New Transgender Veterans’ Health Care Guidelines

The Veterans Administration has issued a Directive to all of its facilities requiring them to provide respectful, confidential healthcare to transgender veterans, including providing hormones and mental health care.

In its fact sheet about the new Directive, the National Center for Transgender Equality (NCTE) correctly notes that not only is the new Directive “an important first step in securing equal access for transgender veterans,” but it also sets “an example of how healthcare providers in both the public and private sector should be treating transgender patients.”  The main features of the new Directive, NCTE’s fact sheet continues, include:

  • All VA staff are to provide care to transgender patients “without discrimination in a manner consistent with care and management of all Veteran patients;”
  • States that all personal information about transgender status and medical care is to be kept confidential;
  • A reiteration that, under existing regulations, sex reassignment surgery cannot be performed or paid for by the VA; and
  • Reiterates that all other medically necessary healthcare for transgender veterans is covered, including sex-specific care like mammograms and pap smears, as well as transition-related care such as hormones and mental health services.

Interestingly, the new Directive is also the first time I recall seeing the federal government issue instructions concerning intersex persons.  NCTE notes that the sex reassignment surgery exclusion does not apply to veterans “with intersex conditions who need surgery to ‘correct inborn conditions related to reproductive or sexual anatomy or to correct a functional defect.’”  The Veterans Health Administration (VHA) is able to make this distinction, NCTE notes, “because the regulation barring sex reassignment surgery does not have any application to intersex conditions, and VHA is aware of the difference between transgender and intersex veterans.”

Also of note is the fact that “A diagnosis of GID [Gender Identity Disorder] or other gender dysphoria diagnoses, is not a precondition for receiving care with the Veteran’s self-identified gender.”  However, as with other veterans using VA care, a physician does need to say the care is medically necessary.

The NCTE fact sheet is available at:

The new Directive itself is at:

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