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A transgender flag waves against the blue sky. The flag has 5 srips with blue, pink, and white color.

Transgender Veterans

"Transgender people have served, are serving, and will continue to serve"
Allyson Robinson
~ West Point Graduate and former officer in the U.S. Army ~

Quick Facts

Quick Facts About Our Nation's Transgender Veterans

  • Transgender people can have a variety of identities including people who don’t identify as male or female, sometimes called non-binary gender identification or gender non-conforming.
  • Over 134,000 U.S. Veterans are estimated to be transgender, with over 15,000 transgender people currently serving in the U.S. military (active duty and reserves). Note that these estimates were obtained before transgender people were allowed to serve openly in the U.S. military.1
  • Transgender people are at least 2-3x more likely to have served in the U.S. military than non-transgender people. Transgender people are motivated to join the military for similar reasons as non-transgender people – patriotism, life direction, and a family history of service. Additionally some transgender people join the military to escape family rejection or violence, or to enter an environment with clear rules about gender expression.1
  • Recent research suggests that Veteran status may contribute to resilience and positive mental health outcomes among some transgender individuals. A recent study of 183 transgender and gender non-conforming older adults (43 Veterans, and 140 non-Veterans) found that prior military service was associated with lower depression symptomatology, as well as greater psychological health related quality of life. 2
  • Transgender people were not allowed to openly serve in the U.S. military until June 30, 2016, nearly 5 years after the repeal of Don’t Ask, Don’t Tell (DADT). This status of transgender Servicemembers is currently in transition. For more information, see the Department of Defense transgender policy webpage.3
  • Transgender Veterans have always been eligible for being treated at the VHA, for more information about what care is currently covered see policy report documents reports by the Department of Veterans Affairs (2013) and Kauth and Shipherd (2016).4,5
  • As of 2017, more than 5,000 transgender Veterans were receiving transition-related care in the VA healthcare system. This figure is considered to be low relative to the number of transgender Veterans in the system given that not all transgender Veterans meet criteria for a diagnosis and also many choose not to disclose their gender identity to providers.6
  • For more information about transgender Veterans, please explore the VA LGBT Health Program Website. You can also find information on transgender Veterans and VA transgender care through the Transgender American Veterans Association website. Of particular interest, is the section with stories of transgender lives and service.

1 Gates & Herman, 2014; [LINK].
2 Hoy-Ellis et al., 2017; [LINK].
3 Sisk & Jordan, 2016; [LINK].
4 Department of Veterans Affairs, 2013; [LINK].
5 Kauth & Shipherd, 2016; [LINK].
6 Cramer, 2017; [LINK].
7 Brown & Jones, 2016; [LINK].
8 Sherman, Kauth, Shipherd, & Street, 2014; [LINK].
9 Simpson et al., 2013; [LINK].

Educational Materials

Educational Materials

Creating a Welcoming Environment

Creating a Welcoming Environment

Gender identity is complex, and people describe their gender in a lot of different ways. As with all identities, it is important to validate the gender identities of transgender clients. One way of doing this is to ask your clients how they identify their gender, and what pronouns they use. In some cases, transgender Veterans will use different pronouns and names than what is written on their legal documents, which means that medical records, especially electronic medical records, can be difficult to amend to reflect a client’s identity appropriately.

It is important to work with your clients, and with the system in which you are practicing, to navigate any barriers that might arise in charting and other documentation. Consider using paperwork that asks clients to identify their sex assigned at birth and gender identity, as well as paperwork which either allows people to write in their gender identity or lists multiple gender identities that a person can choose from when completing necessary forms.

Names and pronouns are just one part of creating a welcoming environment. A lot of what we do in our day to day lives and practice is gendered. Wherever something in your clinical practice is gendered, consider how you can be inclusive of all gender identities. For some helpful tips, visit the links below.

Useful Tips

  • Creating a Trans Welcoming Environment: A Tip Sheet for SA Service Providers »
    This brief, easy to read (and use) tip sheet is written specifically for sexual assault service providers who are working with a transgender or gender non-conforming client. It is intended as an overview, a set of reminders, to ensure heightened sensitivity to the needs of trans* survivors.
  • Create a Safe and Welcoming Clinic Environment »
    Transgender people may avoid seeking care due to prior discrimination or disrespect in a clinic setting. Providing a safe, welcoming and culturally appropriate clinic environment is essential to ensure that transgender people not only seek care, but return for follow-up. There are several key components to creating an appropriate setting for transgender care.

 

Resilience and Stress-Related Growth

Resilience and Stress-Related Growth

Resilience

“Commonly refers to the ability to withstand or overcome significant stress or adversity,” though there is no one, widely agreed upon definition that identifies exactly what fosters resilience in transgender and other minority populations.1 Some potential resilience factors that have been more widely studied include family support, peer support, and identity pride.1 Research suggests that high social support may foster resilience, while low social support increases minority stress. Both concepts can be interrelated with ‘coming out’ for the first time as transgender.1, 2 Pride in one’s identity/identities may also be a mediating factor, with important implications for multiple intersecting identities that may place someone at higher risk for stigma and discrimination, such as transgender women of color.3


Stress-Related Growth

The idea that personal growth can occur through adversity, or trauma, depending upon how adversities and the ability to overcome adversities are perceived. When applied to LGBTQ communities, stress-related growth often takes into account resilience factors such as community support and connectedness of individuals to communities.4 Similar to resilience, there are important implications for intersectional identities, with several research studies focusing on the interaction between gender identity, religion, and stress-related growth.5, 6


Community Pride

With the aforementioned importance of community connectedness and community pride, it may be important for clinicians working with transgender Veterans to consider ways of fostering pride during the coming out process, as well as during times of increased identity distress. One way of doing this is to help transgender Veterans connect with one another through VA and community groups. It may also be helpful to identify influential figures that Veterans can relate to who have publicly displayed resilience and/or stress-related growth. See a list of notable transgender Veterans.


1 Colpitts & Gahagan, 2016; [LINK].
2 Singh, Hays, & Watson, 2011; [LINK].
3 Singh & McKleroy, 2011; [LINK].
4 Vaughan & Waehler, 2010; [LINK].
5 Rodriguez & Follins, 2012; [LINK].
6 Golub, Walker, & Longmire-Avital, 2010; [LINK].

Treatment Considerations/Health Disparities

Treatment Considerations/Health Disparities

Transgender Veterans face a number of physical and mental health disparities. They are also more likely than non-transgender Veterans to have experienced military sexual trauma (MST), as well as non-sexual harassment and assaults. Some may even have been dishonorably discharged. Despite these barriers, transgender Veterans have serviced honorably for decades, with higher rates of service connected disability than among non-transgender Veterans.1

While it is sometimes possible to have dishonorable discharges related to sexuality and gender amended through Vet Centers and other legal services, the complicated history of transgender military service and VA care may leave transgender people feeling uncertain about the safety of seeking important medical services both in and out of the VA. Studies have found that transgender Veterans may fear disclosing their identity to providers 8,9. Increased understanding of the unique needs of transgender Veterans can positively impact treatment planning and delivery. VA is working hard to create a welcoming environment for transgender Veterans including having visible signs that help dispel understandable fears that they are not welcome at VA.

Transgender Veterans’ racial and ethnic identities, socioeconomic status, religious or spiritual affiliation, age cohort, disability status, and era of service, among other characteristics, are all important aspects of identity that impact each Veteran’s experience, worldview, and treatment. Providers should integrate all of these factors into treatment.26 Below is other important information to consider when working with transgender Veterans.

Important Considerations/Health Disparities


1 Blosnich, Brown, Shipherd, & Kauth, 2013; [LINK].
2 Lehavot, Simpson, & Shipherd, 2016. [LINK].
3 Blosnich, Brown, Wojcio, Jones, & Bossarte, 2014; [LINK].
4 James et al., 2016; [LINK].
5 Brown & Jones, 2016; [LINK].
6 Sevelius, Carrico, & Johnson, 2010; [LINK].
7 Johnson, Shipherd, & Walton, 2015; [LINK] .
8 Blosnich et al., 2016; [LINK].
9 Brown & Jones, 2016; [LINK].
10 Lindsay et al., 2016; [LINK].
11 James et al., 2016; [LINK].
12 Sherman, Kauth, Shipherd, & Street, 2014; [LINK].
13 Sherman et al., 2014; [LINK].
14 Meyer et al., 2003; [LINK]
15 Hendricks & Testa, 2012; [LINK]
16 Kelleher, 2009; [LINK]
17 Xavier et al., 2004; [LINK]
18 Ryan, 2009; [LINK]
19 VA Office of Diversity and Inclusion, 2017; [ LINK]
20 Department of Veterans Affairs, 2017; [LINK]
21 Harrison-Quintana & Herman, 2012; [LINK]
22 Breyer et al., 2014; [LINK]
23 Cosgrove et al., 2002; [LINK]
24 Stephenson, Riley, Rogers, Suarez, Metheny, Senda, Saylor, & Bauermeister, 2017; [LINK]
25 Sloan, C.A., Berke, D.S., & Shipherd, J.C. (in press). Utilizing a dialectical framework to inform conceptualization and treatment of gender dysphoria. Professional Psychology: Research and Practice).
26 Adult Transgender Care: An Interdisciplinary Approach for Training Mental Health Professionals. Kauth, M.R. & Shipherd J.C. (Eds.). New York: Routledge.

Useful Resources



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