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There Are an Estimated 1,320–6,630 Transgender Service Members in the Active Component, but Not All Will Seek Gender Transition–Related Treatment

• It is difficult to estimate the number of transgender personnel in the military due to current policies and a lack of empirical data. Applying a range of prevalence estimates, combining data from multiple surveys, and adjusting for the male/female distribution in the military provided a midrange estimate of around 2,450 transgender personnel in the active component (out of a total number of approximately 1.3 million active-component service members) and 1,510 in the Selected Reserve.
• Only a subset will seek gender transition–related treatment. Estimates derived from survey data and private health insurance claims data indicate that, each year, between 29 and 129 service members in the active component will seek transition-related care that could disrupt their ability to deploy.

The Costs of Gender Transition–Related Health Care Treatment Are Relatively Low

• Using private health insurance claims data to estimate the cost of extending gender transition–related health care coverage to transgender personnel indicated that active-component health care costs would increase by between $2.4 million and $8.4 million annually, representing a 0.04- to 0.13-percent increase in active-component health care expenditures.
• Even upper-bound estimates indicate that less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy.

Previous Integration Efforts and the Experiences of Foreign Militaries Indicate a Minimal Likely Impact on Force Readiness

• The limited research on the effects of foreign military policies indicates little or no impact on unit cohesion, operational effectiveness, or readiness. Commanders noted that the policies had benefits for all service members by creating a more inclusive and diverse force.
• Policy changes to open more roles to women and to allow gay and lesbian personnel to serve openly in the U.S. military have similarly had no significant effect on unit cohesion, operational effectiveness, or readiness.

Recent U.S. Department of Defense (DoD) policy banned transgender personnel from serving openly in the military. Potential changes to this policy raised questions regarding access to gender transition–related health care, the range of transition-related treatments that DoD will need to provide, the potential costs associated with these treatments, and the impact of these health care needs on force readiness and the deployability of transgender service members. A RAND study identified the health care needs of the transgender population and transgender service members in particular. It also examined the costs of covering transition-related treatments, assessed the potential readiness implications of a policy change, and reviewed the experiences of foreign militaries that permit transgender personnel to serve openly.

• Chapter One

  Introduction

• Chapter Two

  What Are the Health Care Needs of the Transgender Population?

• Chapter Three

  What Is the Estimated Transgender Population in the U.S. Military?

• Chapter Four

  How Many Transgender Service Members Are Likely to Seek Gender Transition–Related Medical Treatment?

• Chapter Five

  What Are the Costs Associated with Extending Health Care Coverage for Gender Transition–Related Treatments?

• Chapter Six

  What Are the Potential Readiness Implications of Allowing Transgender Service Members to Serve Openly?

• Chapter Seven

  What Lessons Can Be Learned from Foreign Militaries That Permit Transgender Personnel to Serve Openly?

• Chapter Eight

  Which DoD Policies Would Need to Be Changed if Transgender Service Members Are Allowed to Serve Openly?

• Chapter Nine

  Conclusion

• Appendix A

  Terminology

• Appendix B

  History of DSM Terminology and Diagnoses

• Appendix C

  Treatments for Gender Dysphoria

• Appendix D

  Review of Accession, Retention, and Separation Regulations