Transgender Military Personnel in the Post-DADT Repeal Era

Purpose of Study

In light of recent shifts in military policy and medical guidelines, combined with an openness of the US military to allow openly gay service members without any noted negative impacts, it is reasonable to assume that a dialogue regarding policy changes concerning transgender men and women with respect to military service is on the horizon. This study is the first to explore this previously undocumented realm and capture the firsthand accounts of transgender men and women who currently serve as uniformed personnel of the US military.

Method

We employed a phenomenological approach ²⁷ as a general lens through which to present a revelatory case study, ²⁸ investigating “the structures of consciousness as experienced from the first-person point of view.” ²⁹ Through a phenomenological lens, we strived “to see the inherent logic of human experience and to articulate that logic or sense faithfully, without distortion.” ³⁰ Employing phenomenology in the spirit of Edmund Husserl and Alfred Schultz, we elected to present a single case study. Such a method is justified to “investigate a contemporary phenomenon within its real-life context especially when the boundaries between phenomenon and context are not clearly defined and evident.” ³¹ Moreover, according to Yin, a revelatory case study is most appropriate “when the investigator has an opportunity to observe and analyze a phenomenon previously inaccessible to social science inquiry” making the descriptive information alone revelatory. ³² To date, we know of no other peer-reviewed research that has focused on the lived experiences of transgender service members making this case study the first of its kind, and thereby, revelatory of its own accord.

Using qualitative data attained through a series of interviews, we observed the logic of what it meant to be a transgender member of the US military and then described this human phenomenon without bias or speculation. By describing and not explaining the observed data, a phenomenological approach allowed an understanding to emerge that was not founded merely in subjective perceptions, but instead revealed through a rigorous unearthing of an invariant structure within this previously unexplored realm of the human experience. Through a process of phenomenological bracketing, we grouped interview data into seven themes, identifying the principal elements of a certain experience that provided general insight into what it was like to serve in the military as a transgender man or woman, not merely for a particular individual. Irrelevant particulars of individual accounts were set aside.

Sample

We interviewed a stratified convenience sample of self-identified transgender US military service members. All subjects were originally members of a private online support group comprised entirely of transgender military personnel. Although we did not have direct access to the online group, one of the forum members to whom we had been introduced through a previous research project, collaborated with our research team and publicized (an Institutional Research Board [IRB]-approved) call for subjects to the online group. Of the approximate eighty members of the group, forty-seven forum members initially responded and indicated a willingness to speak with us via an anonymous survey. We requested interviews from twenty-one of the forty-seven respondents based on their self-identified military status as either serving on active duty, in the active guard reserve or as a traditional reservist. Of the twenty-one potential subjects identified by our protocol, we conducted fourteen interviews yielding a 67 percent response rate. The web-based interviews yielded 507 minutes of digitally recorded data with individual interviews averaging 39 minutes in length. Interview duration ranged from 18 to 74 minutes. One of the fourteen subjects had been separated from the military within the last five months at the time the interview took place. Of the seven subjects not interviewed, five declined the interview while two were deployed overseas preventing their participation due to privacy concerns.

Subjects

Despite being a convenience sample, respondents spanned all of the service branches except the US Coast Guard. The sample pool was 15.4 percent Air Force, 38.5 percent Army, 7.7 percent Marines, and 38.5 percent Navy; 69.2 percent of interviewees were enlisted personnel, 30.8 percent were commissioned officers and one subject (7.7 percent) was an officer candidate. The average subject age was twenty-seven years, with ages spanning twenty-one to forty-two years. In all, 61.5 percent of the subjects identified themselves as female-to-male (FTM) transgender individuals, 38.5 percent identified as male-to-female (MTF) transgender individuals, while one subject self-identified as a cross dresser with no desire to change gender. None of the subjects expressed a sexual preference for males exclusively; 61.5 percent of the subjects said they were attracted to females only, while 38.5 percent described their sexual preference as fluid. None of the subjects had undergone sex reassignment surgery, though 69.2 percent were either medically approved for or undergoing hormone replacement therapy (HRT).

Procedure

Recruiting a sample of active duty transgender service members was a primary challenge to this investigation. Because transgender service members face tremendous risks in revealing their identity, the IRB mandated a procedure to elicit volunteers with complete anonymity. Using this procedure, we solicited volunteer participation using a snowball sampling technique asking trusted agents to reach out to transgender service members, which resulted in forty-seven volunteers who responded to our anonymous online survey. Participants were asked to create an anonymous e-mail account and a fictitious name in the survey, so they could be contacted for an interview while maintaining complete anonymity.

After recording volunteers’ (fictitious) names and (anonymous) e-mail addresses in a database, letters were sent out electronically to participants approximately two to four weeks in advance of the anticipated interview welcoming them to the study. In the introductory letter, the purpose and process of the study was explained. After scheduling a mutually acceptable time by e-mail, electronic invitations to interview were e-mailed to participants with an access number and secure passcode to enter the web-based audio-only platform. After obtaining subjects’ express consent to have the interview recorded, the lead interviewer engaged in several minutes of conversation to put the subject at ease and then proceeded to ask the subject questions regarding active duty transgender military service in the personal and professional realm. While the questions were specific, they served a dual purpose both to elicit specific information and to encourage subjects to reflect generally on their experience.

All interviews were conducted over a recorded audio platform using a commercial web conferencing system. All authors participated in each interview with one person conducting the interview and remaining fully present and engaged with the subject, while the other researchers documented key themes, events, and concepts. Immediately following each interview, the authors held a private conference to discuss and record any other observations and capture real-time analysis and thematic connections. All interviews were recorded and held in a secure electronic storage location. A professional transcriptionist transcribed each confidential interview, identifying all dialogue by page and line number to facilitate coding. Paper copies of each interview were produced and subsequent themes identified by bracketing.

Motivations and Limitations

The coauthorship of this study has dramatically expanded our own individual perspectives as we engaged a realm previously unknown to any of us. Two authors have significant military backgrounds (twenty years and ten years, respectively) while the third has no military experience. Our initial motivation for pursing topics in the realm of military social policy had been grounded in our own intellectual curiosity regarding the effects of open homosexuality on the military if DADT were to change. We also felt our lack of a personal connection to our research topics would be seen as a scholarly strength. ³³ Although we never set out to study transgender personnel in the US military, it was only because of our previous work prior to DADT repeal on gays in the military that we gained the attention and trust of the gatekeepers for the transgender military community who allowed us access. We don’t intend for this study to answer any questions definitively, but rather provide a starting point to begin asking the right questions as we continue to further our understanding of a realm for which we collectively know very little.

In the following section, we report our results, relying heavily on descriptive analysis of the firsthand, lived experience accounts from our subjects. Analyzing the data as a phenomenological investigation using a revelatory case study approach can be quite “powerful for understanding subjective experience, gaining insights into people’s motivations and actions, and cutting through the clutter of taken-for-granted assumptions and conventional wisdom.” ³⁴

Theme 1: Pronoun Usage

Nearly all subjects reported a general level of acquiescence with respect to the gender ambiguity many of them face on a daily basis. Pronoun usage emerged as a key indicator of the confusion of others.

I have gotten over the fact that if they use the right pronouns, then great. If they don’t, then you know, we move on, because I have to—because of the different modes that I have to switch back and forth with between my job or my life or people that I work with and whether or not we’re in uniform or not in uniform. FTM active-duty Naval junior officer (5–10 years of service)

My commander, my first sergeant, all the platoon sergeants, my unit as a whole—everybody refers to me with male pronouns and it’s fine. And they forget sometimes—I mean, they know, but they’re just so used to me being one of the guys and it’s normal for them, that they forget. FTM enlisted Army reservist (5–10 years of service)

My voice is definitely deep. For the people who don’t know me…most of them think that I’m a male, so they call me sir. I look like a guy. My hair’s cut short. The only time I get “ma’am-ed” is by my actual coworkers who actually know that I’m female. FTM Army Active Guard Reserve (AGR) officer (11–15 years of service)

Right now I’m kind of in this androgynous kind of hell. I’m kind of a litmus test for how good or how accepting and tolerant people are, that kind of a thing. And they very much see or pretty much use whatever pronouns that they are comfortable with, which is a very odd place to be. I’m free from the harassment, free from bullying, free from—not really free from general military macho-esk transphobia, homophobia, but I’m not the subject of it. MTF active duty Naval junior officer (5–10 years of service)

Generally I know I’m getting close when random Marines that I work around—men I don’t know or actually—not that I work around but that I see, say see me like at the commissary or the BX or something like that and when they’ll start saluting and using female pronouns around me…and it’s probably because I need to get a haircut. So then it’s a question of how masculinized is that haircut going to make me feel and make me see in the mirror and then how much of a fall is that going to be on a personal emotional level before I can start recovering and picking myself back up again. MTF active duty Naval junior officer (5–10 years of service)

The particularly frequent use of gender binary salutations (e.g., “sirs” and “ma’ams”) within military culture makes regular pronoun confusion inescapable for service members. Our subjects expressed varying levels of stress in dealing with routinely being addressed as a gender other than that with which they identify. Those subjects who had supportive social structures from peers, family members, and commanders expressed lower levels of anxiety than those who found themselves more socially isolated.

Theme 2: Dress and Personal Appearance

All transgender subjects in our study expressed a desire to present exclusively as the gender with which they individually identified, particularly with respect to the clothing they elected to wear.

I opt for the tie. Outside of—after [redacted for anonymity] hours, yes, I always present as male. I do a pretty—I actually get to where that I don’t pass. If ever anyone—I think I was somewhere the other day—oh, I know what happened. I have to shave because I get invited to these nice swanky little events and I’m like I can’t—now I have to try to look like a female [redacted]. I can’t have like this dark lip and all this extra hair on my face, so I had to shave. And then I went somewhere after changing out of uniform and someone called me a female. I was surprised. It was like the first time in a year that someone had thought I was a female. It was funny to me actually. FTM officer candidate

I am extremely dysphoric when it comes to wearing anything male—so from when I first wake up in the morning to everything I put on. I don’t really own any male underclothes. That’s the worst part about it. And I’m not comfortable wearing them. So getting dressed in the morning was difficult. I had to either wake up earlier and then go to bed later or go to bed earlier than everybody else just to avoid not getting noticed, not getting seen. MTF active duty enlisted Navy (5–10 years of service)

I just switched over to a new unit and everyone there thought I was male and I had to say, “No, I’m female.” And that’s why it’s the worst situation for anybody that’s transgender to pass and actually become and people see you as the gender that you identify as, but still have to identify as female…and the sad part is for me myself like as I’m transitioning, I haven’t felt any better in my life. I feel so much better about myself personally than I have my entire life. FTM active-duty junior enlisted Marine (less than five years of service)

We really don’t wear our dress uniforms. All of our ACUs are exactly the same, and I do use the males’ bathroom at the unit. It’s just when we’re in big training groups, they don’t let me do that. But at my unit when we’re just going on the weekends, they let me use the males’ bathroom and it’s not a big deal to anyone there. FTM enlisted Army reservist (5–10 years of service)

Theme 3: Clarity of Identity

None of the subjects interviewed reported confusion with their gender identity. We recognized this could have been an artifact of our sampling procedure. Subjects displayed general confidence in their gender identity, irrespective of the attitudes of others. A number of MTF subjects acknowledged joining the military as an attempt to overcome their transgender nature by immersing themselves in an overly masculine environment, to no avail. Similarly, many FTM subjects acknowledged being drawn to the military for its perceived culture of gender irrelevance.

I had always known that I had a lot of male tendencies. I really liked it when I would get mistaken as a male even, you know, as a lesbian. And, you know, I would even stuff my pants. It just—it felt right.

Q. And how did you change emotionally when you actually had that epiphany [that you were a transgender male]?

A. It was great. It was kind of hard though, because I knew—I’d already made my life kind of hard being, you know, different from everybody by being a lesbian, and now here I want to go and change my gender. So, I knew it was going to be kind of tough with my family, but it was something I felt I needed to do. Since I have made those steps and actually taking testosterone, my life has been so much better. As far as my emotional stability, I have just really calmed down. It’s just been so great. FTM Army AGR officer (11–15 years of service)

“Well, let me just ask you something.” And I was like, “Yes, sir.” And he was like, “How—is it harder black or female or gay [in the military]?” I was really stunned that he asked me that—I didn’t know what to say, so I just was like, “Try being all three. I don’t know. I’ve never known how to separate them.” FTM officer candidate

I’ve identified as a man since I was probably three. FTM active-duty Naval officer (5–10 years of service)

I was always like different like since I was a kid. My dad told me when I was a kid I would scream, throw tantrums, say, “I’m a boy! I’m a boy!” And so I’ve always been different. I didn’t really make the connection in my head until after I got out of the house when I was seventeen and I got to my first school and I started researching it online and I was like, “Wow, like I’m definitely not gay. Like I definitely identify more with males.” I didn’t really completely identify as transgender until about three years ago. And it was then that I knew I was going to get top surgery and I knew that I wanted to take some level of testosterone. FTM active duty junior enlisted Marine (less than five years of service)

I spent 28 years in the closet as a conservative Christian before I came out of the closet, and I think that that might play into it was that I was so used to hiding but still having to have the confidence of just being who I was. The difference between when I came out of the closet and when I wasn’t—was in the closet was really the fact of acknowledgment. There was no difference really in my personality. FTM active duty Naval officer (5–10 years of service)

My birth name was female and I had it legally changed about a year and a half ago to my new name, which is—it could kind of go either way. It was really scary how easy it was [to change my first name]. I was dreading it, thinking it was going to be so hard and they were going to ask all these questions, you know, and I had all these excuses lined up in my head, and there was nothing. They just took the court document, sent it through the system and bam, my name was changed. FTM Army Active Guard Reserve (AGR) officer (11-15 years of service)

And a lot of this happened because I see myself as a man, and seeing myself as a man I don’t see why people—other men would be attracted to me, at least if they weren’t gay. Like I was attracted to gay men, which didn’t make a lot of sense because, you know, I identified as a lesbian and I was like “Oh, gay men, I absolutely love them.” And then when I’m around straight men I felt, “Oh, I’m one of them. No big deal. These are my people. I think like them. I hang out with them. It’s nothing. They wouldn’t be attracted to me.” FTM active duty junior enlisted Air Force (Less than five years of service)

It’s very difficult to connect with males emotionally as well as socially, because it always feels like a facade. I have to fake being this thing that they portray. It’s very weird to me. Socially it’s very confusing, as compared to when it comes to when I’m socially, emotionally talking with women. MTF active duty enlisted Army (less than five years of service)

I joined the military to find something I could be proud of, something I could really work hard at, maybe fix myself, maybe finally like myself. I absolutely detested everything about myself. I didn’t know there was such a thing as Trans. I thought that a woman who thought she should have been a man was in the wrong body and that’s why she was a lesbian. FTM active duty junior enlisted Air Force (less than five years of service)

I’ve been masking it, hiding it, not trying to cure it. I went into the military to become a man. MTF active duty enlisted Army (less than five years of service)

In a nutshell, from top to bottom the biggest piece is finding myself and realizing I’m not confused. I know exactly who I am, what I am, as well as these feelings, desires, issues, problems, and hopes that I have actually stem from my personal interpretation of how I feel emotionally. MTF active-duty enlisted Army (less than five years of service)

All of the subjects interviewed for this study were confident in their gender identity. We found no evidence that any of the subjects in our sample chose to pursue a particular gender identity, rather each interview confirmed gender to be something that existed inherently and unchangeable inside each of them. The individual clarity of subjects’ self-perception of gender identity was consistent, profound, and remarkably resilient.

Theme 4: Double Standards

Subjects, whether FTM or MTF, reported anxiety over perceived double standards within the military. Despite the rhetoric often articulated in organizational settings regarding gender neutrality, all subjects reported strong gender-binary differences. How standards were enforced largely depended on individual chains of command. Those subjects who reported healthy workplace environments also described their individual leaders and supervisors as being inclusive, supportive, and tolerant. Commanders who narrowly interpreted and strictly enforced policy were often in charge of organizational environments that could be described as hostile.

You kind of have to balance your personal opinions and how you would choose to be seen versus how they want you to appear. I primarily joined the military because I thought it would kind of help my dysphoria go away since the military is so focused on everyone being the same and equal. But it’s not. There are so many double standards that I’ve found just being enlisted in the last year that amaze me that I don’t think a lot of people see from a civilian standpoint. FTM active duty Naval junior officer (Less than five years of service)

Well, it was pretty well known as far as the command staff that I was pretty much transsexual. They [my leadership] looked the other way for the most part just as long as I didn’t really do anything to call too much attention to it and that I followed the hair regulations. MTF junior enlisted Army National Guard (less than 5 years of service)

One of the main things that they like to preach—and they being the leadership—is how they don’t see gender and we should all be treated equally. But we have—males and females have different physical fitness standards. There’s different uniforms that we have to wear, you know, different regulations of how you wear that uniform. Just simple things like that that to somebody who’s transgender can really mean a lot. FTM active duty Naval junior officer (Less than five years of service)

I am very jealous of my brethren. The military tends to give females a little bit more leeway in terms of appearance. Hair standards are a lot more lax. Physical appearance is a lot more lax. Mannerisms are encouraged to be more, I guess, heteronormatively masculine, very straight to the point; not really ditsy or anything like that. You have to be professional all the time. So, there are things that a transman can do in order to present as masculine that translates very well into the military world where it’s, “Oh well, I’ll just have a short haircut,” and it’s not really a big deal. But coming at it from the other direction, male hair but male hair standards are rather strict and there’s a lot of disagreement over what exactly should be interpreted from the regs. So specifically with my community, my naval community, they like to think of themselves as like a smarter version of Marines, so the high-and-tight is the norm and they think the outside of that is wrong. So there’s a very—I’m not held to that standard because the Navy is a little bit more realistic about what you can have for hair, but it’s still a fight about once a month or so. MTF active duty Naval junior officer (5–10 years of service)

It just kinda feels like everything is backwards. There’s no real place, because we still have to share everything with the female population, showers and rooms and PT tests and things like that. And even if you do the male standard, they don’t care. FTM enlisted Army reservist (5–10 years of service)

What has completely blown my mind is that whereas I was seen as a male as not much of a leader—and I’m also very small; I’m only five-foot-four and I’m 135 pounds I’m a lightweight, which is good for passing; bad for a physical presence in the military. And since transition, when perceived either as Trans or a natal woman my leadership qualities, the way people assess me as a leader, has changed radically. And it’s been—that’s been a stunner to me, because I went from being perceived as a very weak male that nobody would follow to a strong woman that people would want to get behind. And that’s been—you know, I keep shaking my head at it because it’s such a new experience for me because honestly it’s never happened before. MTF Naval Reserve officer (16–20 years of service)

Both MTF and FTM subjects expressed displeasure with the way the opposite gender seemed to be granted more leniency. Subjects noted that females were often afforded more latitude in personal appearance regulations, though there also existed general consensus that the male-dominated culture of the military strongly favored masculine, rather than effeminate, behavior. These assertions highlighted a consistent incongruence in gender expectations within military institutions. The subjects in this study continually questioned the veracity of justifications for differing standards.

Theme 5: Performance

Many, but not all, subjects often felt a need to perform at a higher level than their peers in order to protect themselves from unwanted scrutiny.

What I’ve found so far is that as long as you do your job and you do it well, a lot of people are willing to look the other way. I mean, there’s a lot of people that I know of that are actually on hormones and have been on hormones for a year or more, and that’s obviously enough time to see physical changes. But because they’re good at their job, they’re a good soldier, sailor, or Marine; people are willing to not question that. FTM active–duty Naval junior officer (Less than five years of service)

I’ve definitely tried to go ahead and do the best possible job that I could, just because I knew that so many people were watching me and that everybody was pretty much waiting for me to slip up. In fact, I was working well outside of my pay grade at the time. I started off as an E2 being an NCOIC of my—first my battalion S2 and then later working up to my brigade S2. And it wasn’t until the last nine months of active duty that I finally ended up getting both an NCOIC and an OIC. Up until that point I was pretty much in charge of the entire unit S2. MTF junior enlisted Army National Guard (less than 5 years of service)

One of my defense mechanisms since basic training has been go above and beyond; step up; try to push myself beyond my limitations that I felt like I couldn’t perform before. I entered the military under the pretense that my mother was right: I’m too emotionally weak; I’m too frail altogether that I can’t be able to perform this. Yet I have excelled beyond what both my parents have done when they were in the service back in the early to mid-1980s. MTF active–duty enlisted Army (less than five years of service)

Although both self-reported information and official documentation on the performance of our subjects were requested, the limited nature of self-reported data and concerns about maintaining the anonymity of subjects, made any viable assessment of duty performance impossible within the scope of this study. The variance in self-assessed job performance we received was indistinguishable from what one would expect from a randomized cross-sectional sample, with the notable distinction that our subjects often felt they must exceed performance expectations in order to protect themselves from inquiry that could lead supervisors to uncover their gender identity. We recognize our sampling method also overrepresented the officer population by about twice as much as the actual military population. We cannot draw any conclusions on duty performance based on this study beyond the summary analysis presented here.

Theme 6: Relationships

Subjects indicated varying degrees of openness to family, friends, and coworkers—and in some cases, supervisors and commanders— with respect to their gender identities. Rarely negative reactions were reported, though there existed a revelation bias where subjects would likely not reveal their transgender nature to others who were believed to react negatively. Yet, the reaction of others to a subject’s “coming out” was reported as being overwhelmingly positive and supportive in most cases. Some negative reactions were encountered, but subjects reported many of those particular relationships as improving with time and moving toward acceptance.

At the last training we went to, they [my unit] put my name on the male sleeping arrangements, and then the commander was like, “Oh man, we can’t do that.” So they had to switch me, because we were with like four or five other units doing a battalion training. So, it was crazy. But my unit as a whole is very supportive. FTM enlisted Army reservist (5–10 years of service)

I am currently married to a female assigned at birth, who is currently going through his transition phase from female to male. And I’ve been trying to support him on that aspect alongside with what’s going on with me…We do have a child. I met him when he was pregnant a little over five years ago. Our daughter is a little over five right now. MTF active-duty enlisted Army (less than five years of service)

My dad kinda of beat me up when he found out that I even had a girlfriend when I was like 11. I was in sixth grade. And so we got into it back and forth. I ran away a lot. My mom still goes back and forth, and depending on who she’s in front of, she’s supportive and if she’s next to this person, she’s not supportive. So we really don’t even talk anymore. We don’t have much of a relationship at all. But my grandmother is very supportive. And now my father is actually very supportive. He came to my pre-deployment thing before I left and hung out with me and my family and my kids and we had a great time. FTM enlisted Army reservist (5–10 years of service)

With each and every one of them [my friends], I came out to them. I told them and they all pretty much had the same reaction, “Oh well, that makes sense.” And they were all really cool about it. One of them has even been around me as me instead of just at work. MTF active duty enlisted Navy (5–10 years of service)

[Some officers and senior NCOs] have insulted me by telling me I’m not quite man enough; that I shouldn’t be in the military; people like me are a disgrace; stuff like that. Typically, I just stood there at parade rest and just kind of ignored them, let it go in one ear and out the other and just moved on about my business afterwards. I would regularly receive flack like that. MTF junior enlisted Army National Guard (less than 5 years of service)

When I transferred from the [one state] National Guard to the [a different state] National Guard, the officer that swore me in did actually know that I’m a transsexual. In fact, he’s one of my Air Force counterparts here on post and had no problem as far as all that goes—as far as swearing me in knowing I’m transsexual. MTF junior enlisted Army National Guard (less than 5 years of service)

Relationships formed with peers, family members, and superiors can profoundly impact the mental well-being of transgender military members. Subjects cautiously approached all relationships, receiving varying levels of understanding and acceptance in return, though most reactions were very positive. In general, subjects reported family members as having more difficulty accepting their gender identity than friends. This was largely a result of selection bias—being able to choose one’s friends and not one’s family. We found significant differences in how commanders and supervisors dealt with suspected gender dysphoria in their subordinates. Some commanders (senior leaders/supervisors) embraced a philosophy of “people first” and did not actively pursue transgender members for discharge. Others in leadership positions took a “by the book” perspective and aggressively took action to oust any suspected transgender military member, if not officially, then by making the work environment sufficiently difficult to function within.

Theme 7: Hormone Usage

Subjects varied widely in their use of HRT, as did various military health care providers in providing treatment. Because the military does not recognize transgender service members, military health care does not permit counseling services or HRT to treat gender dysphoria. However, many subjects found resourceful ways to engage HRT and similarly, supportive health care providers also found creative ways to treat their transgender patients.

I had a hysterectomy for medical reasons and the endocrinologist that I see prescribes HRT—estrogen and testosterone—for me. However, I choose not to take the estrogen. And he knows what I’m doing and what I’m going through, and he has me on testosterone for an average male… and, since I have no ovaries, I am allowed to get HRT, so Tricare pays for everything. FTM Army Active Guard Reserve (AGR) officer (11–15 years of service)

I’ve been on hormone replacement therapy for it was nine months on the first, and I’ve done this under the closet of my leadership as obviously if they were to know I would certainly be discharged. However, I know of a lot of people that are on hormones and have even gotten surgeries and have notified their leadership and that they have continued a long and fruitful career. Unfortunately with me that’s really the case. My clinic did end up finding out that I’m on hormone replacement therapy and currently I’m being investigated by Office of Special Investigations (OSI) because of this. FTM active duty junior enlisted Air Force (Less than five years of service)

I am actually in the process of possibly looking for some kind of counseling. And that’s just to have somebody to talk to about it who understands it; that’s professional to kind of help me deal with that kind of thing. But I am not looking to get any hormone therapy any time soon. I’m trying to get the Navy to pay for my top surgery, because I’m well-endowed enough that I can get away with calling it bothering my back, which it does. FTM active duty Naval junior officer (5–10 years of service)

It gets harder and harder every month, every year. Before I started my hormones, I was going through a lot of depression, because I had to hide myself. I had to basically put on this facade every day that I’d be a person I didn’t want to be. I had a lot of depression before I started HRT. Once I started it, it’s like the world opened up a little bit more. MTF active duty enlisted Navy (5–10 years of service)

There’s nothing really black and white as to what to do with somebody in my situation. That’s why they [my leadership] want to fight for me and give me a different base so I can continue my service and continue my treatments. I know there are others out there in my situation that are on hormone replacement therapy, their leadership knows and everything is right as rain. FTM active-duty junior enlisted Air Force (Less than five years of service)

I was on hormones once in 2007, and then I got investigated for homosexual conduct and they came to my house and tore apart all my stuff and called my family members and asked a bunch of questions. It was pretty complicated. I almost lost my job actually. FTM enlisted Army reservist (5–10 years of service)

I guess overall generally it’s been pretty difficult and stressful as far as just the overall being transgender in such a gender binary society, being the military. I’ve been on HRT for approximately two-and-a-half years now. I had started my transition while on active duty and had pretty much completely, I guess, come out and have been open since my ETS from active duty. MTF junior enlisted Army National Guard (less than five years of service)

The reported behavior of medical professionals in the military by subjects in our study closely followed the patterns observed with commanders and supervisors. In some cases, health care providers put the care of their patient above all else and interpreted existing rules and policies to treat transgender subjects for gender dysphoria as they saw fit. In other cases, health care providers interpreted rules and regulations more strictly and denied transgender subjects the treatment they sought. In cases where transgender military members were unable or unwilling to seek treatment through official military organizations, they often sought treatment in the commercial medical sector, and in some cases, the black/gray markets, to obtain hormones. In 100 percent of the cases where a subject reported using hormones, they reported dramatically positive improvements in their psychological well-being. In many cases, this improvement was directly correlated with the physical changes that manifested as a direct result of the treatment, prescribed or otherwise.