VA halts gender-affirming care for transgender veterans

The Department of Veterans Affairs (VA) will no longer offer gender-affirming medical treatment to transgender former service members, the department announced Monday, citing an executive order President Trump signed on his first day back in office.

Steven L. Lieberman, the department’s acting undersecretary for health, wrote in a March 14 memo first reported by NPR that the VA would rescind a 2018 directive outlining “the respectful delivery of health care to transgender and intersex Veterans.”

The 2018 policy protected access to treatments like hormone therapy and pre- and post-operative care for gender-affirming surgery, though the VA has never offered transition-related surgeries. The policy also allowed trans veterans to use restrooms and be assigned rooms in VA facilities that match their gender identity and required staff to use their chosen names and pronouns.

In a news release on Monday, the VA said it was reversing the policy to comply with Trump’s Jan. 20 executive order proclaiming that the U.S. government recognizes only two sexes, male and female, and preventing federal dollars from being spent on what the White House has called “gender ideology.”

“Effective immediately, VA will not offer cross-sex hormone therapy to Veterans who have a current diagnosis or history of, or exhibit symptoms consistent with gender dysphoria,” the VA said, referring to a diagnosis characterized by severe emotional distress stemming from a mismatch between a person’s gender identity and sex at birth. Exceptions may be made for trans veterans already receiving care, it added.

The department also no longer will offer services like voice training or items like chest binders, surgical compression vests, wigs and dilator sets for trans veterans, according to Monday’s announcement.

Transgender former service members who are eligible for VA care “will continue to receive comprehensive VA health care, which includes preventive and mental health care,” the department said, adding that Monday’s announcement “does not affect VA medical care for eligible Veterans who identify as lesbian, gay, bisexual and queer.”

Money allocated for gender-affirming care will be redirected to help severely injured VA beneficiaries, such as paralyzed veterans and amputees, regain their independence, the VA said.

The department said Monday that it does not keep consistent or reliable records on the total number of veterans who have received gender transition care through the VA, the amount of money spent on treatment or the number of employees involved.

The RAND Corporation estimated in 2016 that the Department of Defense spent between $2.4 million and $8.4 million annually providing transition-related health care to service members, the population that makes up future veterans.

A Congressional Research Service report updated in January found the department spent roughly $15 million on care for 1,892 transgender active-duty service members between 2016 and 2021, though that amount includes the cost of surgical care, which the VA does not provide.

According to an estimate from the Veterans Health Administration, less than one-tenth of a percent of the 9.1 million veterans enrolled in VA health care are transgender.

“I mean no disrespect to anyone, but VA should not be focused on helping Veterans attempt to change their sex. The vast majority of Veterans and Americans agree, and that is why this is the right decision,” VA Secretary Doug Collins said in a statement.

Asked which data or public opinion polling Collins was alluding to, VA Press Secretary Pete Kasperowicz directed The Hill to a map of the 2024 presidential election results.

“All eligible Veterans – including trans-identified Veterans – will always be welcome at VA and will always receive the benefits and services they’ve earned under the law,” Collins said. “But if Veterans want to attempt to change their sex, they can do so on their own dime.”

VA facilities, according to Monday’s announcement, have already blocked transgender veterans from using restrooms, locker rooms and patient rooms that match their gender identity. The department has begun sending letters of support to non-VA providers to provide gender-affirming surgeries to veterans, it said.

In a statement, Lindsay Church, executive director of Minority Veterans of America, said the VA’s decision to roll back protections for gender-affirming care “is a direct attack on the dignity and well-being of transgender, nonbinary, and intersex veterans — one that will have deadly outcomes.”

“VA is abandoning those who have served, stripping us of critical health care protections, and sending a clear message that our lives and service to our country do not matter,” Church said.

Major medical organizations say gender-affirming care for trans adults and minors is medically necessary and often lifesaving, though not every trans person chooses to transition medically or has access to care.

Emily Shilling, president of SPARTA Pride, an advocacy group for transgender service members, called the VA’s announcement “a betrayal” of the “sacred trust” foundational to military service. Shilling is one of several transgender service members suing the Trump administration over another executive order to prevent trans people from serving openly in the military.

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