Despite a recent White House memo announcing the intent to ban most transgender people from military service, ongoing court cases are keeping the military in a holding pattern on the issue.
While Defense Department officials say nothing has changed or will change regarding transgender recruitment or retention until the courts decide, a debate continues to rage over just what the costs and implications are regarding allowing transgender troops to serve openly.
Several active-duty transgender troops, including an officer who advised the Pentagon's "panel of experts" on the matter, said the costs and risks are not as high as some have claimed.
"We will continue to access and retain" transgender individuals in compliance with the rulings of four federal courts despite directives from President Donald Trump and Defense Secretary Jim Mattis based on the recommendations of a thus-far secret Pentagon panel of experts, said Maj. Dave Eastburn, a Pentagon spokesman.
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Eastburn said two transgender individuals had been recruited under court orders to resume enlistments Jan. 1, and no transgender troops currently serving have been forced out pending a final resolution of the legal actions.
Active-duty Air Force Lt. Col. Bryan "Bree" Fram, a 15-year intelligence officer and astronautical engineer, was among nine transgender service members who met with the Pentagon's panel to make the case that they be allowed to continue to serve.
Fram described coming out to colleagues when then-Defense Secretary Ashton Carter in June 2016 directed that transgender troops could serve openly.
"One by one, they came up to me and said, 'It's an honor to serve with you,' " he said.
Fram said he told the Pentagon's panel of experts that the views he was expressing were his own and do not reflect those of the Air Force or the Defense Department.
He declined to give specifics but said, "If people are forced from the military, it would be incredibly unfortunate to be treated differently than any other American. I'm definitely hopeful that, at some point, legislative or judicial action will allow us to continue to serve."
In an article for the Spart*A advocacy group in response to the Pentagon's actions, Fram wrote that despite the proposed ban, "transgender service members will lace up their boots and go to work in service to this nation, just as they have done for their entire career.
"However, those same service members are faced with a reversal of policy that removes their opportunity to better themselves and tells them to leave the military or, if in a narrow segment, stay as a second-class citizen."
Fram took particular issue with the Pentagon study's assertion that transgender service members would be at greater risk of suicide due to mental stress over their sexual identities.
"As far as I am aware, there have been no known suicides of active-duty transgender service members since the policy change," he wrote, referring to the 2016 decision under Carter that permitted transgender troops to serve openly.
On Tuesday, for the second time in as many days, Mattis declined comment on an order announced late Friday night by the DoD and Trump. Advocacy groups claim that order would effectively ban transgender individuals from serving.
"I really don't want to go into that," Mattis said at an off-camera session with Pentagon reporters. "I'm not going to discuss transgender," he added, while court proceedings are underway.
On Monday, Mattis said the transgender directives from the DoD and the White House are part of the overall effort to "build the most lethal service."
But Matt Thorn, head of the OutServe-SLDN (Servicemembers Legal Defense Network) advocacy group, said the proposals would have the opposite effect.
"This is a categorical ban" on transgender individuals serving in the military, Thorn said, and the result would be to "undermine our readiness and lethality."
Panel of Experts
In August, Trump renewed his call for a ban but said he would await the findings of a study ordered by Mattis from a panel of experts, including combat veterans.
The Justice Department has refused to name the experts, but a 46-page report on the panel's findings was issued by the office of Robert Wilkie, undersecretary of defense for personnel and readiness.
In a memo to Trump, Mattis said the study group "included the representatives of the service Secretaries and senior military officers, many with combat experience."
In a memo concurring with Mattis, Trump said the study group's recommendations on transgender service would also apply to the Coast Guard, which is under the Department of Homeland Security.
Trump said he agrees with Mattis that "transgender persons with a history or diagnosis of gender dysphoria -- individuals who the policies state may require substantial medical treatment, including medications and surgery -- are disqualified from military service except under limited circumstances."
Gender dysphoria is generally described as the condition or feeling that one's emotional and psychological identity as male or female is the opposite of one's biological gender.
In his memo to Trump, Mattis also referenced gender dysphoria. He said the Obama administration had "adopted a policy that allowed for the accession and retention in the Armed Forces of transgender persons who had a history or diagnosis of gender dysphoria. The policy also created a procedure by which such Service members could change their gender."
Mattis said, "There are substantial risks associated with allowing the accession and retention of individuals with a history or diagnosis of gender dysphoria" who would "require, or have already undertaken, a course of treatment to change their gender."
Allowing transgender troops to continue to serve "could undermine readiness, disrupt unit cohesion, and impose an unreasonable burden on the military that is not conducive to military effectiveness and lethality," he wrote.
In a statement, Dr. Arthur Evans, head of the American Psychological Association, rejected the conclusions of the White House and Pentagon on gender dysphoria and the ability of transgender people to serve.
Evans said the APA "is alarmed by the administration's misuse of psychological science to stigmatize transgender Americans and justify limiting their ability to serve in uniform and access medically necessary health care."
"Substantial psychological research shows that gender dysphoria is a treatable condition, and does not, by itself, limit the ability of individuals to function well and excel in their work, including in military service," he said.
One of the arguments against the service of transgender troops involves the medical costs of keeping them in the ranks. But Fram said the military currently spends about $80 million annually to treat erectile dysfunction, including about $40 million for Viagra.
"Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail," Trump said in his series of tweets last year.
However, an analysis by Military Times showed that total military spending on erectile dysfunction amounts to $84 million annually, or about 10 times the cost of the annual transition-related medical care for active-duty transgender service members.
Navy Lt. Cmdr. Blake Dremann, a 12-year active-duty supply officer who underwent transition from female to male in the military, said that as a female he helped with the integration of women aboard submarines.
Dremann, now stationed at Fort Belvoir, Virginia, served more than three years aboard the Ohio-class ballistic submarine Maine, and went on patrol five times. He was also among the transgender troops who met with the Pentagon's panel of experts.
Dremann, who made clear that the views he was expressing were his own and not those of the Navy, said he stressed that medical treatments for transgender service members would not impact readiness any more than a person being treated for a shoulder or a leg injury.
During his own transition from female to male, Dremann said he never missed training or a deployment.
"You just don't miss deployments," he said. "You handle your medical problems" to comply with the needs of the service.
Dremann, president of the Spart*A advocacy group, which represents about 800 transgender active-duty, reserve and National Guard service members, said the latest memos from the White House and Pentagon, and the ongoing court cases, had put transgender service members "in a technical state of limbo" and had already led to confusion among commanders.
Dremann said he has had to advise several transgender service members whose commanders mistakenly thought they were to begin administrative separations immediately.
OutServe and other advocacy groups have joined the suit brought by Washington State Attorney General Bob Ferguson in federal district court in Seattle (Karnoski v. Trump) that won a temporary injunction against any changes in the current rules.
On Tuesday, the plaintiffs argued to make the injunction permanent. Judge Marsha Pechman withheld a ruling but ordered both sides to submit briefs on constitutional questions.
She also signaled the government will have an uphill fight in changing the current rules enacted under the Obama administration.
Pechman dismissed the main argument of Justice Department lawyer Ryan Parker that the Pentagon should be given deference on issues of national defense. Pechman noted that the courts once gave deference in allowing the military to segregate troops by race, to ban women from serving, to ban women from combat, and to ban gays.
"In retrospect, all of that deference was in error," Pechman said, according to The Associated Press.
In testimony in the Seattle case, transgender Army Staff Sgt. Catherine Schmid, stationed at Joint Base Lewis-McChord, said the Trump administration proposals would deny her the civil right to serve the country in uniform.
"When people say that transgender can't serve, that our units are negatively influenced by our presence, or that my medical care makes me unable to do the most basic parts of my duties, what they're really saying is that I'm not capable of performing the duties of the job for which I've been trained," Schmid said.
In addition to the Seattle case, federal district courts in Washington, D.C.; Baltimore; and Riverside, California, have all initially ruled against the government on transgender military service.
The court cases were the aftermath of Trump's Tweets last July calling for a ban on transgender individuals serving or being recruited. The Tweets caught the Pentagon by surprise, and Joint Chiefs Chairman Gen. Joseph Dunford quickly issued a memo to the services telling them to stand pat until there was clarification.
Advocacy groups lined up to reject the Pentagon's action and join in the legal battles to reverse the directives.
The Trump administration's "continued insistence on viciously targeting our military families for discrimination is appalling, reckless, and unpatriotic," said Ashley Broadway-Mack, president of the American Military Partner Association and spouse of an active-duty U.S. Army officer.
"Military experts already thoroughly studied this issue and found transgender service members should be able to serve openly with dignity and honor -- as they proudly do now -- with the full support they need and deserve," Broadway-Mack said in a statement.
One of the most conservative members of Congress, Sen. Joni Ernst, R-Iowa, a member of the Senate Armed Services Committee and an Army veteran of Iraq, also expressed doubts about the moves against transgender individuals in the ranks.
On CBS-TV's "Face the Nation" program on Sunday, Ernst said, "I've asked transgenders [sic] myself, if you were willing to lay down your life beside mine, I would welcome you into our military."
Ernst said that transgender individuals would have to meet the standards of the military, "but if there are transgenders [sic] that meet those qualifications, certainly I would gladly have them serve in our United States military."
Sen. Jack Reed, D-Rhode Island, a former Army Ranger and ranking member of the committee, said of the ban, "President Trump may think it helps him with his political base, but it's a real disservice to the professionalism of all our troops."
"Thousands of transgender soldiers are currently serving in all branches of the U.S. Armed Forces, and the Trump administration still has not made a compelling, fact-based case for kicking them out, or preventing highly qualified Americans from enlisting," Reed said.
A previous study by the Rand Corp. commissioned by the DoD backed former Defense Secretary Carter's decision to allow transgender individuals to serve openly and said medical costs would be minimal.
Rand estimated that medical treatments for transgender troops would cost between $2.4 million and $8.4 million in an annual budget of more than $6 billion for military health care.
"The implication is that even in the most extreme scenario that we were able to identify, we expect only a 0.13 percent [$8.4 million out of $6.2 billion] increase in [military] health care spending," the Rand report said.
The 46-page report from the Pentagon's panel of experts disputed much of the Rand study while at the same time citing Rand's research to support different conclusions.
Thorn, of OutServe-SLDN, charged that the Pentagon study amounted to "an attempt to ban a problem that doesn't really exist. Their own data doesn't even support their claims" on the burden to the military of having transgender troops serving.
Various estimates from advocacy groups and Rand have concluded that there are anywhere from 5,000 to 15,000 transgender individuals on active duty, or in the Guard and reserves.
The Pentagon's report said that "8,980 service members reportedly identify as transgender, and yet there are currently only 937 active-duty service members who have been diagnosed with gender dysphoria since June 30, 2016," when Carter allowed them to serve openly.
"In any event, rates for genital surgery are exceedingly low -- two percent of transgender men and 10 percent of transgender women," the report said.
The Pentagon report said that "of the 424 approved service member treatment plans available for study, 388 included cross-sex hormone treatment, but only 34 non-genital sex reassignment surgeries and one genital surgery have been completed thus far."
In addition, "only 22 service members have requested a waiver for a genital sex reassignment surgery," the report said.
"Given the limited data, however, it is difficult to predict with any precision the impact on readiness of allowing gender transition," it said.
The panel of experts received conflicting views from commanders on the impact of transgender service on unit cohesion, deployments and readiness.
"On one hand, some commanders with transgender service members reported that, from the time of diagnosis to the completion of a transition plan, the transitioning service members would be non-deployable for two to two-and-a-half years," the panel of experts said.
"On the other hand, some commanders, as well as transgender service members themselves, reported that transition-related treatment is not a burden on unit readiness and could be managed to avoid interfering with deployments," the report said.
In a blog post, Rand senior political scientist Agnes Gereben Schaefer defended Rand's research and disputed the Pentagon study on the effects of transgender service on deployability and unit cohesion.
"Our analysis estimated that the readiness impact of transition-related treatment would lead to a loss of less than 0.0015 percent of total available labor-years in the active component," Gereben Schaefer said.
As for unit cohesion, she said the available research is mixed on how "friendship, liking, caring and closeness among group members" impacts performance.
"In other words, unit members' ability to contribute effectively to the efforts of the group matters more for unit performance than unit member similarity or liking for one another," she said.
-- Richard Sisk can be reached at Richard.Sisk@Military.com.