VA Secretary Denis McDonough made the announcement about the VA planning to offer gender confirmation surgery to transgender veterans at a Pride event in Orlando, FL, last month. McDonough is shown here raising the Pride flag over VA headquarter.
Photo from the Office of the Secretary of Veterans Affairs Twitter feed
WASHINGTON — With VA’s announcement that it will begin initiating the process to offer gender confirmation surgery to transgender veterans, the move highlights not only the shift between one administration and the next in how transgender individuals are treated, but also how the larger cultural conversation has changed in regard to their rights.
VA Secretary Denis McDonough made the announcement last month at a Pride event in Orlando, FL, saying it was “the right thing to do.”
“We are taking the first necessary steps to expand VA’s care to include gender confirmation surgery—thereby allowing transgender vets to go through the full gender confirmation process with VA at their side,” he declared.
Transgender veterans currently can receive all gender-confirming care at VA, with the exception of gender confirmation surgery. Servicemembers and veterans have testified before Congress about how difficult it is to receive gender-confirming care when it needs to be fragmented between military, VA and private providers, depending on what services are covered.
In 2019, seeking this type of care became more difficult for active duty servicemembers when President Donald Trump instituted a ban on all transgender individuals serving in the military. He cited the “tremendous medical costs” of gender confirmation treatment as justification for the ban. It was a position that some defense and healthcare officials said they could not support, explaining that the estimated $8 million cost was a miniscule fraction of DoD’s budget.
This image is on the VHA’s LGBTQ+ Health Program’s website: https://www.patientcare.va.gov/lgbt/
President Joe Biden reversed the ban when he entered office. He also directed the Department of Health and Human Services to prohibit discrimination on the basis of sexual orientation and gender identity by healthcare organizations receiving federal funding. This reversed a Trump-era policy that allowed these organizations to discriminate against transgender individuals.
The new policy at VA will take time to finalize. It requires a change in the Code of Federal Regulations, which VA has warned could take as long as two years. VA plans to use that time to hire providers and develop the framework to provide a full continuum of care for those seeking gender-confirmation surgery.
As for how many veterans that will include, VA is estimating that fewer than 4,000 veterans would be interested in this type of procedure. The department said it will work to estimate the annual cost of the rule change as they move forward with implementing it; VA officials noted, however, that the cost will vary depending on whether the veteran seeks the care in VA or through a community partner.
This is not the first time VA has tried to change the rules banning the department from providing gender confirmation surgery. VA proposed the same rule change in 2016. However, it approached the move much more hesitantly, announcing it would be taking public comments prior to initiating the rule change.
Before the public comment period even began, VA hit a wall of criticism from legislators and conservative critics. Many questioned whether VA had the resources and whether gender confirmation surgery—then referred to as sex reassignment surgery—was medically necessary.
Shortly afterward, Trump began his four-year term, and the proposal to lift the ban quickly died.
VA’s recent announcement was met with much the same criticism as five years ago, with opponents focusing on tight funds and intimating that gender-confirmation surgery is not medically necessary.
“President Biden and Secretary McDonough should be less focused on winning the culture wars and more focused on helping the veterans who are suffering from the actual wars,” declared Rep. Mike Bost (R-IL), the ranking Republican on the House Committee on Veterans’ Affairs. “Congress has been waiting for months for them to come to the table and help us deliver care and benefits to toxic-exposed veterans who are sick and dying. We have gotten no response. Yet, somehow, they found time to decide that taxpayers should pay for gender transition surgeries at VA medical facilities. This announcement clearly has more to do with advancing a radical liberal agenda than serving veterans.”
The medical literature around gender confirmation surgery has grown in the last five years, however, and studies have found the long-term mental health benefits to be significant. A 10-year longitudinal study released in August 2020 found that, for every year that passed since the surgery, the likelihood of the individual seeking mental health treatment appeared to fall by as much as 8%.1
According to VA officials, the impetus for the rule change is rooted in serving veterans.
“Gender-affirming procedures have been proven effective at mitigating serious health conditions, including suicidality, substance abuse and dysphoria,” a VA spokesperson explained. “Updating this policy would allow VA to provide transgender and gender diverse veterans with coordinated, medically necessary, transition-related surgical procedures. In addition, revising the medical benefits package would enable a safe, coordinated continuum of care that is veteran-centric and consistent with VA values of equity and respect for all veterans.”
- Bränström R, Pachankis JE. Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. Am J Psychiatry. 2020 Aug 1;177(8):727-734. doi: 10.1176/appi.ajp.2019.19010080. Epub 2019 Oct 4. Erratum in: Am J Psychiatry. 2020 Aug 1;177(8):734. PMID: 31581798.
