ORLANDO, Fla. — The U.S. Department of Veterans Affairs is taking the first step toward providing gender-confirmation surgeries through its health-care network, Secretary Denis McDonough announced at a Pride Month event in Orlando Saturday — a historic move he said is simply “the right thing to do.”
Vowing to create a “safe and caring” environment for all veterans, McDonough cited the need to overcome a “dark history” of discrimination against LGBTQ military service members. The announcement marks the start of what is expected to be a two-year process to expand the VA’s capacity to provide and cover the surgeries.
“This time will allow VA to develop capacity to meet the surgical needs that transgender veterans have called for and deserved for a long time, and I am proud to begin the process of delivering it,” McDonough told a cheering crowd.
For Army Sgt. Lynn Brownfield, a gay woman who had to remain closeted when she served in the 1980s, the news brought tears of joy.
“I attended many, many funerals of veterans who died from AIDS because they couldn’t receive care (through the VA system),” the 57-year-old said. “So now to have a VA secretary who respects us and values the fact that we were willing to die for our country — a country that rejected us — is just so incredible. It makes me so proud.”
McDonough said he chose Orlando for the announcement partly to acknowledge the work of the Orlando Vet Center, which provides a range of counseling services to veterans and their families. But he also noted the city’s June 2016 mass shooting at Pulse, a gay nightclub, that left 49 people dead.
“For generations, service members who identify as lesbian, gay, bisexual, transgender or related identities faced brazen discrimination or even worse — not just in our Armed Forces, but in so many aspects of their lives,” the secretary said. “That is the dark history we must overcome, at VA and in America, and it echoes to this day, in horrific incidents like the Pulse nightclub shooting that devastated this community five years ago.”
Some 80% of LGBTQ+ veterans have faced prejudice or rejection in the military, the secretary said.
According to a 2018 article in the American Medical Association’s Journal of Ethics, an estimated 134,000 U.S. veterans have gender dysphoria, clinically significant distress or impairment due to feeling trapped in a body that doesn’t match their sense of who they are. Gender confirmation surgery, once considered merely cosmetic, is now widely accepted among physicians as a medically necessary intervention for selected patients.
McDonough said the change was based on reports from VA clinicians that LGBTQ+ veterans often face considerable mental health harm — including a heightened risk of suicide — because of societal rejection and discrimination.
“We’re making these changes not only because they are the right thing to do, but because they can save lives,” he said.
In 2013, the military began providing mental health services and prescription hormone therapy for transgender veterans, but the directive also specifically denied coverage of what was then called “sex reassignment surgery.”
Gina Duncan, director of transgender equality for the statewide LGBTQ civil rights organization Equality Florida, said her agency was “thrilled to have allies at the highest level of government” and noted the contrast with recent moves by the Florida Legislature and Gov. Ron DeSantis to limit transgender youth participation in school sports.
“In a moment of fierce state and local backlash against the transgender community, this move by the Biden administration is a reminder that elections matter,” Duncan said. “Support for transgender veterans and the lifesaving healthcare they need to live authentically is a critical component to fulfilling our nation’s promise of caring for those who’ve served.”
McDonough said he did not know how much opposition to expect but that the decision is ultimately up to President Joe Biden, who repealed the former Trump administration’s ban on transgender military service on his fifth day in office.
According to VA Press Secretary Terrence Hayes, the department expects that fewer than 4,000 veterans would be interested in the surgery. The cost to the VA has yet to be calculated, he said.
Researchers estimate that .6 percent of the U.S. population—roughly 1.4 million people—self-identify as transgender, but transgender individuals are believed to be more common in the military than among the civilian population.
Gender-confirmation surgeries can include mastectomy, hysterectomy, genital reconstruction and facial feminization, among other procedures.
McDonough noted the VA is also changing the name of the Veterans Health Administration’s LGBT health program to the LGBTQ+ Health Program — language that he said “proudly reflects new community standards of inclusiveness.” All VA medical facilities now have LGBTQ+ veteran care coordinators who face legal consequences if they divulge private veteran health information outside the VA walls.
“We’re making a concerted effort to create a safe and caring environment for LGBTQ+ veterans in all of our hospitals,” McDonough said.
