Impact of Transgender Personnel on Readiness and Health Care Costs in the U.S. Military Likely to Be Small

For Release

June 30, 2016

If the U.S. military decides to let transgender people serve openly, the number would likely be a small fraction of the total force and have minimal impact on readiness and health care costs, according to a new RAND Corporation study.

The U.S. Department of Defense has been reviewing its policy on allowing transgender personnel to serve openly and receive gender transition-related treatment during military service. The Office of the Secretary of Defense asked RAND, a nonprofit research institution, to study the health care needs of this population, identify potential health care utilization and costs associated with extending health care coverage for transition-related treatments, assess the potential readiness impacts of allowing transgender service members to serve openly, and review the experiences of foreign militaries.

Because there have been no rigorous studies of the size or health care needs for either the U.S. transgender population or the transgender population serving in the military, the RAND study applies a range of estimates from available research to estimate the number of transgender individuals serving in the military.

The study estimates the number of transgender individuals currently serving in the active component of the U.S. military at between 1,320 and 6,630 out of a total of about 1.3 million service members. However, not all of these transgender service members would be expected to seek medical treatment related to their gender status or become nondeployable.

“Only a small portion of service members would likely seek gender transition-related medical treatments that would affect their deployability or health care costs,” said Agnes Gereben Schaefer, lead author of the study and a senior political scientist at RAND.

The study estimates that between 30 and 140 new hormone treatments could be initiated a year and 25 to 130 gender transition-related surgeries could be utilized a year among active component service members. Additional health care costs could range between $2.4 million and $8.4 million, representing an approximate 0.13-percent increase.

In terms of readiness, RAND estimates that 10 to 130 active component members each year could have reduced deployability as a result of gender transition-related treatments. This amount is negligible relative to the 102,500 nondeployable soldiers in the Army alone in 2015, 50,000 of them in the active component.

Eighteen countries allow transgender personnel to serve openly in their militaries. RAND researchers focused on the policies of four with the most well developed and publicly available policies on transgender military personnel: Australia, Canada, Israel and the United Kingdom.

In these militaries, a service member's gender is considered to have shifted in terms of housing, uniforms, identification cards, showers and restrooms when a service member publicly discloses an intention to live as the target gender and receives a diagnosis of gender incongruence. However, physical fitness standards typically do not fully shift until the gender transition is medically complete. In no case did the RAND team find evidence of an effect on operational effectiveness, operational readiness or cohesion.

“The foreign militaries we studied have reported harassment and bullying incidents, but these effects have been mitigated by having clear policies and comprehensive training across their militaries,” Schaefer said.

If the U.S. Defense Department were to decide to allow transgender service members to serve openly, the RAND study recommends the department:

  • Make sure there is strong leadership support
  • Develop an explicit written policy on all aspects of the gender transition process
  • Provide education and training to the rest of the force on transgender personnel policy, but integrate this with other diversity-related training and education
  • Develop and enforce a clear anti-harassment policy that treats harassment aimed at transgender personnel like other forms of harassment
  • Make subject-matter experts and gender advisers serving within military units available to commanders seeking guidance or advice
  • Identify and communicate the benefits of an inclusive and diverse workplace.

Other authors of the study, “Assessing Implications of Allowing Transgender Service Members to Serve Openly,” include Radha K. Iyengar, Srikanth Kadiyala, Jennifer Kavanagh, Charles C. Engel, Kayla M. Williams and Amii M. Kress.

Research for the study was sponsored by the Office of the Secretary of Defense and conducted within the Forces and Resources Policy Center of RAND's National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Department of the Navy, the Marine Corps, the defense agencies and the defense intelligence community.

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