This Report -- -- Chapter 2. What Are the Health Care Needs of the Transgender Population?: Definitions of Key Terms and Concepts -- Health Care Needs of the Transgender Population -- Military Health System Capacity and Gender Transition--Related Treatment -- Potential Consequences of Not Providing Necessary Gender Transition--Related Care -- -- Chapter 3. : What Is the Estimated Transgender Population in the U.S. Military? : General Population Estimates of Transgender Prevalence -- Prevalence-Based Approach to Estimating the Number of Transgender Service Members in the U.S. Military -- -- Chapter 4. How Many Transgender Service Members Are Likely to Seek Gender Transition-Related Medical Treatment? -- Prevalence-Based Approach to Estimating the Number of Gender Transition-Related Treatments in the U.S. Military -- Utilization-Based Approach to Estimating the Number of Gender Transition-Related Treatments in the U.S. Military -- Summarizing the Estimates -- -- Chapter 5. What Are the Costs Associated with Extending Health Care Coverage for Gender Transition-Related Treatments?: Private Health Insurance Cost Estimates -- Sensitivity Analyses -- Summarizing the Estimates -- -- Chapter 6: What Are the Potential Readiness Implications of Allowing Transgender Service Members to Serve Openly?: Impact on Ability to Deploy -- Impact on Unit Cohesion -- Costs of Separation Requirements Related to Transgender Service Members -- -- Chapter 7. What Lessons Can Be Learned from Foreign Militaries That Permit Transgender Personnel to Serve Openly?: Policies on Transgender Personnel in Foreign Militaries -- Effects on Cohesion and Readiness -- Best Practices from Foreign Militaries -- Lessons Learned and Issues to Consider for U.S. Military Policy -- -- Chapter 8. : Which DoD Policies Would Need to Be Changed if Transgender Service Members Are Allowed to Serve Openly?: Accession Policy -- Retention Policy -- Separation Policy -- Deployment Policy -- -- Chapter 9. Conclusion -- APPENDIXES -- References. Current U.S. Department of Defense (DoD) policy bans transgender personnel from serving openly in the military. DoD has begun considering changes to this policy, but the prospect raises questions regarding access to gender transition–related health care, the range of transition-related treatments that DoD will need to provide, the potential costs associated with these treatments, and the impact of these health care needs on force readiness and the deployability of transgender service members. A RAND study identified the health care needs of the transgender population and transgender service members in particular. It also examined the costs of covering transition-related treatments, assessed the potential readiness implications of a policy change, and reviewed the experiences of foreign militaries that permit transgender personnel to serve openly