Transgender troops on active duty may qualify for sex-reassignment surgery if their physicians deem it necessary, according to Pentagon officials.

After news broke last week that incarcerated Army Pvt. Chelsea Manning was granted authorization to undergo gender reassignment surgery, a Defense Department spokesman said Monday that the option is available to all transgender active-duty troops if their doctors recommend it and senior military health officials approve it.

The announcement clarifies the scope of treatment available to transgender military personnel and differs significantly from earlier Defense Department statements, which noted that cosmetic surgery for gender reassignment "in most cases" would be considered elective and not covered by the military health system.

The benefit does not apply to non-active duty Tricare beneficiaries. Defense Department spokesman Air Force Maj. Ben Sakrisson said that starting Oct. 3, the military health program will cover therapy and hormone treatments for Tricare beneficiaries with gender dysphoria but not surgery.

According to Sakrisson, gender reassignment surgeries for active-duty personnel will be conducted at either a military hospital or, if qualified care is unavailable at a military facility, at a private hospital paid by Tricare.

Defense Secretary Ash Carter announced June 30 that gender dysphoria is no longer a disqualifying condition for military service.

Under the new policy, transgender troops must have a personal transition plan approved by a military doctor, a standard requirement for major procedures for active-duty troops.

When Carter made the announcement, defense officials said DoD didn't expect a large number of requests for surgery as many transgender individuals do not choose to undergo surgery.

They added that the most common treatment for gender dysphoria is hormone therapy, but some surgeries, such as breast implants and resconstruction may be deemed medically necessary.  

According to a USA TODAY report on Sept. 16, at least five transgender troops are pursuing treatment outside the military health care system, including one seeking sex-reassignment surgery.

Three are sailors or Marines and the other two are airmen, according to the report.

Manning's attorneys said Sept. 13 the Army had agreed to cover the cost of gender reassignment surgery for the soldier, who is serving a 35-year sentence at Fort Leavenworth Disciplinary Barracks in Kansas for disclosing classified material and unclassified sensitive documents to the website WikiLeaks.

Manning ended a five-day hunger strike after being told she was eligible for surgery, according to her American Civil Liberties Union attorneys.

The Veterans Affairs Department has proposed a plan that would allow VA to cover sex-reassignment surgery on a case-by-case basis. 

A Rand Corp. report estimated that between 1,320 and 6,630 active-duty personnel are transgender. The report estimated that between 29 and 129 troops might seek medical treatment, including hormones or surgery, a year, for their condition.

Advocates say the cost of providing health treatment for gender dysphoria is $40,000 to $50,000 over the lifetime of the service member.

Patricia Kime covers military health care and medicine for Military Times. She can be reached at

Staff reporter Andrew Tilghman contributed to this report. 

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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