A study commissioned by Defense Secretary Ash Carter found that a small portion of service members are transgender and allowing them to serve openly in the military would cost little and have no significant impact on unit readiness.
The study by the RAND Corp. estimated that 2,450 of the 1.2 million active-duty members of the military are transgender, and that every year around 65 will seek to transition to the other gender.
The RAND study said that if the Pentagon did not cover the medical procedures for service members — like hormone therapy and surgery — they would likely avoid seeking medical care and would have higher rates of substances abuse and suicide.
Paying for the procedures would cost the Pentagon $2.9 million to $4.2 million a year, the report said. By comparison, the Pentagon each year spends $6 billion of its $610 billion budget on medical costs for active-duty service members.
The Pentagon is wrestling with how to end its ban on allowing transgender people to openly serve at a time when a North Carolina law requiring people to use bathrooms and locker rooms corresponding to their sex at birth has prompted a heated debate. Democrats largely believe the law is discriminatory while some Republicans strongly support it.
In July, Carter signaled that he was open to ending the Pentagon’s policy and created a working group to study how to integrate transgender people into the services. As part of that process, RAND was asked to examine the consequences of allowing transgender people to serve openly. The RAND study was completed in March, and Brad Carson, the senior Pentagon official in charge of the working group, gave a memo to defense officials in April on how to carry out the policy change.
But since then, Carson has resigned, the process has stalled, and Carter has declined to release the report. Carter’s aides said they have a policy of not releasing reports until after a decision directly tied to them is made, but transgender advocates have accused Carter of sitting on the report because it shows that there would be few hurdles to allowing transgender people to serve openly.
A person who has worked on the transgender issue in the military provided a copy of the study to The New York Times on the condition of anonymity because he did not want to be identified disclosing a document that has not been released to the public.
The study’s authors acknowledge that it is difficult to know how many transgender people there are in the services because the issue has not been widely examined. To estimate those figures, the authors relied on research studies that tried to determine the rate of transgender people in society.
The report is written mainly in an academic tone. But the authors used some of their most-pointed language to describe the negative effects of the military continuing its current policy of not paying for the medical costs of transgender transitions.
“The discussion of health care among military transgender personnel is incomplete without considering the potential unintended effects of constraining or limiting gender transition-related treatment,” the report said. “Adverse consequences of not providing transition-related health care to transgender personnel could include avoidance of other necessary health care such as important preventive services, increased rates of mental and substance use disorders, suicide, and reduced productivity.”
Transgender people who are denied health care may turn to other solutions “such as injecting construction-grade silicon into their bodies to alter their shape,” the report said. Studies have shown that there is a dramatic reduction in suicide rates among transgender people after they receive surgery, it added.
One of the most difficult issues the Pentagon would have to confront with transgender service members would be how to deal with them in the period of time before and during their gender transition, the report said.
“DoD will need to establish policies of when individuals may use the uniforms, physical standards, and facilities (e.g. barracks, restrooms) of their target gender,” the report said, adding that before deployments the Pentagon would need to ensure that the service members were given mental health screening to ensure their readiness.
The report said that it found the underlying assumption in the military was that the presence of transgender people would hurt bonding and operational readiness. It said similar concerns were raised before gays and lesbians were allowed to serve openly in the military, and there was little evidence that this had been an issue.
While there is limited public data, foreign militaries that have allowed transgender individuals to serve openly — like Israel, Australia and the United Kingdom — have had no significant problems with “cohesion, operational effectiveness, or readiness,” according to the report.
Carter was asked about the issue twice last week, including by a cadet at the Air Force Academy. He said “there aren’t any hang-ups” and he expected that the plans to begin the new policy would be completed soon.
“This is a complicated issue,” he said. “And I think it has a lot of ramifications that are very practical ones.”
Aaron Belkin, director of the Palm Center, a research institute that has studied the effects of having gays, lesbians and transgender people in the military, said that he was not reassured by Carter’s comments.
“What’s worrisome is that Carter has said this is a complicated issue, and we’ve learned in the past from ‘don’t ask, don’t tell’ that that sometimes signals they are not moving towards a good place,” Belkin said. “We know that implementation and repeal of the ban is not complicated.”