March 13, 2014

Former Surgeon General Faults Military’s Transgender Ban

SAN FRANCISCO, CA – March 13, 2014 – A commission co-chaired by a former US Surgeon General released a report today concluding that the Pentagon’s ban on transgender military service is not based on sound medical reasoning, according to the Associated Press. In one of the first and most detailed assessments of the basis and impact of the current policy, the Transgender Military Service Commission examined all medical and psychological aspects of transgender military service, and found inconsistencies and inaccuracies in the Pentagon’s rationale for the exclusionary policy, which remains in affect despite the scrapping of “don’t ask, don’t tell.”

According to the commission’s report, “there is no compelling medical reason for the ban,” which the commissioners also found to be an “expensive, damaging and unfair barrier to health care access for the approximately 15,450 transgender personnel” who currently serve in uniform. “Medical regulations requiring the discharge of transgender personnel are inconsistent with how the military regulates all other medical and psychological conditions,” the report found, “and transgender-related conditions appear to be the only gender-related conditions that require discharge irrespective of fitness for duty.”

“The ban on transgender service has long been a policy in search of a rationale,” said Dr. Joycelyn Elders, who served as US Surgeon General from 1993 until 1994. “We looked hard for any type of sound rationale and found none. Reforming the policy is really a simple matter of updating references to outdated medical science and removing unnecessary barriers to enlistment and retention.” Dr. Elders and former Coast Guard Director of Health and Safety Alan Steinman co-chair the commission, which is sponsored by the Palm Center.

In addition to Dr. Elders and Admiral Steinman, the commission includes a retired general and two of the nation’s leading scholars on medical aspects of gender nonconformity. Palm Center Director Aaron Belkin said the new report “challenges US policymakers and political leaders to reassess why the military still bans transgender personnel when the policy has outlasted its rationale.” Unlike “don’t ask, don’t tell,” he said, the transgender service ban is not regulated by federal statute but by Pentagon policy, and could be eliminated by the president.

Admiral Steinman said that addressing the healthcare needs of transgender personnel “is no more complex or difficult than other routine medical situations that the military deals with thousands of times a day.” Admiral Steinman served as the Coast Guard’s Director of Health and Safety (equivalent to both the Surgeon General and Chief of Safety Programs for the other branches of the armed forces) from 1993 until 1997.

Among the report’s findings:


  • There is no compelling medical rationale for banning transgender military service, and medical regulations requiring the discharge of all transgender personnel are inconsistent with how the military regulates medical and psychological conditions.
  • Medical conditions related to transgender identity are the only gender-related conditions requiring discharge irrespective of fitness for duty.
  • Eliminating the ban would advance numerous military interests, including enabling commanders to better care for their service members.
  • Other military regulations have been updated to reflect the latest consensus of psychiatric experts on mental health issues, but while that consensus no longer classifies gender non-conformity as a mental illness, military regulations have not been amended to reflect the latest understanding of the scientific community about gender non-conformity.
  • The prohibition on medically-necessary cross-sex hormone treatment is based on inaccurate understandings of the complexity, risks and efficacy of such treatments, and is inconsistent with the fact that many non-transgender military personnel use prescribed medications of similar strength, even while deployed to combat zones.
  • Non-transgender personnel are allowed to undergo reconstructive surgeries, while transgender personnel are barred from obtaining medically-necessary gender-confirming surgery, at great cost to their physical and mental health.
  • Existing medical and other regulations are fully adequate to govern the service of transgender personnel and any related medical conditions that arise.
  • The US military can look to the experiences and standards of at least twelve allied militaries that allow transgender service, as well as several inclusive US federal agencies, as models in formulating administrative policy to address fitness testing, records and identification, uniforms, housing and privacy for transgender military service.