Any day now the Pentagon is expected to unveil new rules for transgender troops, ending the longstanding policy that deems them medically unfit for military service.
Many service members and advocates are eager to see the new policy's details and how the Defense Department plans to tackle an array of potentially thorny issues as it's rolled out across the force. Here are five key items to watch for:
The Defense Department will have to determine how to treat prospective recruits who have a diagnosis of "gender dysphoria." It’s likely to become a routine question recruiters ask, and a new policy may require those recruits to show some evidence that the condition is “stable.” That definition may vary and could include documentation from a doctor showing that the individual does not require treatment. Or, in the case of individuals who undergo gender transitions, the military may require some time to pass before enlistment. That’s normal for many medical issues. For example, if a prospective recruit has a knee injury, it’s common for the military to require several months of rehabilitative treatment before shipping off to boot camp.
Uniforms, grooming & fitness
The new policy will give the service branches some guidance on how to transition active-duty service member from one gender to the other. For troops, that will mean adhering to different grooming standards and uniform regulations and meeting new standards for physical fitness, which can impact promotion opportunities. It also may require official transition to a new barracks or berthing quarters. The Pentagon will hand down broadly written rules and then let the individual services hammer out the details. Advocates will be watching closely to see what timeline the services are given — and whether the process stretches into a new administration after President Obama leaves the White House in January.
What will be the role of military doctors? The new Pentagon policy is likely to include details for how the military health system will work with troops who are diagnosed with gender dysphoria and require treatment, such as hormone therapy or surgery. For some rare medical conditions, troops can be referred to civilian health care professionals who are reimbursed through the Tricare health system, resulting in treatment completely outside the military health system. But in the case of gender dysphoria, the policy may require some involvement from military doctors.
The new policy may also offer unit-level commanders some guidance on how to supervise transgender troops. Typically commanders have some say in major medical treatment that is a medical necessity but not an emergency. (Experts say gender dysphoria rarely warrants emergency treatment.) For example, a soldier might require knee surgery, but a commander can order that to be postponed until after deployment if the condition is not an emergency. It’s unclear what role commanders will play in approving hormone therapy or gender reassignment surgery for troops in their unit, when transgender troops can undergo surgery or begin hormone therapy. “The commander always has discretion to move the treatment a little bit to the left or right,” said Aaron Belkin, an advocate for transgender service with the Palm Center in California. “But commanders should not be given veto powers to deny medically necessary care.”
Words will matter
Beyond the legalisms, Defense Secretary Ash Carter’s words will carry a lot of weight as the active-duty force of 1.3 million begins to implement the change. That’s especially true after Carter and the Pentagon’s bureaucrats took far longer than initially expected to roll out the policy. Carter’s statements along with the service chiefs' will impact the behavior of individual commanders across the force, Belkin said. “There needs to be a strong statement of support from Secretary Carter on down that, regardless of how people feel about each other, they will have to work together. And all service members should be treated with dignity and respect, and anything else will not be tolerated,” Belkin said.