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Transsexualism / Transgenderism in the US Military

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[quote]To minimize confusion in this post, I will combine the terms transsexual(ism) and transgender(ism) to just "trans" and "trans-ism." These terms are still relatively new and have not yet been fully defined, especially due to their many similarities.

Various interest groups and political leaders have begun to investigate the policies of denying trans personnel from joining the US Military, the administrative separation of trans personnel upon discovery, and denying coverage for trans procedures or care.
[url="http://www.defense.gov/news/newsarticle.aspx?id=122225"]http://www.defense.gov/news/newsarticle.aspx?id=122225[/url]
[quote]
Hagel was also asked whether department policy regarding trans individuals serving in the military should be revisited now that gays and lesbians are allowed to serve openly. He called the issue complicated because of its' medical component.
“These issues require medical attention. In austere locations where we put our men and women in many cases [those military posts] don’t always offer that kind of opportunity,” he explained.
“I do think it should continually be reviewed … because the bottom line [is] every qualified American who wants to serve our country should have an opportunity, if they fit the qualifications and can do it. This is an area we’ve not defined enough,” Hagel said. [/quote] This is a politically sensitive topic in a progressively tolerant society. Additionally, as recent policy changes allowing Lesbian, Gay, and Bisexual individuals to continue to serve, it seems the DoD is still discriminating or punishing the last letter of the ever so popular acronym, "LGBT."

Why is the military allowed to deny entry or discharge personnel for these conditions? Titles 10 and 14 of the US Code and the Civil Rights Act of 1964 only protect against discrimination based on race, color, religion, sex and national origin. Age and medical conditions are not protected. Note that the Americans with Disabilities Act and Title 42 of the US Code generally do not apply to uniformed military service members, but they usually extend to most civilian personnel in the DoD. This also means that unless the Supreme Court rules at some later date, the legislature could reinstate some version of DADT, or repeal the repeal of DADT and allow the DoD do selectively enforce it in it's own way. Of course this is definitely not going to happen anytime soon, but the point is that it could legally happen.

One of the key points is that the Air Force and DoD do not consider trans-ism "unfitting" but rather "unsuiting." In short something "unfitting" is a medical disability or disease that prevents military service due to a physical condition (AFI 48-123), while something "unsuiting" is a behavior or disorder that somehow precludes service due to the nature of the condition and the requirements of military service (AFI 36-3208). Some conditions blur this line, and others have specific exemptions, such as PTSD. These categories are considered beyond the member's control and the member will not be "punished" but may require application of "Force Management Programs."

An example of this subtle difference might be highlighted in a presumptive ADHD diagnosis. Let's imagine an Airman sees her PCM with a complaint of difficulty concentrating. After some discussion, the doctor might order some laboratory tests.
[list]
[*]If the labs are normal, the doctor may refer the patient to Mental Health and/or the Behavioral Health Optimization Program (BHOP). Despite a year or more of counseling and various medication trials, the member has had minimal improvement. She has continued difficulty performing her duties and little desire to remain in the Air Force. Her Mental Health providers and Commander would likely pursue an Administrative Discharge for an "unsuiting" condition. This would be a UNIT COMMANDER ADMINISTRATIVE action with MEO/EEOC and AF/JA oversight.
[*]If the labs identify an abnormally low TSH levels and other results, the doctor refers the member to an Endocrinologist. The specialist diagnoses her with some variant of hyperthyroidism. After a year of various medication trials and possible procedures, the hyperthyroidism is only minimally controlled and still requires regular evaluation by the Endocrinologist, regardless of whether her ADD-like symptoms have improved or not. Her doctor compiles the medical information from her medical record and begins the Initial Review In Lieu of Medical Evaluation Board (I-RILO MEB) process for an "unfitting" condition. This would be a MEDICAL action with PERSONNEL (AFPC) oversight.

[/list] AFI 36-3208, para. 5.11.9. states that to pursue administrative discharge, "[...] A recommendation for discharge under these provisions must be supported by a report of evaluation by a psychiatrist or PhD-level clinical psychologist who confirms the diagnosis of a disorder listed below, as contained in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). [...]" The specific definition is in para. 5.11.9.5. as "Transsexualism or Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT)."
The most recent edition of the DSM has changed the class of disorders from “Sexual and Gender Identity Disorders” to the more accommodating term of "Gender Dysphoria." This move was to emphasize that [url="http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf"]"Gender identity disorder [...] is neither a sexual dysfunction nor a paraphilia."[/url] Despite this change, the American Psychiatry Associations' compromising and opinion, the DoD retains ultimate ownership of personnel actions.

But why does the DoD consider trans-ism "unsuiting?" There will likely be numerous and varied answers to this question in the coming months, but here's my belief in the reality. In general, these conditions just aren't conducive to military service and are costly to the Military Health System. These conditions, whether they are presumably resolved prior to entry or not, and whether they will or have undergone surgical procedures or not, will almost certainly require extensive medical support. The specialty services most likely to be heavily utilized might include psychiatry/psychology/behavioral health, endocrinology, and urology/gynecology. The US Military doesn't exist to provide health care no matter how significant or costly a condition may be (though it doesn't always feel that way), but rather to provide independently-medically capable servicemembers to execute the various missions of the DoD. Such frequent evaluation and medical support precludes deployment or assignment to numerous locations, such as Korea, Turkey, or Africa. In summation, the logistics just don't add up.
Certainly there will be many people who would decry trans-ism as some corruption or aberrance, or others who could claim it would demoralize the unit. Whether these reasons have any merit or applicability is secondary. In the 21st century, it appears that religion and culture will be taking a back seat to finances.[/quote][/background][/size][/font][/color]
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Expect the topic of intersex and chromosomal abnormalities to creep into transgender discussions. Transgenderism/Transsexualism can be under the umbrella of Gender Dysphoria, a psychiatric condition (possibly with contributing neurological conditions). Intersex is a general medical term for certain abnormalities of the reproductive system, including the presence of organs of both sexes (aka hermaphroditism). Chromosomal abnormalities are related to intersex but covers an even wider category of conditions. For anyone interested in this topic, I recommend you read these articles as an introduction.

http://hosted.ap.org/dynamic/stories/U/US_MED_INTERSEX_CHILDREN

http://www.nlm.nih.gov/medlineplus/ency/article/001669.htm

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http://endtransdiscrimination.org/report.html

Interesting data. This shows at what age trans folks transition. Where we lack data is how many people importantly, specifically, are there more FTM or MTF persons? Assuming they are about even, and these policies for trans individuals to serve are changed, there would more likely be FTM people in junior Enlisted ranks, and more MTF in Officer and senior Enlisted ranks. Of course this doesn't consider the generational mindset of people born in the 70's and before, and the people who would've joined from that time.

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