Uncle Sam foots the bill

Dr. Patrick Lappert of Decatur, Ala., is a plastic surgeon who served in the U.S. Navy for 24 years. Recently, a patient sought to remove tattoos from her lower arm to qualify for military enlistment. The patient, in her mid-20s, identified as a male and was taking cross-sex hormones, which had led to severe metabolic syndrome and diabetes. The patient was planning to enlist in the military after hearing it would now fund surgeries to further alter her body to appear as male.

“The patient thought tattoos would be disqualifying but not the other medical conditions resulting from taking cross-sex hormones,” Lappert said. “This speaks to guidance that is being passed down from higher authority.”

Five days into his term, President Joe Biden reinstated a 2016 Obama administration policy permitting transgender individuals to serve openly in the U.S. military. Former President Donald Trump revoked the policy in 2017. Biden’s executive order cited two former U.S. surgeon generals stating transgender troops are as medically fit as their non-transgender peers and that there is no medically valid reason, including gender dysphoria, to bar them from military service or limit their access to “medically necessary” care.

The Pentagon followed the order with a new policy in March offering transgender troops access to medical treatments and surgeries to present as the opposite sex. Now, as service branches roll out policies on transgender troops, concerns remain that the military is relying on unproven gender theories on happiness and psychological wellbeing over military readiness and morale.

“The real cost is to the mission of the military and the effectiveness of the military,” said Elaine Donnelly, president of the Center for Military Readiness. “Military effectiveness will be made secondary. … The intangible costs and effects on military culture are incalculable.”

Military policy, such as the Army’s directive released in June, require active service members to receive a diagnosis of gender dysphoria and establish a treatment plan, which could include therapy, cross-sex hormones, and surgical interventions. Once the treatment plan is completed, the service member can change their gender marker to reflect their self-identified gender. Individuals with gender dysphoria wishing to enlist must first live in their self-identified gender for 18 months and obtain government identification or a court order with their changed identity.

Lappert believes politics, not science or military readiness, is driving the policy. He noted service members taking cross-sex hormones require regular blood monitoring, according to Endocrine Society guidelines, due to the high likelihood of elevated blood pressure and metabolic syndrome. This would render them unsuitable for overseas combat or service in remote duty locations.

Donnelly said the policies also fail to account for incalculable costs such as recovery, travel time, and complications associated with transgender surgeries; elevated depression and suicide rates; the impact on women’s athletics and private spaces; and the loss of military doctors and nurses who object to performing irreversible and experimental medical interventions because of ethical concerns.

Transgender medical interventions have come under growing international scrutiny. Critics point to the lack of scientific evidence and long-term studies on treatments and surgeries for individuals with gender dysphoria and to the lifelong and irreversible effects.

Between 2015 and 2017, 994 active duty service members diagnosed with gender dysphoria accounted for 30,000 mental health visits, according to military data retrieved for a 2018 report prepared by former Defense Secretary James Mattis.

The military has already absorbed a high price tag for integrating transgender troops and funding surgeries to permanently alter their bodies. The Pentagon has spent $15 million since 2016 treating 1,892 transgender service members, according to Defense Department data obtained by Military.com. Of that amount, $11.5 million went to psychotherapy and $3.1 million was spent on 243 “gender affirming” surgeries, many of which Lappert noted are elective aesthetic surgeries, such as mastectomies for women, breast augmentation for men, removing genitalia, surgically replicating genitalia, facial surgeries, hair removal, and voice reduction operations.

Lappert said a female-to-male chest “masculinization” surgery costs roughly $5,600, whereas genital surgeries cost up to $150,000. This was consistent with prices listed at the Philadelphia Center for Transgender Surgery, for example, where “male-to-female” surgeries were estimated to cost $140,450.

“With the knowledge that the military provides these services or pays for them, the floodgates are going to open,” Lappert said.