The U.S. Department of Defense is considering a change in policy to allow transgender military personnel to serve openly. A RAND study examined the health care needs of transgender personnel, the costs of gender transition–related care, and the potential readiness implications of a policy change. The experiences of foreign militaries that permit transgender service members to serve openly also point to some best practices for U.S. policymakers.

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Assessing the Implications of Allowing Transgender Personnel to Serve Openly

by Agnes Gereben Schaefer, Radha Iyengar Plumb, Srikanth Kadiyala, Jennifer Kavanagh, Charles C. Engel, Kayla M. Williams, Amii M. Kress

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Research Questions

  1. What are the health care needs of the transgender population?
  2. What is the estimated transgender population in the U.S. military?
  3. How many transgender service members are likely to seek gender transition–related medical treatment?
  4. What are the costs associated with extending health care coverage for gender transition–related treatments?
  5. What are the potential readiness implications of allowing transgender service members to serve openly?
  6. What lessons can be learned from foreign militaries that permit transgender personnel to serve openly?
  7. Which DoD policies would need to be changed if transgender service members are allowed to serve openly?

Recent U.S. Department of Defense (DoD) policy banned transgender personnel from serving openly in the military. Potential changes to this policy raised questions regarding access to gender transition–related health care, the range of transition-related treatments that DoD will need to provide, the potential costs associated with these treatments, and the impact of these health care needs on force readiness and the deployability of transgender service members. A RAND study identified the health care needs of the transgender population and transgender service members in particular. It also examined the costs of covering transition-related treatments, assessed the potential readiness implications of a policy change, and reviewed the experiences of foreign militaries that permit transgender personnel to serve openly.

Key Findings

There Are an Estimated 1,320–6,630 Transgender Service Members in the Active Component, but Not All Will Seek Gender Transition–Related Treatment

  • It is difficult to estimate the number of transgender personnel in the military due to current policies and a lack of empirical data. Applying a range of prevalence estimates, combining data from multiple surveys, and adjusting for the male/female distribution in the military provided a midrange estimate of around 2,450 transgender personnel in the active component (out of a total number of approximately 1.3 million active-component service members) and 1,510 in the Selected Reserve.
  • Only a subset will seek gender transition–related treatment. Estimates derived from survey data and private health insurance claims data indicate that, each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy.

The Costs of Gender Transition–Related Health Care Treatment Are Relatively Low

  • Using private health insurance claims data to estimate the cost of extending gender transition–related health care coverage to transgender personnel indicated that active-component health care costs would increase by between $2.4 million and $8.4 million annually, representing a 0.04- to 0.13-percent increase in active-component health care expenditures.
  • Even upper-bound estimates indicate that less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy.

Previous Integration Efforts and the Experiences of Foreign Militaries Indicate a Minimal Likely Impact on Force Readiness

  • The limited research on the effects of foreign military policies indicates little or no impact on unit cohesion, operational effectiveness, or readiness. Commanders noted that the policies had benefits for all service members by creating a more inclusive and diverse force.
  • Policy changes to open more roles to women and to allow gay and lesbian personnel to serve openly in the U.S. military have similarly had no significant effect on unit cohesion, operational effectiveness, or readiness.

Recommendations

  • DoD should ensure strong leadership and identify and communicate the benefits of an inclusive and diverse workforce to successfully implement a policy change and successfully integrate openly serving transgender service members into the force.
  • DoD should develop an explicit written policy on all aspects of the gender transition process to minimize any impact on service member or unit readiness.
  • DoD should provide education and training to the rest of the force on transgender personnel policy, and it should integrate this training with other diversity-related training and education.
  • DoD should develop and enforce a clear anti-harassment policy that addresses harassment aimed at transgender personnel alongside other targets of harassment.
  • DoD should make subject-matter experts and gender advisers serving within military units available to commanders seeking guidance or advice on gender transition–related issues.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    What Are the Health Care Needs of the Transgender Population?

  • Chapter Three

    What Is the Estimated Transgender Population in the U.S. Military?

  • Chapter Four

    How Many Transgender Service Members Are Likely to Seek Gender Transition–Related Medical Treatment?

  • Chapter Five

    What Are the Costs Associated with Extending Health Care Coverage for Gender Transition–Related Treatments?

  • Chapter Six

    What Are the Potential Readiness Implications of Allowing Transgender Service Members to Serve Openly?

  • Chapter Seven

    What Lessons Can Be Learned from Foreign Militaries That Permit Transgender Personnel to Serve Openly?

  • Chapter Eight

    Which DoD Policies Would Need to Be Changed if Transgender Service Members Are Allowed to Serve Openly?

  • Chapter Nine

    Conclusion

  • Appendix A

    Terminology

  • Appendix B

    History of DSM Terminology and Diagnoses

  • Appendix C

    Treatments for Gender Dysphoria

  • Appendix D

    Review of Accession, Retention, and Separation Regulations

Research conducted by

This research was sponsored by the Office of the Under Secretary of Defense for Personnel and Readiness and conducted within the Forces and Resources Policy Center of the RAND 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 Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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