It’s not unusual for the 45th President of the United States to go on a Twitter “bender” when he is unsupervised. But this month, one of his benders hit the endocrine community hard, when, on July 26, he tweeted:
“Please be advised that the United States Government will not accept or allow transgender individuals to serve in any capacity in the U.S. Military…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.”
The announcement effectively blindsided the military, which did not have plans to re-instate any such ban, and its response was swift: the military challenged the President to an intellectual exercise of drafting coherent policy that would (a) justify the ban; and (b) communicate a process. Until and unless that occurs, the military announced that transgender individuals should not be concerned about being kicked out of the military. According to the New York Times: “In a letter to the military service chiefs, Gen. Joseph F. Dunford Jr., the chairman of the Joint Chiefs of Staff, said that the policy on who is allowed to serve would not change until the White House sends the Defense Department new rules and the secretary of defense issues new guidelines. His letter stated that: “In the meantime, we will continue to treat all of our personnel with respect,” (https://www.nytimes.com/2017/07/27/us/politics/transgender-military-trump-ban.html)
Aside from the problem of dictating policy through Twitter, and the fact that it was announced on the anniversary of Harry Truman lifting the ban on African Americans serving in the military (see: https://www.vox.com/identities/2017/7/26/16034656/truman-integration-military-trump-trans), the proposed ban is not based on sound medical reasoning. According to the American Medical Association (see https://www.ama-assn.org/ama-statement-transgender-americans-military): “There is no medically valid reason to exclude transgender individuals from military service. Transgender individuals are serving their country with honor, and they should be allowed to continue doing so.”
According to a 2016 RAND Corporation study, as many as 15,000 active-duty troops may be transgender, and “have minimal impact on readiness and health care costs” for the Pentagon.
The response to the tweet was swift: the medical community issued a strong rebuke (See:
http://time.com/4875375/transgender-ban-military-doctors-react/). The public’s response – Republicans and Democrats alike — made clear that the ban was morally unacceptable, and several Republicans in Congress swiftly denounced the ban.
The main issue is the costs of gender-transition surgeries, which the Obama administration considered carefully, and decided to cover. The justification was that the costs of $2.4 million and $8.4 million annually for transition-related medical care was a drop in the bucket when compared to medical costs for the myriad of other conditions treated (see: https://www.nytimes.com/2015/06/09/opinion/what-doctors-say-about-transgender-troops.html). A study published in The New England Medical Journal (see: http://www.nejm.org/doi/full/10.1056/NEJMp1509230) concluded that “doctors agree that such care is medically necessary.”
Care for transgender patients represents a military health-care spending increase of 0.04 to 0.13 percent, which is one tenth of the annual budget of roughly $84 million the military spends on medication for erectile dysfunction. (See: https://www.theatlantic.com/health/archive/2017/07/things-that-cost-more-than-medical-care-for-transgender-soldiers/534945/)
Slate Magazine conducted an interview with Jesse Ehrenfeld, M.D., an expert in transgender health care and military service who stated: “There are some poorly done studies involving mental health that have been cited to suggest that trans individuals are at heightened risk of suicide or other mental health challenges solely because they are trans. That’s misinformation. There’s good emerging data demonstrating that when we provide a supportive environment and good high quality care to trans individuals, those issues seem to go away and people do well.” (See: http://www.slate.com/blogs/outward/2017/07/28/jesse_ehrenfeld_on_trump_s_transgender_troops_ban.html
Clearly, there are a myriad of ethical and constitutional problems with the President’s tweet; it echoed uncomfortable policies such as the ban on African Americans serving in the air force because of the risk of sickle cell (see: https://www.ncbi.nlm.nih.gov/pubmed/2197408)
Those who are oppose transgender troops raise concerns about psychological fitness, and whether mixing transgender troops into the traditional military population of troops is a social experiment. (See: https://www.nytimes.com/2017/07/26/us/politics/trump-transgender-military.html?_r=0)
If we’re going to use the “psychological fitness” argument, we need to consider the psychological fitness of a Commander –In-Chief who has poor impulse control on Twitter.