An analysis of the potential costs of providing health care for transgender troops' unique medical needs indicates that the figures are "too low" to play a major role in the policy debate underway as to whether these service members should be allowed to serve openly, according to a new article in the New England Journal of Medicine.
Aaron Belkin, a political science professor at San Francisco State University and director of the Palm Center, a public policy think tank that focuses on LGBT issues, estimates that transition care — gender reassignment surgery and/or hormone therapy — for troops would cost the Defense Department $5.6 million a year, depending on how many service members choose to use the services.
According to Belkin, an estimated 12,800 transgender personnel serve in the U.S. military. And not all of them will seek transition services health care.
An estimated 94 to 188 transgender troops may seek transition care, said Belkin, basing his assessments on the rates of services sought by troops in the Australian armed forces as well as U.S.-based insurance companies.
"Some transgender individuals do not change their bodies to match their gender identities [but] government agencies, courts and scientist agree that for many, transition related care is medically necessary," Belkin wrote in the article, Caring for our Transgender Troops -- The Negligible Cost of Transition-Related Care."
Defense Secretary Ash Carter on July 13 ordered the formation of a working group to examine the U.S. military's longstanding prohibition on allowing transgender men and women to serve openly in the military.
Carter signaled that he expected the policy to change once top military officials create a policy that will allow these service members to serve openly and transition, if desired.
"Current regulations regarding transgender service members are outdated and are causing uncertainty that distracts commanders from our core missions," Carter said in a statement July 13.
According to the Pentagon, the group will examine questions on dress code and grooming standards, fitness, billeting, health care and more.
Belkin said the actual cost of caring for these troops, however, could be lower because "transition-related care has been proven to mitigate serious conditions including suicidality that, left untreated, impose costs."
Under current rules, transgender individuals are considered medically unfit for service and can be honorably discharged if diagnosed with "psychosexual conditions, including but not limited to transsexualism, exhibitionism, transvestism, voyeurism, and other paraphilias," according to DoD Instruction 6130.03.
The "don't ask, don't tell" policy that barred gays from serving openly in the military was repealed in 2011, but it did not apply to transgender troops.
Belkin said that the cost of care is low, and even if it is higher than estimated, it still would have a "negligible effect on the military health budget because of the small number treated."
"Some observers may object to the concept that the military should pay for transition-related care, but doctors agree that such care is medically necessary," he wrote.
Staff writer Andrew Tilghman contributed to this report.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
