When President Trump announced a new ban on transgender people serving in the military late Friday, it was somewhat of a surprise — Defense Secretary Jim Mattis had reportedly recommended in February that Trump allow transgender people to serve. It turns out that Vice President Pence and some of the country’s most prominent anti-LGBTQ activists had a role in reversing the outcome, which explains why the report explaining the decision is rife with anti-trans junk science.
Slate’s Mark Joseph Stern reported Friday night that, according to multiple sources, Pence played “a leading role” in creating the report, along with Ryan T. Anderson of the Heritage Foundation, which has been dubbed “Trump’s favorite think tank,” and Tony Perkins of the Family Research Council (FRC), an anti-LGBTQ hate group. Both Heritage and FRC praised the report Friday. According to Stern’s reporting, it was true that Mattis favored allowing transgender military service, but Pence “effectively overruled” him.
A separate source independently confirmed to ThinkProgress Saturday that Pence was involved, characterizing him as forming his own ad hoc “working group,” including Anderson and Perkins, separate from the panel of experts Mattis had assembled. Though it bears Mattis’ signature, the report released Friday appears to reflect the findings of Pence’s working group and not the committee report that Mattis submitted to Trump last month. Mattis’ original document was not currently publicly available at the time of the recommendation, but it was widely reported that Mattis favored an inclusive approach that resembled what had originally been proposed by Defense Secretary Ash Carter under President Obama in 2016. His February recommendation, also released Friday, jibes with the new report, contradicting reports at the time.
How exactly Pence overruled Mattis’ recommendation over the past month the source did not know. But his working group’s influence is apparent. In particular, the report features numerous anti-trans talking points that FRC and other anti-LGBTQ groups have used in various campaigns favoring discrimination against transgender people. It also attempts to distort the research on transgender health in ways that directly parallel Anderson’s recently released book, When Harry Became Sally: Responding to the Transgender Moment. Anderson likewise argued in his book against supporting trans people in their gender transitions, and the recommendations in the report rely on a strikingly similar framing.
Asked directly on Saturday whether he was involved in the report, Anderson cheekily responded in a series of tweets that “there’s no evidence” he was involved in crafting the report, but he repeatedly refused to directly deny his participation.
“‘Privacy” concerns and “unit cohesion”
One of the most obvious biases in the new report is an emphasis on concerns about how transgender people in the military might somehow infringe on the privacy of other soldiers — particularly women. These are the same arguments Perkins, Anderson, and others have made in justifying overturning LGBTQ protections in Houston or defending North Carolina’s HB2, a law that mandated discrimination against transgender people.
According to the report, transgender people would violate other troops’ privacy simply by sharing a space with them — to the detriment of unit cohesion:
Allowing transgender persons who have not undergone a full sex reassignment [sic], and thus retain at least some of the anatomy of their biological sex, to use the facilities of their identified gender would invade the expectations of privacy that the strict male-female demarcation in berthing, bathroom, and shower facilities is meant to serve.
As examples of these burdens, it notes suggestions from the Carter policy about modifying shower facilities to provide more privacy or adjusting the timing of showers to accommodate service members who express “discomfort” sharing a facility with a transgender person. While these accommodations sound simple, the report instead characterizes them as requiring “significant effort… to solve challenging problems.”
Borrowing a related argument opponents of trans equality frequently use (including Anderson in his book), the report also expresses concern that respecting transgender identities would be unfair and even dangerous to other service members when it comes to athletics and training. “Biological females who may be required to compete against such transgender females in training and athletic competition would potentially be disadvantaged,” the report claims. This ignores that the NCAA and International Olympic Committee have both established clear standards for allowing transgender people to compete according to their gender identity, recognizing that transitioning mitigates gender-related advantages.
Not so subtly, the report concludes that unit cohesion will deteriorate if the anti-transgender prejudices of other service members are not catered to. “The potential for discord in the unit during the routine execution of daily activities is substantial,” it argues. The RAND study that informed the Carter policy had dismissed concerns that lifting the ban would impact cohesion and readiness.
Experts on transgender military service have made clear that lifting the ban will not impact unit cohesion. Three former armed forces secretaries even testified in one of the lawsuits challenging the ban that it is unjustified.
Moreover, “unit cohesion” is the same hollow argument that was previously used to defend “Don’t Ask, Don’t Tell” (DADT), a law that prohibited lesbian, gay, and bisexual people from serving openly in the military. Such warnings even included near-identical concerns about shared shower use. Following DADT’s repeal, a study showed that LGB inclusion had no negative impact on military morale, despite similar warnings.
“Considerable scientific uncertainty”
The report also contorts itself considerably to misrepresent both the experience of transitioning as well as the research about the health and well-being of transgender people. This is where the report most noticeably resembles Anderson’s book, as it uses several of the exact same sources and distorts them in the exact same way.
One of the overarching themes in both the report and Anderson’s book is that the “quality” of the research showing the benefits of transition is allegedly subpar. It’s an attempt to claim that no matter how much research there is showing transition is an effective way to treat gender dysphoria, it simply isn’t reliable for reasons like small sample sizes. Anderson has used this approach to justify his position that trans people should be discouraged from transitioning, while the report uses it to justify skepticism about whether people who have transitioned can be trusted to serve capably.
Two examples the new report use are a Centers for Medicare and Medicaid Services (CMS) review from August 2016 and a Hayes Directory review, both of which found that there were actually few studies of the same breadth and rigor that is often used to assess coverage of other medical concerns. But the report relegates to a footnote that CMS still covers transition-related procedures on a case-by-case basis and likewise ignores entirely that, as ThinkProgress has previously pointed out, the Hayes Directory review is actually frequently cited by various health insurance policies to explain why it is the plans will cover transition-related procedures. In other words, these reviews of the research tend to support the exact opposite conclusion that the report (and likewise Anderson) draws from them.
The report expresses concern that there have been no “randomized controlled trials” on the effectiveness of hormone replacement therapy (HRT) or gender confirmation surgeries. Because of the nature of transgender identities, however, it would be difficult and likely unethical to take such an approach. That’s because gender dysphoria is uniquely a mental health concern treated with physical changes to the body. An individual who was receiving a placebo instead of hormones would easily notice that their body was not undergoing the expected changes. Moreover, given the overwhelming evidence that transgender people do benefit from transitioning, a human subjects review board would likely consider it unethical to deny them medically necessary treatment as part of such a study. The small population of transgender people also limits the size and scope of such studies.
Nowhere does the report even mention that every major medical organization in the U.S. has arrived at a consensus that transgender people should be affirmed in their gender identities and supported in their transitions. The American Medical Association has even explicitly expressed support for lifting the military’s ban on transgender service. The report likewise makes no mention of the widely-used standards of care developed by the World Professional Association of Transgender Health (WPATH), which recognize the benefits of affirmative care.
As has become inevitable in just about every attempt to justify anti-trans discrimination (including Anderson’s book), the study also wildly distorts studies about the suicidality of transgender people.
“High rates of suicide ideation, attempts, and completion among people who are transgender are also well documented in the medical literature,” the report asserts. It cites an analysis of the National Transgender Discrimination Survey (NTDS), which found that 41 percent of trans people had attempted suicide at some point in their life. It also cites a Swedish study, which the report claims found mortality and psychiatric hospitalization for patients who had undergone sex reassignment surgery as compared to a healthy control group.”
What the report downplays is the context of both studies. The NTDS study found significant connections between the high suicide rate and anti-trans discrimination, including factors such as racial stigma, poverty, unemployment, having less education, how easily they were perceived as trans, homelessness, bullying and violence, family rejection, and health care discrimination.
Likewise, the Swedish study did not find significantly higher suicide rates in transgender people who underwent surgery after 1989. Its author, Cecilia Dhejne, explained in an interview that the older group’s experience “likely reflects a time when trans health and psychological care was less effective and social stigma was far worse,” emphasizing that transition “won’t resolve the effects of crushing social oppression.” She has repeatedly rebuked those who use the study to justify rejecting the legitimacy of transgender identities. “I have said many times that the study is not design to evaluate the outcome of medical transition,” she said in a Reddit AMA last year. “[I]t does say that people who have transition[ed] are more vulnerable and that we need to improve care.”
The report essentially manufactures doubt about the health outcomes of transgender people to justify the very kind of discrimination that is the most significant factor for trans people’s negative experiences. This is most apparent when the report attempts to rationalize allowing current transgender service members to continue serving:
While the Department believes that its commitment to these Service members, including the substantial investment it has made in them, outweigh the risks identified in this report, should its decision to exempt these Service members be used by a court as a basis for invalidating the entire policy, this exemption instead is and should be deemed severable from the rest of the policy.
In other words, if the courts conclude that the policy is blatantly hypocritical by allowing some trans people to continue to serve while banning others from joining, the military will responding by kicking them all out to achieve consistency.
The ex-trans framing
What is perhaps most bizarre about the report is its attempts to show how a transgender person could still serve under the new policy. Essentially, they have to be ex-trans.
The report states that a diagnosis of gender dysphoria is inherently disqualifying for service. This is despite the fact that the American Psychiatric Association does not recognize gender dysphoria as a disorder. It maintains diagnostic criteria for people who are distressed by their gender identity because such a diagnosis is often required for insurance companies to cover transition treatment.
Besides the exemption for current trans troops, the report offers only two ways that someone diagnosed with gender dysphoria could still serve:
- If an individual is trying to join the military but has previously been diagnosed with gender dysphoria, they must show that they have gone three full years without symptoms and be “willing and able to adhere to all standards associated with their biological sex.”
- If a current service member is newly diagnosed with gender dysphoria, they may continue serving so long as they do not require gender transition and are “willing and able to adhere to all standards associated with their biological sex.
Given that transitioning is the best proven way to resolve the distress of gender dysphoria, it’s unclear who would qualify to serve under these circumstances.
This approach, however, reflects prominent anti-trans views. FRC publicly advocates against affirming transgender people, insisting, “There is no rational or compassionate reason to affirm a distorted psychological self-concept that one’s ‘gender identity’ is different from one’s biological sex.” Anderson’s book likewise focuses on a few exceptional individuals who regretted steps they took to transition their gender, which he argues proves that transition is not helpful or necessary. Anderson, however, did not ask permission from these “detransitioners” to use their narratives and they subsequently objected to being used in a book that rejects transgender people.
The bottom line of the report is that the only good way to be trans in the military is to not be trans. This flies in the face of countless military experts and is easily disproven by the thousands of transgender people already capably serving in the U.S. as well as in 19 other countries, including Australia, the United Kingdom, France, Germany, Spain, Canada, and Israel.
But as the report largely reflects the views of Pence, a longtime opponent of LGBTQ equality, and some of the top anti-LGBTQ activists in the country, it’s easy to see how it arrived at such discriminatory conclusions.
UPDATE: This post has been updated to reflect the release of Mattis’ February recommendation to Trump.