President Trump’s blunt Wednesday-morning tweets about how the U.S. military will no longer “accept or allow” transgender service members contained enough questionable, hurtful charges to fuel a steady clip of outrage all afternoon.
Among those charges — along with the feared “tremendous medical costs” and the idea that the country is “burdened” by transgender service members — was this: the suggestion that being a transgender person is inextricably linked to and defined by seeking medical interventions.
Evidence points to the idea that surgeries, in particular, are a relatively rare part of a transgender person’s transition. But beyond that, critics of the Trump tweets say, defining transgender individuals by their medical procedures is a damaging and dehumanizing idea to put forth.
“Trump’s tweet does harm on so many levels and not least in perpetuating the idea that being trans is about surgery,” transgender author, activist, and GLAAD board of directors co-chair Jennifer Finney Boylan tells Yahoo. “Many trans folks, of course, don’t need or want medical interventions. For those that do, it’s worth remembering that coverage of transition-related expenses are negligible within the overall cost of employer-related health care.”
Boylan points out that SPARTA, the LGBTQ military advocacy group, notes that trans coverage amounts to “an increase of less than one half of one percent in employer’s plans.” But, she adds, “More importantly, what trans people in the military really need is respect and support for the immense sacrifices they make for their country.”
Among the existing numbers about what percentage of transgender people actually opt for some sort of medical intervention — including the debated 2016 stats from the American Society of Plastic Surgeons, which claimed a 19 percent spike in unspecified “gender-confirmation surgeries” — is a small study by endocrinologist Josh Safer, published in the journal Endocrine Practice.
Safer, an associate professor of medicine at Boston University and medical director of the Boston Medical Center’s department of Transgender Medicine and Surgery, looked at the choices of 100 of his patients from 2015.
What Safer and his colleagues found, he tells Yahoo, is that “the typical goal for most transgender individuals, in my experience, is to align appearance with gender identity. The primary way of doing that is with hormones,” which are in general “very inexpensive,” he says, adding that “for only a small minority does it include surgery.”
Of those who did opt for surgery, Safer found, the most common was top surgery, among transmen (individuals assigned female at birth and transitioning to male), involving a mastectomy and chest reconstruction. “It was incredibly popular,” he says, even among those without insurance. The least popular surgery was also among transmen, which was genital surgery, the options for which are complex and bring results widely viewed as being less than ideal (with loss of sensation and low functionality).
Most popular among transwomen, meanwhile, is breast augmentation surgery, followed by facial feminization and then vaginoplasty, Safer found.
“The number one concern for most of my patients is how people treat them and interact with them, and sometimes it’s those you have the most casual relationship with that matter most,” he explains.
But the bottom line, Safer says, is this: “You’re transgender no matter what you do about it. … Gender identity, the way I look at it, is essentially a biological phenomenon, and there could theoretically come a day when we are able to identify its biological components.” He adds, “It’s like left-handedness. And how do you know you’re left-handed? You just are.”
Seeing Trump’s tweets, Safer says, was both “disappointing” and “so illogical,” as the point about cost is simply not true. “Top surgery is in the single-digit thousands, which makes it a low-cost surgery. Even vaginoplasty is in the low tens of thousands, which is half the cost of heart surgery — and you only do it once.”
(Indeed, a June 2016 study from the RAND Corporation estimated the existence of between 1,320 and 6,630 transgender active-duty service members — out of 1.3 million service members in total — and noted that not all of them would seek transition-related medical treatment. The study estimated that gender-transition medical procedures would only increase military health care costs by between $2.4 million and $8.4 million each year — an increase of between 0.04 and 0.13 percent.)
Numbers aside, Safer notes, “The harm these [tweets] do to service members, who are already sacrificing for our country, is going to be far more expensive.”
That’s a sentiment that Jenn Burleton, executive director of the national TransActive Gender Center, based in Portland, Ore., can relate to deeply. As a transgender woman, longtime activist, and former U.S. Marine, she tells Yahoo of Trump’s tweet, “The damage is that it continues to perpetuate the dehumanization of transgender people and works toward simplifying [being transgender] as nothing more than the pursuit of physical medical alternations of your body, as opposed to an innate natural variation in human development.” Further, she says, such thinking only serves to “demonize trans people and have them seen as the undesirable other.”
Burleton, who enlisted in the Marines at 17 and says she was one of the first service members discharged specifically for being transgender, concurs with the endocrinologist’s view that “the least [physically] impactful, most affordable, and most affirming treatment is hormonal intervention.” But beyond the idea of surgery being a low priority for many transgender people, she says, Burleton finds the scenario of a trans person enlisting in the military specifically to have surgery on the government’s dime to be ludicrous.
“As a trans person myself, as well as a former service member, I can say that getting surgery while on active duty is a process that would remarkably interrupt a transgender person’s service,” she says. “So I could imagine a majority would not be opting to have surgery while on active duty. How many times can we say ‘red herring issues that have no foundation in reality’?”
As Burleton sees it, “This myth that transgender people will only enlist for service to their country and put their lives on the line simply to get access to ‘free’ surgery is just a blatant attempt to dehumanize transgender people, to say that their service and citizenship and even their humanity is not authentic. And that’s terrifying.”
She adds: “I enlisted at the height of the Vietnam War, because I wanted to serve. And even now, with that so far in my distant past, this is so infuriating. And insulting.”
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