Spc. Alex Ketchum thought she’d done everything right.
The 22-year-old infantryman started her transition from man to woman in late 2015. Eight months later, former Defense Secretary Ash Carter lifted the military’s ban on transgender service, and by the following March, Ketchum had completed the steps to change her gender in the military’s personnel system.
Now, as the Army is bringing women into its first gender-integrated infantry units, she is by default one of the first women to serve in the infantry — in an all-male unit, no less.
“Wow, what are the odds?” Ketchum told Army Times in March, as she was waiting for her battalion commander’s signature to finish her transition. “I just really want to be happy.”
But that could all come crashing down now, following President Trump’s July 26 announcement via Twitter that he intended to ban military service for transgender Americans.
....Transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming.....— Donald J. Trump (@realDonaldTrump) July 26, 2017
After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow......— Donald J. Trump (@realDonaldTrump) July 26, 2017
....victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you— Donald J. Trump (@realDonaldTrump) July 26, 2017
The tweets came more than a year after Carter lifted the previous ban, allowing currently serving troops to come out of the closet. By late September, the Defense Department had released a directive with regulations for how trans service members could go about changing their genders on their military records.
Carter had given the department until July 1 to implement a transgender accessions policy, which became a sticking point after he was replaced by retired Marine Gen. Jim Mattis when the Trump administration came in.
Mattis opted to delay allowing transgender civilians to enlist or commission into the military, pending further study, announcing the move on June 30.
A Mattis memo says he wanted to give the services time to ensure the change won't affect readiness.
Trump’s tweets threw a wrench in those plans, but according to a July 27 statement from Chairman of the Joint Chiefs of Staff Marine Gen. Joseph Dunford, the department won’t be making any policy changes until it receives a memo from the White House and puts together an implementation plan.
All transgender U.S. servicemembers will continue to be treated with respect, but DOD will eventually implement President Donald Trump’s policy which may ban their service, Chairman of the Joint Chiefs Gen. Joseph F. Dunford said Thursday.
Meanwhile, when the news first broke, Ketchum was called in to meet with her chain of command, to include her battalion commander, company commander, platoon leader, platoon sergeant and team leader.
“They said that just because it’s a tweet – they need written policy,” she told Army Times on Tuesday. “They’re not just going to act on a tweet. So they told me to just keep doing what I’m doing.”
Under the radar
Though trans service members were officially banned prior to 2016, many troops were able to take hormones and begin their transitions while serving, while keeping up with physical and appearance standards.
Ketchum spent more than a year taking female hormones and saving for a battery of facial surgeries while deploying to Korea with her unit, beginning in late 2015.
Just as she was coming home, the service released its transition policy for transgender soldiers.
“I was already far into my hormone replacement therapy by that time, but it really did make a lot of things easier,” Ketchum said.
The policy requires transgender soldiers to get a diagnosis from a military doctor, outline a plan for transition, then complete it and have it signed by their battalion commander.
“It helped with allowing me to go out and get my surgery done, as well as getting started on all the important paperwork and whatnot to start pushing toward changing my gender on [the Defense Enrollment Eligibility Reporting System],” she said.
Ketchum’s treatment plan included her existing hormone therapy and some cosmetic surgeries to feminize her looks, which she paid for out of pocket while on approved leave.
The Army declined multiple requests from Army Times to provide the number of soldiers currently seeking to change their gender markers, but the Associated Press reported in October that there were 10 on the record at the time.
Ketchum is one of several transgender soldiers who have come out in recent years, including some still on active duty, like Staff Sgt. Tricia King, based at Joint Base Lewis-McChord, Washington, who told her story to Business Insider in 2016.
“There’s plenty of transgender people who were in the Army. A lot of them have gone out and retired and that’s usually when they transitioned,” Ketchum said. “The first wave of us is having to test out all these newer processes and dealing with this, especially in combat MOSs. Hopefully I help out someone who ends up in the same shoes as me.”
‘You’ll never be a girl’
Like many transgender people, Ketchum first realized that what she saw in the mirror and what she felt inside didn’t match up when she hit puberty.
“It scared the hell out of me,” said the Mesa, Arizona, native. “At home is when I dressed up as a girl. I wasn’t very confident to dress up as a girl in school.”
Once high school was over, she was faced with a decision.
“I had mediocre grades, so I knew that I didn’t want to get any loans to pay for college nor did I want to work at some dead-end job,” she said.
The Army offered “something different,” she said, but she was pretty sure she wouldn’t be able to join if she transitioned first. So at 19 years old, she enlisted in August 2014, and found herself at infantry basic training at Fort Benning, Georgia.
“I picked it because it sounded cool,” she said, adding that despite her gender identity, she had no trouble envisioning herself as the G.I. Joe-type.
She reported to 2nd Battalion, 8th Cavalry Regiment, 1st Armored Brigade Combat Team, 1st Cavalry Division, where, at least in the beginning, everyone just assumed she was a gay man.
“They all got a hint of it,” Ketchum said. “I kind of already looked pretty feminine, and I was already attracted to guys and kind of dressing up with girl pants all the time and tighter shirts than anyone else.”
She “just seemed like a regular soldier,” Capt. Tony Nguyen, her former company commander, who took over in May 2015, told Army Times in February.
It wasn’t until later that year that the other shoe dropped — Ketchum found out that she could take hormone replacements while serving.
“Originally what I had planned was, I was going to transition after I got out of the Army, because I didn’t know I was allowed to transition while I was in,” she said.
But by going to a civilian doctor, she was able to pay out of pocket and begin her transition while on active duty, then plan to start living as a woman after her enlistment ended.
She did, however, let the chain of command know.
“I just wanted to let him know, ‘Hey, what’s your plan? What’s your timeline? What are your goals?’” Nguyen said. “I try to be very empathetic toward the soldiers, but I know you’re going to go through a struggle. I was trying to be as supportive as possible with her transition at the time.”
The company commander consulted an Army behavioral health specialist, then ran his plan up the chain of command.
“I just notified my boss, ‘Hey, sir, I have one soldier going through the process, and I’m not going to treat him, at the time, any different from the other soldiers,’ ” he said. “I also pitched my boss my plan. He’s still identified as a male at this point in time, so as long as he can uphold the male standards, it’s good to go.”
Ketchum continued to keep her hair short, wear the male uniform and pass the male fitness test.
“Hormones do a lot, and the first thing they do is affect your physical strength,” she said. “But I’m still able to ruck and all that, to do my job. It’s just the push-ups.”
But as expected, the gay jokes from her platoon mates escalated, Ketchum said.
“They tried to shut it down with their comments, saying that ‘You’ll never be a girl,’” she said. “It got physical. It got pretty bad. You can only imagine, having breasts develop in a unit like this.”
Things came to a head during a trip to the field, Nguyen said, when Ketchum took exception to a discussion between two other soldiers, and it escalated to throwing fists. A similar thing happened at their battalion Christmas run.
“We expected it to happen, because it’s just the nature of being in the infantry,” Nguyen said. “Folks are just unnaturally cruel to each other, all the time, regardless of your gender.”
Ketchum brought her concerns to her first sergeant, she said, and that group of soldiers never bothered her again.
“You have to think about the enlisted population,” Nguyen said. “They’re fairly young, and their maturity level is not so great.”
His advice to Ketchum was to be open about the transition, but also to let some things go.
“Alex was a little immature at the time, in the beginning, where he wanted to make a big deal out of everything,” Nguyen said. “And I told him, ‘Hey look, man, I’m here to support you 100 percent. But if you don’t choose which battles to fight, you’re just going to be viewed as that guy or that gal who doesn’t want to play ball — you’re going to isolate yourself from your peers. They’re not going to even want to be around you, because they’re going to fear you causing a SHARP complaint against them or something.’”
Meanwhile, the Army was working to integrate its last male-only MOSs — the last of which were the infantry and cavalry — by creating mixed gender units with a certain number of female officers and noncommissioned officers.
But in 2016, there was nowhere else for a soldier like Ketchum to go.
“I wasn’t worried about how I had no female leadership in the company. Other folks were concerned that we had no female leadership in the company,” Nguyen said. “Alex would’ve had to go somewhere else. Well, where would she go in the Army that has female leadership in the infantry, at this point in time?”
There were some discussions about what to do, he added, and a feeling that maybe the battalion would rather pass his soldier off to another unit rather than support her.
“That was my frustration, too. Instead of being supportive of the process, they were trying to find — hey look, what’s legally allowed? What’s medically allowed? They were being more risk-averse than being supportive of the soldier,” Nguyen said. “I receive my orders and I execute. However, at the end of the day, I’m not going to treat any soldier any less than what they deserve.”
That battalion commander did not pass Ketchum’s story along to the brigade commander, Nguyen said, which he found out during a conversation with the colonel.
“So every time something happens with Alex, every incident that occurs, I brief my boss, just so that he’s tracking. Every fight, every argument, every medical appointment, even her surgery. Just keep him informed,” he said. “I was taken aback when the brigade commander wasn’t even tracking about this.”
The situation stayed mostly between the captain, his first sergeant and Ketchum.
“With me, when I talked to a few folks in the brigade, they were like, ‘Oh, you’re not the only one with a transgender soldier in your formation.’ Oh, really? Then how is this the first time that anyone is hearing about this?” he said. “I think the battalion commander was being cautious — too cautious — in waiting to engage the brigade commander until the Army policy came out.”
‘Ahead of the guidance’
By the end of June 2016, the Defense Department had officially lifted its ban on transgender service members, and put it to the services to put their own directives in place.
“That gave me a leg to stand on, to tell my boss, no, I’m not going to find a reason to get rid of this person,” Nguyen said.
And, conveniently, Ketchum’s ad hoc transition was right in line with what the Army released as a policy.
At the end of September, a directive for currently serving soldiers went live. Those wishing to transition would need a diagnosis from a military doctor, a tailored transition plan — detailing medications, surgeries and the amount of time required — and a signature from a battalion-level commander.
“Alex was so far along in the process that she was actually ahead of the guidance,” Nguyen said.
It had taken just a few months for a couple of working groups at the Defense Department and within the Army to put it together, using testimony from currently serving transgender soldiers, expertise from VA doctors currently treating transgender veterans, and research from partner nations who allow transgender troops to serve openly, according to the Army secretary’s supervisory assistant deputy for health affairs within manpower and reserve affairs.
“As far as the medical plans, we went with official society guidelines,” Col. Mary Krueger told Army Times in May. “The 2009 Endocrine Society guidelines are considered to be the standards of care for management there. For health affairs, they actually brought in experts who were currently performing care of transgender service members.”
Ketchum went in her for diagnosis days after the policy dropped.
“They saw the fact that I’ve been on hormones for a while, nothing in my mind is changed, I’ve already had everything saved up for this surgery,” she said. “There was really no reason not to diagnose me for gender dysphoria.”
Almost a year into hormone treatments and saving for surgery, her transition was nearly complete before the paperwork got moving.
“It helped with allowing me to go out and get my surgery done,” she said.
In December, Ketchum flew to California for surgery to feminize her appearance. She had her nose slimmed, her Adam’s Apple shaved, her brow bone shaved and her brow area lifted.
Four months later, her battalion commander signed off on her transition, and she was officially a woman in the infantry. She’d also made the decision to re-enlist.
“What changed? I kind of like it,” she said of the grunt life. “When we’re not doing BS, cleaning and tedious stuff, when we actually do our jobs, it’s pretty cool.”
It’s also a steady job, she added.
“It’s not a bad deal, what you get out of it. You get job security, a place to live and food — even if the food’s crap,” she said. “You have decent pay, you get free medical care. I know a lot of people are struggling out there in the civilian world. I don’t want to struggle out there, especially with what I’m doing.”
But now that the Army has caught up to her, Ketchum’s options for her next unit are a brigade at Fort Hood, where she is, or one at Fort Bragg, the only two places in the infantry with gender-integrated chains of command.
I’ve already been told that I’m like the guinea pig in all this, and I’m paving the way for all the other people that are coming in, so they don’t have to go through the inconvenience that I have to go through,” she said.
But she’s not concerned about having to reintroduce herself to another unit.
“I’m just going to do the same that I did here and pretty much just go with the flow,” she said. “It’s policy now, so as long as I keep repeating what I did when I was here, I don’t think there’ll really be much problem.”
The Army does plan to study the implementation of its transgender policy, Krueger said, with as little intrusion as possible.
“Overall, in the bigger picture, the Army will be taking a look to see how effectively the policy was rolled out,” she said, in terms of development and then training for individual units. “We usually use our [inspector general] for that process, because they go and do inspections to make sure we’re doing what we say we’re doing.”
Nguyen suggested that medical or behavioral health keep track of the transitions and that units and soldiers be able to report any issues as they arise, without any mandatory meetings or follow-up from the chain of command.
“That commander’s perspective is exactly one of the reasons why we’re not reaching down and getting into their business at that level,” Krueger said.
There is a central DoD coordination cell that commanders can reach out to, she said.
“If a soldier going through the process is having issues, then the Army needs to look at their chain of command and how their chain of command is supporting them, not the individual soldier,” Nguyen said.
Ketchum said she would be happy to share her feedback and be a resource for the Army to introduce to other soldiers.
“I totally would. It’s only fair,” she said. “That’s the whole point, for people to feel more confident in doing this, and not feeling like they have to be in the closet. And living out their career worried.”
For now, currently serving transgender troops are safe, but DoD has yet to enact an accessions policy with guidelines for transgender civilians to enlist or earn their commissions.
The directive, which was scheduled to go into effect this summer, has been delayed for at least six months as the four DoD services hammer out requirements, or whether to allow transgender Americans to join at all.
The Army and Marine Corps have had the most concerns, a military official told Military Times, including what qualifies as a completed transition and how long a recruit has been stable in their new gender before signing a contract.
Despite the logistics of allowing transgender troops to openly serve, Nguyen said, he thinks the service is moving in the right direction.
“I think the Army is taking the right steps. The maturity level in the service has changed a bit,” Nguyen said. “You read all the bad news in the media these days, but you do see the best of the best in America in the military. They are able to handle controversial issues such as this.”
Nothing has changed for now, but the services are prepared to follow Trump’s policy. In the meantime, congressional Democrats and the American Civil Liberties Union have vowed to fight the decision with legislation or lawsuits, if it comes to that.
DoD, if it returns to a ban on transgender service members, would have to decide whether to grandfather in those currently serving, or come up with a severance package that would include an honorable discharge, complete with education and other veterans’ benefits.
Critics of transgender service point to issues of cost for medical care as well as unit readiness, because surgery recovery time and seeking behavioral health treatment can render a service member non-deployable.
A 2016 RAND study estimated that the military would spend $8 million a year on transition-related medical care, calling the expense ”minuscule” in the scope of DoD’s current medical bills.
The most expensive and involved part of transition would be genital reassignment surgery, which most transgender people do not undergo.
Much more common are cosmetic surgeries like breast implants or reductions, as well as facial surgeries, that are not covered by DoD — like the ones Ketchum paid for herself.
“If I were to get reassignment surgery, it would definitely be out of my own pocket,” she said. “I would want to go to my own surgeon instead of the military giving it to me.”
Further, she said, it’s not in her plans.
“I think that’s kind of too far. They’re already covering our hormones, and the majority of transgender people don’t actually go through with getting reassignment surgery,” she said. ”I want to be able to deploy with my unit. One year or more for recovery is a little bit much.”
Ketchum, for her part, is hoping for the best — joining a gender-integrated infantry unit at Bragg or Hood later this year — as well as preparing for the worst.
“It’s all about waiting, really. Now, I feel like I should still be getting out with my benefits, if that’s the situation. It would just be a separation,” she said. “At that point, I would just go to college, honestly.”
Ketchum still wants to serve, regardless, she said.
“I mean, if feels kind of sh---y and kind of screwed up, but it doesn’t make me regret serving,” she said.