| Perspectives on Texas

The Texas Legislature’s current emergency session to consider transgender bathrooms and other issues was overshadowed this week by President Trump’s tweets on transgender policy in the U.S. military. The prominence of these issues and the heated debate about them arise in part because of their complexity. This complexity should be a caution to politicians that diligent research is a better path to resolving the issues than 30-day legislative sessions or 140-character communications. For example, in 2012, the American Psychiatric Association (APA) changed its earlier position that being transgender is a disease. This change has had a substantial impact on the cost of how transgender people are treated in the military.

Medical cost is a major factor in the debate about whether transgender people can serve in the military. Surgical sex transitions are expensive, so it is a legitimate question whether that expense should be borne by taxpayer funds devoted to the military. But that issue in turn depends on whether being transgender is a disease. According to the Diagnostic and Statistical Manual of Mental Disorders published by the APA, it is not. In the latest edition of that authoritative publication, the name of the condition has been changed from “gender identity disorder” to “gender dysphoria.” The publication states that “gender nonconformity is not in itself a mental disorder.”

This change is not dissimilar to an earlier change in the same APA diagnostic manual — when it ceased classifying homosexuality as a disease. That change went a long way toward removing stigma from a very productive group of people. It also removed any justification for providing insurance or free medical care for homosexuality as a medical disorder.

Similarly, declassifying being transgender as a disease speaks directly to and impacts the cost issue. If gender dysphoria is not a mental illness, then it is not something that health insurance or health programs in the military should cover. If someone wants to transition surgically from one sex to the other, that would be akin to uninsured cosmetic surgery.

If gender dysphoria, however, generates other medical problems like depression, then these should be insured in the same way that the sex-related problems of cisgender people are treated. In other words, medical care should be dispensed to transgender people in the same way that it is dispensed to non-transgender people.

There is resistance to this idea because many believe that being transgender is a choice — that transgender people are not authentic. That does not appear to be the case. In a publication about fair treatment of transgender athletes, the NCAA (which governs collegiate athletics — not a radical organization) writes that “gender identity is a core aspect of a person’s identity, and it is just as deep-seated, authentic and real for a transgender person as for others.” Just last week, The Texas Lawyer reported on a senior, distinguished patent litigator who had transitioned from male to female. The lawyer’s Facebook posting announcing the transition stated, “with the support of my wife, family, friends and law firm, I have now dealt with a life-long condition I have no control over, transgender.”

Furthermore, choosing to be transgender would not be a very rational choice because transgender people are often subject to widespread abuse and discrimination. Clearly it is a condition — part of the human condition — not a disease or a choice.

Therefore, the military should be open to people with this condition just as it is open to people with many conditions that are not diseases. That is a completely separate question from paying substantial amounts of money for sex-transition surgery.