University of Southern California Dissertations and Theses

Transgender experience in the U.S. military: opportunities for effective inclusion

(USC Thesis Other)

Transgender experience in the U.S. military: opportunities for effective inclusion

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content

Transgender Experience in the U.S. Military:
Opportunities for Effective Inclusion

by

Michael Robert Stegen

A Dissertation Presented to the
FACULTY OF THE ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
in Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

August 2023

Copyright 2023 Michael Robert Stegen
2

Abstract
The U.S. military has historically discriminated against specific populations, disallowing
military service by people of color, women, and sexual minorities at point in that past.
Transgender people were not allowed to openly join the military until 2016, only to be prohibited
again in 2017, and further being once again allowed in 2021. This history as left a legacy of
stigma and promoted a culture where harmful behaviors toward transgender people are
prominent, leaving these military members with unmet psychological needs. This study of 10
transgender people who have recently separated or retired from the military highlights the mental
struggles this population experiences due to discriminatory, harassing, and abusive behavior
present in the military context, The findings further highlight common barriers to receiving
gender-affirming care that transgender people in the military experience, citing disruptions and
delays within the process for obtaining permission to receive the treatment; a problem that
further exacerbates their mental distress. Aside from these experiences and challenges,
transgender people who serve in the military report feeling supported by people in leadership
positions and report being satisfied with the quality of medical care they receive within the
military health system.
Military commanders and leaders can mitigate these harmful experiences by taking
deliberate steps to modify the current culture and promote the inclusion of this population.
Commanders should be educated on issues affecting transgender people and the effect these
issues can have on mental health and organizational performance. Additionally, commanders
should create avenues for allyship and advocacy within their organizations, which could include
resource groups, advocacy groups, and affinity networks. Further, commanders and leaders at all
levels should deliberately foster stronger inclusion by including transgender military members in
3

policymaking and policy-reviewing initiatives to ensure forward momentum toward full
inclusion of transgender people in the U.S. military.

4

Acknowledgments
This dissertation represents the culmination of the invaluable contributions and support
from several people in my life. I would like to express my deepest gratitude to those individuals.
To transgender people everywhere: Within your journey lies the strength to embrace
authenticity despite diversity. You are a reminder that true strength arises from the depths of self-
discovery. I will forever admire your courage; wherever you go, remember you’re not going alone.
To Dr. Eric Canny for his exceptional professorship and unwavering support from the
early stages of this journey. Dr. Canny's astute guidance, compassionate nature, and dedication to
personal growth have been a constant source of inspiration. I am truly grateful for his mentorship
and the transformative impact he has had on both my academic and personal development. I
further extend my sincere thanks to Dr. Courtney Malloy for her timely intervention when I
found myself drifting off course. I am deeply appreciative of her guidance and her commitment
to my academic success. Furthermore, I am indebted to Dr. Kathy Stowe, who not only served as
my dissertation chair but also provided invaluable support and expertise throughout this
scholarly endeavor. Dr. Stowe's dedication, guidance, and collaborative approach have been
instrumental in the completion of this dissertation. Her extensive knowledge and commitment to
my success have greatly enriched my journey.
Most importantly I would like to express my heartfelt appreciation to my husband, John,
for his unwavering support and numerous contributions to my success. John, thank you for being
my steadfast pillar of support, always here to pick me up be whatever I need in my moments of
crisis--a listening ear, an IT expert, a cook, a delivery man, and the list goes on. I would have
given up long ago if it weren’t for you. Above all, I am profoundly grateful for your unwavering
belief in me and for being a dedicated father to our boys. Your love, friendship, and support have
been the foundation upon which I have built my academic achievements.
5

To my sons, Beau and Tyler, I extend my deepest gratitude for your understanding,
patience, and unwavering support throughout this journey. Thank you for your understanding
during times when I was occupied with school, for giving me the space I needed to focus on my
studies, and for your unwavering love and encouragement. Your presence in my life has been a
constant source of motivation and inspiration.
Each of you has played an integral role in my academic journey, and I am deeply grateful
for your unwavering support, guidance, and belief in my abilities. Thank you for being the pillars
of strength and for contributing to my success.

6

Contents
Chapter One: Introduction………………………………………………………………………..9
Background of the Problem .....................................................................................................9
Purpose of the Study and Research Questions ........................................................................ 12
Importance of the Study ......................................................................................................... 12
Overview of Theoretical Framework and Methodology ......................................................... 14
Definitions ............................................................................................................................. 15
Organization of the Dissertation ............................................................................................ 16
Chapter Two: Review of the Literature…………………………………………………………18
Chronosystem: Changes in Policy over Time ......................................................................... 20
Macrosystem: Sociocultural Considerations ........................................................................... 24
Exosystem: Transgender People in the Military ..................................................................... 29
Mesosystem: Military Support Services and Transgender Servicemembers ............................ 38
Microsystem: Transgender Servicemember’s Immediate Environment .................................. 39
Conceptual Framework .......................................................................................................... 47
Chapter Three: Methodology…………………………………………………………………….52
Research Questions ............................................................................................................... 52
Overview of Methodology ..................................................................................................... 52
The Researcher ...................................................................................................................... 53
Data Sources.......................................................................................................................... 53
Data Analysis ........................................................................................................................ 56
Credibility and Trustworthiness ............................................................................................. 56
Ethics .................................................................................................................................... 57
Chapter Four: Findings…………………………………………………………………………..58
Participants ............................................................................................................................ 58
Findings for Research Question 1 .......................................................................................... 60
Findings for Research Question 2 .......................................................................................... 73
Summary of Findings ............................................................................................................ 81
Chapter Five: Discussion and Recommendations ...................................................................... 82
Discussion of Findings .......................................................................................................... 82
Recommendations for Practice............................................................................................... 88
Limitations and Delimitations ................................................................................................ 92
7

Recommendations for Future Research .................................................................................. 93
Researcher Reflection ............................................................................................................ 94
Conclusion ............................................................................................................................ 94
References………………………………………………………………………………………..97
Appendix A: Interview Protocol………………………………………………………………..107

8

List of Figures
Figure Page
1. Conceptual Framework 45

9

Chapter One: Introduction
Studies have shown that the effects of past discriminatory policies limiting the ability of a
member to be open about their sexuality persist in LGBTQ+ military members, despite changes
in the policies themselves (McNamara et al., 2020). Further, McNamara et al. point out that past
discriminatory policies have a lasting effect on LGBTQ+ members’ decisions on whether to
conceal their sexual orientation or identity. In a report assessing total inclusion for members of
the LGBTQ+ community, Alford (2016) posits that transphobia likely causes servicemembers to
conceal their true identity, having a negative effect on mental health and well-being over time. In
a similar study, Hill (2016) found a significant correlation between identity concealment and
poor health. This study also revealed that transgender members refrain from reporting levels of
health issues they feel could affect their ability to serve, further exacerbating their problems. The
problem of practice is that transgender U.S. military members are marginalized and subjected to
discrimination, harassment, and abuse, negatively affecting their mental health and their
willingness to be authentic at work.
Background of the Problem
The United States Department of Defense has a long history of discrimination against
LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer) people. Until the mid-1990s, LGBTQ
people were not allowed to serve in the military. Department of Defense Directive 1304.26 was
issued in 1993 (DoD, 1993). More popularly known as “Don’t Ask, Don’t Tell,” the directive
was translated into policy to lessen sexual orientation exclusion while specifically prohibiting
homosexual conduct in the military, but did not make any provisions for transgender military
service. Likewise, when the policy was repealed in the 111th Congress House Resolution 2965
(Congress, 2010), removing sexual orientation as a condition of service, there was still no
10

provision for allowing transgender members to serve. On June 30, 2016, the Department of
Defense issued Directive-type Memo 16-005 prohibiting services from denying individuals the
right to serve based on gender identity.
On July 26, 2017, President Donald Trump used Twitter to announce that “…the US
Government will not accept or allow transgender individuals to serve in any capacity in the U.S.
Military…” (Trump, 2017). He added, “Our military must be focused on decisive and
overwhelming victory and cannot be burdened with the tremendous medical costs and disruption
that transgender in the military would entail,” implying that these members are a burden and a
threat to victory. On January 25, 2021, another substantial reversal of recent policies occurred
when President Joe Biden issued an executive order revoking past discriminatory policies,
stating that all qualified Americans could serve their country in uniform (Biden, 2021).
While the available research indicates increasing support for transgender people serving
in the military, the topic is still widely debated. Studies have identified several trends among
those who are and are not supportive. A study by Haider-Markel et al. (2017) aimed at defining
the population most likely to support transgender people in elections found that supporters are
typically liberal-leaning, educated, more affluent, and less religious. The researchers further
point out that those who are most likely to support transgender people are also more likely to be
supportive of women and others with minority status. Additionally, findings from a study
involving 486 active duty military members, including cisgender and LGB, has shown
widespread support for transgender military service (Dunlap et al., 2020) but did not indicate
why people chose to be supportive or non-supportive. While support was broad across all
military services, Brown et al. (2018), Lewis et al. (2019), and Dunlap, et al. (2020) have showed
that white, religious, heterosexual men were less supportive than people who have traditionally
11

been less privileged. Similarly, results from a laboratory experiment have shown that women are
more likely to support transgender equality than men (Harrison & Michelson, 2018). Further,
these researchers suggest that veterans, traditionalists, and religious conservatives have a stake in
maintaining the status quo in the military and society and are thereby most likely to oppose
transgender military service. Conversely, their research has revealed that higher education,
democratic partisanship, liberal ideology, and identification as LGBTQ+ are common
characteristics of those who are most likely to be supportive. The identified trends infer one’s
position of opposition or support may come from underlying values, beliefs, or ideologies, but
these have rarely been cited as a reason for overt opposition.
Opposition to transgender military service has typically been predicated on concerns for
fiscal responsibility, military unit cohesion, military readiness, or national security. These
concerns have largely been based on an argument that being transgender is a mental illness and
that transgender people are medically unfit for military service. In a comprehensive review of all
DoD-wide regulations that governed transgender people serving in the military, Elders (2015)
pointed out that policies disqualifying transgender people prior to their explicit exclusion from
service in 2017 were based on assumptions regarding their medical fitness for duty. The
researcher concluded that the guidance was immersed in medical and other guidance intended to
maintain good health and order, citing that transgender people are too prone to illness, that
transition surgery is too complex and risky for military medical personnel to undertake, and that
transgender military members would be unable to deploy safely due to the level of medical care
they would require. Similarly, in Military Law Review Journal, Bunn (2010) posits that most
transgender people require extensive medical treatment to live a stable life, further explaining
that therapy can be required frequently and result in severe side effects that can be detrimental to
12

the individual and the mission. The author points out that hormone therapy alone can cause
thrombolytic disease, heart attacks, cancer, and other severe medical debilitations.
In a Presidential Memorandum (Trump, 2017b) that followed, providing clarification of
his expectations on transgender military service, President Trump made the claim that
transgender people experiencing Gender Dysphoria would hinder military effectiveness and
lethality, disrupt unit cohesion, and tax military resources. Moreover, in a subsequent policy, the
(Department of Defense [DoD], 2019) categorized Gender Dysphoria as a serious medical
condition, stating that having this condition could “adversely impact unit readiness and combat
effectiveness”. Research has shown that the classification of transgender people in the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American
Psychiatric Association, 2013) may perpetuate concerns by correlating their identity to one of
mental illness and distress (Elders, et al., 2015; Hill, et al., 2016).
Purpose of the Study and Research Questions
The purpose of this study is to define the reality or experience of transgender people
currently serving in the U.S. military, identify barriers to authentic behavior for transgender
people in the military context, and identify opportunities for leadership to enhance the inclusion
on transgender military members. This study has been designed to provide insight regarding the
following questions:
1. What are the experiences of transgender servicemembers in the US Military?
2. What are the perceived challenges transgender servicemembers face in the US
military?
Importance of the Study
Studying how transgender people experience their time in the United States military is
important for several reasons. First, this research could provide insight into the impact of policy
13

changes. The United States military has a complex history of policies regarding transgender
individuals. By studying how transgender people have experienced these policies, we can gain a
better understanding of the impact that these policies have had on their lives and well-being. This
understanding can help inform policy changes that would improve the experience of transgender
individuals in the military. Further, a better understanding of the experiences of transgender
people in the military can help promote a more inclusive and diverse military culture. By
acknowledging and valuing the contributions and experiences of transgender individuals, the
military can create a more welcoming and supportive environment for all service members.
Additionally, this research may provide support for transgender mental health.
Discrimination, harassment, and exclusion can negatively impact mental health. Transgender
individuals in the military may face additional challenges related to their gender identity. By
studying their experiences, we can identify areas where support and resources may be needed to
promote mental health and well-being. Lastly, by studying the experience of transgender people
serving in the military, we can recognize and honor the sacrifices and service of all military
members, regardless of their gender identity. Transgender individuals have a long military
history, and their contributions to our country are important. By studying their experiences, we
can recognize and honor the sacrifices and service of all military members, regardless of their
gender identity. In summary, studying how transgender people experience their time in the
United States military is important for promoting inclusivity, understanding the impact of policy
changes, supporting mental health, and recognizing the value of all service members.

14

Overview of Theoretical Framework and Methodology
Recognizing that people shape, evoke responses from, and react to their environment
Bronfenbrenner identified the active person as the central force in the development of his model
(Darling, 2007). Further, Bronfenbrenner (1979) posits that individual development takes place
within four systems. These systems are the microsystem, mesosystem, exosystem, and
macrosystem. Originally used to learn about child development, Bronfenbrenner’s theoretical
framework demonstrates that each of these systems interacts with one another, and these
interactions influence the individual central to the environment, affecting how the person
responds and reacts to those influences.
As shown in Figure 1, the model, later updated to include the chronosystem, emphasized
the interaction between the person, process, context, and time as important considerations for
research in development (Hayes et al., 2017). This model can be useful when researching the
transgender person serving in a military setting by providing a framework of inquiry that
considers the interactions at different levels and the effect they have on the transgender person’s
performance at work. This model provides a framework to consider individual factors as well as
aspects of an individual’s microsystem, mesosystem, macrosystem, exosystem, and
chronosystem (Shelton, 2018).
Due to the complex nature of this problem, Bronfenbrenner’s Ecological Systems Model
is the most appropriate framework through which to analyze it. Using this model allowed the
researcher to evaluate factors that influence a transgender person’s environment within the
sphere of different systems as well as identify connections between those systems. With this
model at the core of this research, the scope of this research focused mostly on the individual
level, the microsystem, and the mesosystem. Defining and understanding the influences on these
15

levels provided a comprehensive view of the reality that transgender military members
experience, pinpointing opportunities for the most impactful change and subsequently provide
more sound recommendations for problem resolution. Figure 1 illustrates how Bronfenbrenner’s
Ecological Systems Model informs the conceptual framework of this research. It is important to
note that, although this research did not focus on the exosystem, macrosystem, and
chronosystem, the influence within these systems should not be discounted.
This research project employed a qualitative methodology to explore the experiences and
perspectives of 10 transgender military members. Semi-structured interviews were conducted
with participant, utilizing virtual or phone-based communication to accommodate geographical
separation. The researcher engaged in a thorough analysis process, carefully analyzing interview
responses. Through this iterative process, common themes emerged that provide rich insights
regarding experiences exclusive to transgender people in the U.S. military.
Definitions
Gender refers to the socially and culturally constructed roles, behaviors, activities, and attributes
that a particular society considers appropriate for men and women.
Transgender is a term used to describe individuals whose gender identity differs from the sex
they were assigned at birth.
Cisgender refers to individuals whose gender identity corresponds with the sex they were
assigned at birth.
LGBTQ is an acronym that stands for lesbian, gay, bisexual, transgender, and queer/questioning.
It is used as an umbrella term to describe individuals who identify as non-heterosexual and/or
non-cisgender.
16

Gender identity refers to an individual's personal sense of their own gender, which may or may
not correspond with the sex they were assigned at birth.
Gender expression refers to the way in which individuals express their gender identity to others,
through behaviors, clothing, hairstyles, and other forms of personal presentation.
Gender dysphoria (GD) is a term used to describe the distress that individuals may experience
because of the incongruence between their gender identity and the sex they were assigned at
birth. It is considered a medical diagnosis and is a requirement for access to certain gender-
affirming medical treatments.
Organization of the Dissertation
This dissertation aims to address the problem of practice concerning the marginalization,
discrimination, and harassment endured by transgender individuals in the U.S. military. The
study investigates the experiences and challenges faced by transgender personnel and provides
recommendations for enhancing transgender inclusion. The dissertation is organized into five
chapters, each contributing to the overall understanding of the problem of practice and offering
insights for potential solutions.
The first chapter provides an overview of the problem of practice by highlighting the
significance of transgender inclusion in the U.S. military. It establishes the context and rationale
for the research, identifies key stakeholders, and outlines the research objectives. Additionally, it
presents the research questions that guide the study.
Chapter Two consists of a comprehensive review of existing literature related to
transgender inclusion in the military. It encompasses both theoretical and conceptual
frameworks, providing a deep understanding of the issues involved. The chapter examines
17

relevant research, policies, and best practices to contextualize the research study within the
broader academic discourse.
Chapter Three outlines the research methodology employed to investigate the problem of
practice. It details the research design, including the selection of qualitative research methods
such as interviews and surveys. The chapter also discusses the research participants, highlighting
their demographics and backgrounds. Furthermore, it presents the research questions and
explains the data collection, analysis, and interpretation process.
Chapter Four presents the findings derived from the collected data. It includes a summary
of the research questions and provides an in-depth analysis of the information and quotes
obtained from the interviews. The chapter examines patterns, themes, and trends that emerged,
offering insights into the experiences, challenges, and perspectives of transgender individuals in
the military. The findings are linked back to the research questions to establish their relevance
and significance.
Chapter Five builds upon the findings presented in Chapter Four and offers
recommendations for enhancing transgender inclusion in the U.S. military. These
recommendations are based on the insights gained from the research study and aim to promote a
more inclusive and equitable environment for transgender personnel. The chapter discusses
practical strategies, policy implications, and potential areas for further research.

18

Chapter Two: Review of the Literature
This literature review examines available empirical data and research regarding
transgender people and identifies salient connections between identified concepts useful in
assessing the experience of transgender people serving in the United States (U.S.) military. The
most prominent limitation of this literature review, pervasive throughout, is that there are few
studies available involving transgender people serving in the military to draw from, and the
existing studies are limited to small sample sizes. This limitation is likely because there have
been only short periods of time where transgender people were allowed to serve in the military
openly; there has historically been a perception that one would be subject to repercussions for
disclosing oneself as transgender while serving (Dietert et al., 2015), and because the
Department of Defense (DoD) has not historically collected data on gender identity (Kamarck,
2019). To provide a more substantive review of some concepts and provide context regarding
transgender people serving in the military, this review presents data drawn from scholarly
research on other sexual minority (lesbian, gay, and bisexual) populations in the U.S. military, as
well as military organizations outside the U.S. who have allowed transgender people to serve.
Using ecological systems theory (Bronfenbrenner, 2007; Halpenny, 2017) as a
framework, this literature review presents aspects influencing a transgender military
servicemember’s experience within five interrelated environmental systems: chronosystem,
macrosystem, exosystem, mesosystem, and the microsystem. Although originally developed as a
framework made of four levels (Onwuegbuzie et al., 2013) to understand early childhood
development, when applied to the concept of transgender military service, ecological systems
theory provides a systemic method to evaluate a wide range of factors categorized into smaller
spheres of influence such as the individual’s immediate environment, systems within the
19

individual’s environment, the relationship between the individual and these systems, and the
relationship between multiple systems. Additionally, this model provides consideration for
changes over time (Halpenny, 2017; Neal and Neal, 2013), which is important to consider given
the recency of policy changes and the possible influence historical policy can have on current
attitudes. To provide a contextual foundation, this literature review begins by outlining the
history of transgender military service and policy changes occurring within the chronosystem
outlined in Bronfenbrenner’s model (Bronfenbrenner, 2007; Halpenny, 2017).
This literature review is structured to provide a comprehensive understanding of the
available empirical information regarding the experiences and interactions of transgender
military members within various systems. The first part focuses on the transgender member's
chronosystem, macrosystem, and exosystem. This section begins by examining the historical
context of transgender service in the U.S. military, highlighting significant milestones, policy
changes, and the challenges faced by transgender individuals in this context. Sociocultural
considerations are then explored, referring to theories and perspectives that shape societal
perceptions of transgender people and their suitability for military service. Additionally, this
literature review investigates the existing research on the impact of transgender military
members on the U.S. military as well as the effects of military service on transgender individuals
themselves.
In the second part of this literature review, attention is given to the transgender military
member's mesosystem and microsystem. This section includes a review of support services
available within the military and their relationship with the mental and physical well-being of
transgender military members. Furthermore, it includes research findings on the relationship
between identity expression, authenticity, and job performance among transgender military
20

members. By exploring these interconnected systems, this literature review provides insights into
the various factors that shape the experiences of transgender individuals in the military.
Moreover, this literature review outlines the conceptual framework for the research
project. It synthesizes existing knowledge and theories, highlighting gaps in understanding and
areas that require further investigation. This framework establishes the groundwork for the
subsequent research, offering a roadmap to explore the complex dynamics of transgender
military service. It sheds light on the intersections between individual identity, organizational
support, and overall performance, guiding the exploration of this problem of practice.
Chronosystem: Changes in Policy over Time
The compatibility of sexual minorities with military service has been questioned since the
early 1900s and homosexuality had, until 2011, been prohibited indirectly in the U.S. military
since the Articles of War were implemented in 1917 (LaGrone, 2013). In 1992, presidential
candidate Bill Clinton used “lifting the ban” on homosexuals serving in the military as part of his
platform, asserting that he would do away with policies that had been in place since the Carter
Administration (Baer, 1992; Burelli, 2010). Under President Clinton’s administration, the topic
of sexual minorities in the military faced intense debate, with the Senate Armed Services
Committee and the House Armed Services Committee agreeing on a way forward in May 1993.
In July 1993, President Clinton announced the results of such debates, which were presented in
the form of Department of Defense Directive 1304.26 (DoD, 1993) and an Act dubbed by
Clinton “Don’t Ask, Don’t Tell, Don’t ,”Pursue”, later to be known simply as “Don’t Ask, Don’t
Tell” (DADT). Implementation of DADT was aimed at allowing people to serve in the U.S.
military without being discriminated against or harassed based on their sexual orientation, but
homosexual activity was still against the rules and could result in discharge or punishment
21

(Britannica, 2022; Burelli, 2010). The policy prohibited people who “demonstrate a propensity
or intent to engage in homosexual acts” from serving in the U.S. military under the premise that
doing so would “create an unacceptable risk to the high standards of morale, good order and
discipline, and unit cohesion, which are the essence of military capability (Department of
Defense, 1993). This policy ended the prohibition of military service by homosexual people,
allowing them to serve if they conceal their identity. The policy did not expressly address
military service by transgender people, but at the time, they were excluded by military medical
standards (Kerrigan, 2012; Lewis et al., 2019).
Remaining the principal policy regarding homosexual military service until 2011, DADT
presented challenges for military organizations. Those in support found the policy to be
necessary and fair, allowing homosexuals to serve while avoiding the unacceptable risk to
morale, good order, discipline, and unit cohesion that would be caused by openly admitting
homosexuals (Feder, 2013). Critics of the policy highlight that by penalizing verbal or physical
deviations from heterosexuality, the policy created a sexual stigma manifested through negative
attitudes toward homosexuals and perceived inferior status, rendering homosexual military
members second-class and powerless (Burks, 2011). Military officers criticized the policy on the
basis that the existence of homosexuals alone would negatively impact morale (Britannica,
2022). Moreover, the policy was routinely scrutinized for ambiguous verbiage, broad
implementation guidance, and encouraging homophobic behaviors (Burks, 2011; Reinke et al.,
2011). The policy was also criticized for setting military services up for endless court challenges
(Burelli, 2010; Feder, 2011). Further, the policy was interpreted and enforced differently across
different military installations and units (Burelli, 2010). When the policy was repealed in 2009,
the total number of LGBTQ+ servicemembers who had been discharged was estimated to be
22

between 13,500 and 14,500 (Britannica, 2022; Gates, 2010; Prakash, 2009) with an estimated
total cost of between $290 million and $500 million. While figuring the accurate cost of the
policy was not possible (GAO, 2005), these estimates considered the cost of recruiting and
training a replacement servicemember for every LGBTQ+ member discharged to be estimated
between $22,000 and $43,000 (Gates, 2010).
During the Obama Administration, DADT came to an end, and shifts in military policy
forged an avenue for transgender people to serve in the U.S. military. In 2010, Congress voted to
rescind DADT, and the policy was repealed on September 20, 2011 (Belkin et al., 2013) without
mention of transgender people’s ability to serve, leaving them to serve with ambiguous policy
guidance and in secrecy (Parco et al., 2015). On June 30, 2016, the Department of Defense
issued Directive-type Memo 16-005 prohibiting services from denying individuals the right to
serve based on gender identity, providing a pathway for military departments to provide
members assistance with transgender-specific healthcare and gender reassignment (DoD, 2016).
At the culmination of the above-described acts, all LGBTQ+ individuals, including transgender
people, would be allowed to serve openly in any of the military departments, barring any other
disqualifying factors. This was the first period where transgender people were expressly allowed
to serve in the U.S. military, and this directive remained in effect from 2016 until 2017.
Changes in the U.S. Presidential administration led to further policy changes regarding
transgender military service. On July 26, 2017, President Donald Trump announced on Twitter
that “…the US Government will not accept or allow transgender individuals to serve in any
capacity in the U.S. Military…” (Trump, 2017). He added that “Our military must be focused on
decisive and overwhelming victory and cannot be burdened with the tremendous medical costs
and disruption that transgender in the military would entail” (Trump, 2017), taking a position
23

that transgender military members are a burden and a threat to victory. Following his
announcements on Twitter and in response to The Presidential Memorandums of August 25,
2017, and March 23, 2018, both titled Military Service by Transgender Individuals (Trump,
2013), the DoD (2019) released a policy stating that any transgender individuals wishing to
receive hormone treatment or sex reassignment shall be diagnosed with Gender Dysphoria (GD)
and that GD is considered a serious medical condition. This reversal of the previous policy
disqualified some transgender individuals from serving in the military under the assumption that
such a diagnosis would adversely impact unit readiness and combat effectiveness. In
contradiction, the policy clearly stated that involuntary discharge based on gender identity is
prohibited and transgender individuals are welcome to serve. During the period from August
2017 and January 2021, transgender people were not permitted to join the military openly or seek
gender-related medical services if they were already serving (DoD, 2019).
The culmination of President Trump’s time in office and subsequent swearing-in of
President Biden led to another reversal of policy regarding transgender military service. On
January 25, 2021, the Biden Administration reversed the policy regarding transgender military
service, revoking The Presidential Memorandums from the Trump Administration. In his
Executive Order titled Enabling All Qualified Americans to Serve Their Country in Uniform
(Exec. Order No. 14004, 2021), President Biden disavowed any insinuation that gender identity
should be a consideration for military service, further citing that evidence resulting from a
comprehensive 2016 DoD study (Agnes, 2016) indicated allowing transgender people to serve
openly would have no meaningful negative impact on the Armed Forces. The Executive Order
directed the DoD to immediately prohibit involuntary separations, discharges, or other adverse
24

actions based on gender identity and ordered all services to establish processes by which
transgender people may transition while currently serving.
Understanding the changes in policy regarding transgender military service over time
(Chronosystem) is important to adequately understand the present-day context of the transgender
military experience. The debate surrounding transgender military service has led to back-and-
forth policy changes over the last two decades. Continuing to build off Bronfenbrenner’s
Ecological Systems Model, this author will now present a review of the available data that
describe elements of the Macrosystem, a component of the model that encompasses sociocultural
elements such as attitudes and ideologies (Halpenny, 2017; Neal and Neal, 2013).
Macrosystem: Sociocultural Considerations
An accurate understanding of the sociocultural considerations surrounding transgender
military service begins with a fundamental understanding of how the LGBTQ+ community is
frequently represented, in both research and society, as one group of people without
consideration for the differences between each component or group of people. The acronym
LGBTQ+ is commonly used to refer to the community of lesbian, gay, bisexual, transgender, or
queer/questioning people. The frequent use of this acronym in research demonstrates how often
each sexual minority group is classified and/or researched together as a whole, assuming their
experiences are the same, pointing to a culture that assumes all sexual minorities are simply
“other than heterosexual.” According to Jones (2020), while all sexual minorities experience
some degree of marginalization, and the experiences of lesbian, gay, and bisexual people may be
similar, transgender people surely have a markedly different experience. Similarly, Bowers et al.
(2020a) highlight a prevalent body of research providing the biological characteristics of a
transgender person, pointing out that being transgender is not the same as being lesbian, gay, or
25

bisexual. The consistent classification of all lesbians, gay, bisexual, and transgender people as
one community can lead to misgendering, which can cause underrepresentation of transgender
people in research and create an opportunity for people to make inaccurate assumptions and form
inaccurate expectations (Bowers et al., 2020a; Stryker, 2017). Respectful of the differences
between LGBTQ+ populations, and with an attempt to preserve the individuality of transgender
people, this literature review draws on the history and context of the LGB community in addition
to that of the transgender community to further inform the research and analysis of the literature
pertaining to the transgender community.
Social Role, Social Constructivism, and Attribution Theories
To understand the origins of prevailing opinions regarding transgender people, we draw
on social role theory (Eagly et al., 2011; Koenig et al., 2014), social constructionism (Coppola,
2021; Dietart & Dentice, 2022), and attribution theory (Bowers et al., 2020a). Eagly et al. (2011)
explained that the fundamental concept of social role theory is that men and women gravitate
toward different social roles based on how they have traditionally been distributed within their
society. Their research on social role theory has shown that gender roles in society can emerge
from repeated observations of a person of a particular gender performing a duty or task and that
the more often a singular gender person is viewed performing a task, the expected gender role
becomes more solidified. As such, members of society form gender stereotypes, using a person’s
gender identity as the standard against which their behavior will be regulated and measured.
Eagly et al. (2011), implications of such standard-setting behavior are favorable when gender
identity aligns with what is considered the social norm and elicits negative behaviors, lower self-
esteem, increased vulnerability to health conditions, and loss of economic and social
opportunities when this is not the case (Divan et al., 2016; Eagly et al., 2011). The concept of
26

being transgender challenges the perception that gender is binary. An experiment by Harrison &
Michelson (2018) found that gender identity influences the degree to which one adheres to
gender norms and social roles, pointing out that men are more invested and are less likely to be
supportive of transgender rights. Further, research conducted by Lewis et al. (2019) highlighted
that these gender-related attitudes have a significant effect on attitudes regarding transgender
military service.
This theory has been conceptualized in the recent past in cases where the roles of women
in the military and combat have been questioned. It was not until the late 1970s that most
Western militaries allowed women to hold permanent positions in the military, and since then,
gender integration has been a topic of scrutiny on many fronts (Heinecken, 2022). With
transgender military service being a relatively recent and evolving issue, having surfaced in the
public eye within the last six or seven years, social role theory supports an assumption that
public attitudes may be driven by the absence of clear transgender military presence in the past.
Asserting that the social construction of gender is based on the principle that one’s sex
assigned at birth determines gender, social constructivism theory presents another viable
explanation for common opinions regarding military service by transgender people (Dietart &
Dentice, 2022). Based on the ideas of Vygotsky (1978), social constructivism is a theory about
how people learn, theorizing that learning takes place through interpersonal collaboration and
people’s ideas coincide with their experiences, placing an emphasis on the learner’s sociocultural
position (McKinley, 2015). In the transgender context, social constructivism theory challenges
traditional beliefs that characteristics such as sexuality, gender, and race are biologically
determined, asserting that they are instead defined, changed, and interpreted as a product of
societal history and culture (Kang et al., 2017). This theory provides an explanation for how
27

societies broadly segregate individuals into categories based on race, gender, sex, or other
variables. Considering social constructivism theory, the idea of a dichotomous gender is based
on a concept created by those who came before us, passed down through teaching and
interactions with others, created to serve a purpose in or yield a perceived benefit to our society,
but is not biologically sound (Fjellman et al., 2012; McKinley, 2015).
SCT applied to the context of transgender people infers that much of what the non-
transgender population believes to be true about transgender people has likely been handed
down, is based on ideology, and may not be based on fact, science, or experience. In a survey of
151 former and current military members, Spindel and Ralston (2020) identify political ideology
as one of the strongest predictors of support of transgender military service, as opposed to
experience with the military or transgender people. Likewise, a survey by The Pew Research
Center (2021) revealed that 35% of Republicans report knowing a transgender person, while
48% of Democrats report the same, with these statistics increasing an average of 8% since 2017.
The same study revealed that the attitudes of cisgender members serving in the military mirror
those of the general public. Overall, these beliefs and socially constructed norms are a powerful
influence and are used as a vehicle to influence policymaking, providing a rationale for policies
affecting target populations and having a subsequent effect on that population (Dietart &
Dentice, 2022; Schneider & Ingram, 1993; Schneider et al., 2014). As such, SCT explains how
policies discriminating against transgender people are often created because of socially
constructed norms, religious beliefs, political ideation (Spindel & Ralston, 2020), lack of
knowledge about transgender people (Lefevor et al., 2019) and lack of exposure (Bowers et al.,
2020a; Coppola, 2021; Haider-Markel et al., 2017; Johnson et al., 2015; Lewis et al., 2017).
28

In addition to social role theory and social constructivism theory, Heider’s attribution
theory offers one explanation for opinions regarding transgender military service. Attribution
theory explains how humans instinctively try to assign a cause to observed behaviors (Malle,
2011). Bowers et al. (2020a) pointed out that people consider whether the behavior can be
controlled by the individual and whether the behavior was a result of stable, internal causes
(dispositional) or changing, external causes (situational) such as one’s environment. In a survey
of 1000 U.S. citizens building off attribution theory, Bowers et al. (2020a) found that a person's
belief that being transgender is biological in nature as opposed to a choice made by the
individual lead to more supportive attitudes. Further, Joslyn et al. (2016) explain that the concept
of immutability, being a result of birth and not something that can be changed, leading to
increased support, reduced stereotypes and judgments, and more credibility. Moreover, their
research highlighted a political ideology component to beliefs about transgender people, pointing
out that conservatives are less likely to attribute being transgender to biological differences.
Although biological attribution may seem advantageous to the transgender population, Bowers et
al. (2020b) warned that it could have serious consequences in the future, citing increased
concerns from scholars and activists that this theory could be used to further pathologize
transgender people or even suggest eradication of the transgender gene. Similarly, classification
of transgender people in the DSM-5 (American Psychological Association, 2013) as having
Gender Dysphoria (GD) infers a biological condition but perpetuates a view that transgender
people have a pathological condition and correlates their identity to one of mental illness and
distress (Elders et al., 2015; Hill et al., 2016). The bulk of the research reviewed suggests that the
concept of being transgender is widely misunderstood. The historic precedence of considering
transgender people as part of the larger LGBTQ+ community and representing them as such in
29

research has likely masked opportunities to consider characteristics unique to being transgender
and qualify their experiences in many societal contexts, including the military. Moreover, social
constructivism theory, social role theory, and attribution theory are widely represented in the
research as explanations for different levels of societal support, across different disciplines, for
transgender military service.
Exosystem: Transgender People in the Military
To provide a comprehensive vision of factors affecting or affected by transgender people
serving in the military, it is important to review potential influences that reside outside the
person’s immediate environment while still affecting that environment. Aligned with
Bronfenbrenner’s exosystem, the following sections provide a review of empirical information
addressing the likelihood of transgender people to volunteer for military service and reasons
people support or object to transgender people serving in the military. Further, the review
provides insight into the effects of allowing transgender people to serve in the military, as well as
the effects the military has had on those transgender people who served.
Statistics
While the opinion of lawmakers and the public has not always supported transgender
military service, policy regarding transgender military service has not always been clear, and
despite periods where transgender people were expressly forbidden from serving in one capacity
or another, much of the data available suggest that transgender people have not been deterred
from entering military service and are more likely to serve than cisgender people. Flores et al.
(2016) estimated that the percentage of transgender people who chose to serve in the military is
equal to or higher than the percentage of cisgender people who make the same decision.
Likewise, the U.S. Department of Veterans Affairs (2016) reports that approximately 20% of
30

transgender people have served. Similarly, a study by Gates & Herman (2014) explains that
transgender people are nearly twice as likely to serve in the military as cisgender people,
estimating that over 15,000 transgender people are currently serving on active duty and
Guard/Reserve combined, with another 143,000 having retired or separated. Research by Yerke
and Mitchell (2013) suggests that transgender people join for many of the same reasons that
cisgender people join, pointing out that some join for financial security, educational benefits, a
sense of excitement, family transition. Yerke and Mitchell (2013) posit that transgender people
may be more attracted to military service due to the military’s tradition of hypermasculine
values. According to Gallup (2020) and a 2015 DoD Health Related Behaviors Survey
(Meadows et al., 2015) .6% of adults in America report being transgender, compared to .7%
lesbian, 1.4% gay, and 3.1% bisexual. Gallup (2020) points out that .4 percent of respondents
declined to answer whether they identify as transgender, leaving open the possibility that nearly
1% of active duty service members truly identify as transgender. Further, a 2016 Workplace and
Gender Relations Survey (Davis, et al., 2016) of active duty members revealed that 5% of DoD
active duty members indicated they identify as LGBTQ+, with 12% of DoD women and 3% of
DoD men indicating they identify as LGBTQ+. In this survey, one percent of women and men
identified as transgender, and one percent of women and men were unsure. Additionally, three
percent of women and five percent of men preferred not to answer. The results of this survey
closely resemble the results of the 2015 HRBS (Meadows et al., 2015), leading the author to
believe that the statistics are accurate. The statistics relating to transgender military service vary
from study to study, but estimates remain within a small margin and indicate transgender people
are more likely to join the military than cisgender people and have been serving for decades.
31

Notwithstanding, the fitness of transgender people to effectively serve in the military remains
largely debated.
Transgender Military Service – Impact on the U.S. Military
This literature review has shown that opponents of transgender military service are
concerned about the effects it will have on the military. Reasons cited for opposition include the
financial burden of facilitating healthcare and concerns about unit cohesion and military
readiness. Notwithstanding the paltry amount of research to draw from, there have been studies
aimed at quantifying the monetary implications from which we can draw relevant data.
Regarding unit cohesion and military readiness, this author once again draws on research from
other countries who have allowed transgender people to serve, as well as from studies aimed at
measuring the effects of allowing other sexual minorities to serve.
Financial
While not all transgender military members will seek gender reassignment surgery, the
procedure is considered medically necessary and essential to the mental and physical well-being
of some transgender people (Byne et al., 2012; Committee on Healthcare for Underserved
Women, 2011; Go, 2018; Hembree et al., 2009) and carries a cost for the U.S. military.
Available literature on the monetary impact of allowing transgender people to serve shows that
providing the appropriate medical and clinical care results in healthcare costs that are specific to
transgender people and that these costs can vary widely between members based on their choice
of treatment.
Estimates of the financial impact that medical treatment of transgender people would
have on the U.S. military range from $30K to $75K per individual and the total impact across the
U.S. military has been predicted to be below $10M annually. The variance is likely due to the
32

difference in cost of services between different medical providers as well as the difference in
preferred treatment between individuals. In a paper aimed at assessing the implications of the
repeal of DADT, Bunn (2010) estimated healthcare costs for transgender people to be $2,400 per
year for hormone therapy, $15,000 for initial gender reassignment surgery, and $50,000 for
surgery on other parts of the body to complete the look. Bunn (2010) further pointed out that
additional significant costs can be incurred if further corrective surgery is needed due to
complications, making a case that the surgery is risky and further costs are highly likely. More
recently, a report by the Government Accountability Office (GAO, 2017) estimated the total cost
of treating one transgender member over the course of their career to be approximately $75,000.
Further, in a report published by the U.S. Naval Institute, Caputo (2017) estimates the cost of the
surgery to be $30,000.
A study aimed at identifying the medical implications of allowing transgender people to
serve in the military has shown that 76% of transgender people seek gender affirmation medical
care, which is accomplished with only hormone therapy, while only a small percentage seek to
have gender reassignment surgery (Elders et al., 2015). In a more recent study, Nolan et al.
(2019) estimate the number of transgender people seeking gender-related surgery to be 25%, also
highlighting the difficulty of determining the precise percentage due to the lack of gender
identity data in medical records and population-based surveys. Research conducted by the
RAND Corporation (Schaefer, et al., 2016) estimated the total number of servicemembers who
would seek healthcare related to gender transition to be between 29 and 129 annually out of 1.4
million, meaning an increase in annual military health system costs of between $2 million and
$8.5 million. These figures show the highest estimated cost per individual to be less than those
33

spent treating gender-related medical issues experienced by cisgender military members (Kime,
2015).
Beyond estimates, empirical information regarding actual realized annual costs associated
with treatment of transgender military members is limited. In an article published in Military
Times, Kime (2021) presents figures that show actual U.S. military expenditures on transgender
treatment for the five years between Jan 2016 and Jan 2021 equal $15M. According to the
author, 1,892 military members were treated, and 436 of them received gender reassignment
surgery. The cost of these surgeries came in at approximately $3.1M, showing an average cost
per surgery of approximately $7,100. Further, $11.6M was spent on psychotherapy, while $340K
was spent on hormone therapy.
For context, both estimated and actual costs reflect a total financial impact equaling half a
percent of the annual budget for the treatment of active duty military members. The research
shows that in 2014, total healthcare expenditures for active duty military was approximately $6
billion, while overall cost, including military dependents and retirees, exceeded $55 billion.
Moreover, the Military Times (Kime, 2015) reported that the DoD spent $84 million of its 2014
medical budget on Viagra and other erectile dysfunction drugs, nearly 10 times the maximum
projected cost of treating transgender members. While the financial impact that providing
essential treatment for transgender people serving in the military has not yet been fully disclosed,
both estimates and actual costs consistently indicate the total costs will average $5M annually.
Another aspect of military operations that may be impacted by allowing transgender people to
serve openly is readiness and team cohesion.
Military Readiness and Cohesion.
34

Research aimed at measuring the impact transgender servicemembers have on military
readiness and unit cohesion is limited, especially with regard to the United States military. This
is likely because, until 2016, transgender people were excluded from military service in the
United States. With the paltry nature of available empirical research, it may serve beneficial to
peer through two alternative lenses: militaries of other countries who allow transgender people to
serve openly and measured impact of other sexual minorities who were historically marginalized
but are currently allowed to serve openly. A review of these data points indicates that
transgender people serving openly in the United States military has not and is not expected to
have a negative impact on military readiness or unit cohesion, and that a historically
discriminatory culture may negatively influence unit cohesion. Apart from the United States,
there are eighteen other countries that allow transgender people to serve in the military
(Schaefer, et al., 2016; Elders et al., 2015). A study by the Rand Corporation (Schaefer, et al.
2016) aimed at assessing the implications of allowing transgender people to serve openly
analyzed four of these countries and found that operational readiness, unit effectiveness, and
member cohesion were not impacted by having a transgender member on the team. The same
study analyzed impact on military readiness in the United States military estimated that the total
lost labor would be .0015% of total available active duty labor-years, clarifying that the highest
estimate would equate to a reduction in readiness of .1% due to gender-transition related
treatment. For context, this number can be compared to the 14% reduction in readiness for other
medical, administrative, and legal reasons. (Schaefer et al., 2016).
According to Okros, et al. (2015), the Canadian military lifted its ban on transgender
service in 1998. In this first-ever study of its kind, the same researchers conducted a study within
the Canadian Forces to measure the effects inclusion has had on unit effectiveness. The results of
35

this study showed that, despite other challenges the Canadian Forces encountered when trying to
create a more inclusive environment, organizational effectiveness was not reduced because of
allowing transgender people to serve openly.
According to a study by RAND Corporation (Rostker et al., 2000), past initiatives aimed
at integrating marginalized groups into the military have been successful, regardless of
prevailing social attitudes and the initial beliefs of military officials. Moreover, six months after
the repeal of DADT, Belkin et al. (2012) launched a research study to determine the effects of
the repeal of DADT on military readiness. To enhance the validity of their study, the researchers
vigorously solicited the views of opponents of the repeal, including over 500 anti-repeal generals
and admirals and other well-known opponents. The study, including surveys, in-depth
interviews, and observation of military units concluded that the DADT repeal had had no overall
negative impact on military readiness, unit cohesion, recruitment, retention, assaults, harassment,
or morale. In contrast, they concluded that the repeal had likely improved the military's ability to
accomplish its mission. Belkin’s (2012) research highlighted the benefit of allowing people to
serve openly in the military without providing any data regarding cultural climate change after
the repeal, but information learned from a study in the Canadian military has provided some
context on this facet.
While the data reviewed does not provide evidence that military service by transgender
people reduces cohesion with military units, or decreases readiness, Wise (2019) points out that
the historic ban on transgender people serving in the military has left a legacy of discriminatory
cultural norms, which prevents authentic cohesion. Further, while more research is needed, there
is a growing consensus that transgender people are equally as capable of serving in the military
36

as their cisgender counterparts and their membership has no effect on the effectiveness of
military units (Brown, 2013; Coon, 2018, Goodwin & Chemerinski, 2019).
Transgender Military Service – Effects on the Transgender Military Member
Concern for the effects that allowing transgender people to serve may have on the U.S.
military is central to the debate surrounding policy regarding the same. With a historically
discriminatory culture, one must also consider the effects that serving in the U.S. military may
have on the transgender member. As a minority population that has traditionally been
discriminated against, research suggests that the military culture may promote stigmatization and
undue levels of stress.
Minority Stress Theory and Medical Outcomes
In a first-of-its kind large cohort study of transgender people, Brown & Jones (2016)
discovered significant disparities in mental and psychological diagnoses between transgender
and cisgender people, suggesting the transgender population is at greater risk of suffering some
medical conditions. Minority stress theory, based on the concept that gay people in a heterosexist
society experience chronic stress as a direct result of internalized homophobia, stigma, and
experienced discrimination and abuse related to their sexuality (Meyer, 1995), provides one
explanation for the disparities when applied contextually to the transgender military member.
Meyer (1995) further points out that gender minorities use concealment of their identity as a
mechanism to protect them from prejudice. Research based on minority stress theory highlights
evidence that increased stress experienced by transgender people in the military, directly related
to their gender identity, leads to mental and physical challenges. Consistent with this theory,
studies indicate that people who identify as anything other than a binary gender experience
harassment, discrimination, and victimization at a rate disproportionate to cisgender people
(Harrison & Michelson, 2018), leading to poorer mental and physical health outcomes than
37

cisgender people (Kauth et al., 2017; Lefevor et al., 2019; Mark et al., 2019). Further, Tucker et
al. (2019) found a direct correlation between discrimination and rejection experienced by
transgender people (external minority stress) and shame related to gender identity (internal
minority stress). Wise (2019) explains that military organizational norms are based on historical
discrimination and oppression, and that this oppression contributed to self-hatred and higher
stress levels. This theoretical framework and the prevailing research suggest that transgender
people experience mental and physical challenges more often than cisgender people, and that the
increase may be caused by the culture, work environment, and behaviors of colleagues (Holman,
2018; Lefevor et al., 2019; Tucker et al., 2019).
Structural Stigma and Medical Outcomes
According to Hatzenbuehler (2016), stigma exists at individual, interpersonal, and
structural level. Individual stigma refers to the individual thoughts and behaviors one takes in
response to stigma, concealing one’s true identity for instance. Interpersonal stigma is
experienced in the relationships and interactions between the person or people being stigmatized
and those who are not, while structural stigma refers to the ways institutions and cultural
ideologies drive prejudicial or discriminatory behaviors toward transgender people. This includes
societal-level conditions, cultural norms, and institutional policies that constrain the
opportunities, resources, and well-being of the stigmatized (Hatzenbuehler, 2016).
In a study focused on determining the association between structural stigma and the
effectiveness of psychological interventions, Hatzenbuehler (2016) determined that the efficacy
of psychological interventions was far lower in communities where stigma was the highest,
pointing out that those who perceive highest levels of stigma benefit less from psychological
interventions. Further, research conducted by Hatzenbuehler et al. (2020) focused on the
38

relationship between mortality and structural stigma within the lesbian and gay community.
Analysis of the data in this study revealed that people residing in areas with reportedly higher
structural stigma had the highest mortality risk. A study conducted by Perez-Brumer, et al.
(2015) aimed at identifying structural and individual risk factors for transgender people revealed
that lower levels of structural stigma surrounding transgender people in the United States led to
lower lifetime instance of suicidal ideations and attempts. Hatzenbuehler (2020) also revealed
that lesbian and gay people with life-long partners in the same communities had no increased
mortality risk, supporting the assertion that a strong support system coupled with reduced stigma
promotes better outcomes for this community. Further, in a study involving 248 transgender
military members McNamara et al. (2021) revealed a correlation between stigma and transgender
military members’ willingness to be open to their medical team. LGBTQ+ respondents to the
research revealed a hesitation to disclose their sexual identity to their medical provider unless the
medical provider began a discussion about it first, as well as hesitation to seek mental health care
inside the military community since admitting an emotional or mental concern could be viewed
by one’s leadership as weak and lead to loss of confidence in one’s abilities. This phenomenon
was more prevalent in positions where a loss of confidence or trust would traditionally lead to
revocation of some type of certification or clearance or in those where the same may lead to
being barred from holding the position. Although research suggests that transgender members in
the U.S. military may experience higher levels of stigma and stress that can lead to mental and
physical challenges not seen in the cisgender population, there is further research indicating that
transgender military members have more favorable medical outcomes than non-military
transgender people.
Mesosystem: Military Support Services and Transgender Servicemembers
39

Bronfenbrenner’s mesosystem provides a framework where one can explore the
relationship between different microsystems. Applying this framework in the context of
transgender military service, this author has reviewed available research that applies to the
transgender military member’s experience with support agencies in the military. The research
available for review is limited to that which applies to support of transgender military members
from military medical resources.
The Military Healthcare System and Transgender People
The historic prohibition of transgender military service and the more recent back-and-forth on
the policy from 2016 to 2020 has created a missed opportunity for military medical providers,
leaving a gap in the quality of medical care available to transgender people. In a survey intended
to gauge the readiness of military medical providers, Henry (2017) revealed that nearly 75% of
military healthcare providers reported that they had not received any instruction or training on
providing services for GD or transgender people in general during their medical education.
Further, over half of respondents said they would not prescribe cross-gender treatment even if
they had the training. Similarly, a study by Mizock, et al. (2016) involving 45 transgender people
who took part in semi-structured interviews showed that respondents were routinely
pathologized by mental health or medical providers. Respondents in the study reported that
therapists seemed to focus more on the topic of gender identity even if that was not the relevant
topic at that time, making the respondent feel as though they had a mental illness. Although this
study was not performed in a military setting with patients of the military medical system, it is
reasonable to believe the results of this study are generalizable to the military population.
Microsystem: Transgender Servicemember’s Immediate Environment
40

While the previously covered review of the available literature pertaining to transgender
military service provided fundamental insight regarding the history of transgender military
service, reasons for support or opposition, and impact of allowing transgender people to serve
openly there has been little offered to define the impact of all of this on how a transgender person
experiences the U.S. military. As such, this section will focus on identifying common themes
among transgender military members. It is important to consider, as mentioned previously, that
actual research at this level is very limited. This is likely because before 2016, and during a
period from mid-2017 to 2020, transgender people were excluded from military service. We
begin by reviewing research about experiences with the military health system as reported by
transgender military members.
Transgender Experience with Military Healthcare
While this researcher was unable to find any scholarly research highlighting experiences
within the military health system exclusive to transgender people, a paltry amount of research
regarding transgender veterans and their experience with the Department of Veterans Affairs
(DVA) does exist. The general theme of this research, based on the experience of former military
transgender people, indicates that transgender military members are concerned about the
adequacy of available medical care. According to Dietert et al. (2017), transgender people often
report negative experiences when accessing medical care or mental health services through the
DVA, citing receiving care that was inadequate or inconsistent and encountering medical
providers who were insensitive and disrespectful. In a qualitative study of 174 active duty
service members who identified as gender diverse, Schvey (2020) revealed that transgender
military members often have stigmatizing experiences with medical providers. Participants in
this research recall being assigned to providers who displayed anti-transgender bias and being
humiliated when making changes to their health record demographics related to their identity.
41

Further, in a systematic review of available literature regarding practitioner attitudes toward
transgender people, Brown et al. (2018) points out that attitudes are generally positive, but
negative attitudes do exist. Moreover, anticipation of a negative experience with a healthcare
provider may create a dilemma for those in the transgender community seeking mental health
assistance. Mc Namara et al. (2021) points out that the two options for military members to
receive mental health or spiritual assistance are the chaplain or a mental health provider.
According to respondents in the study by Mc Namara (2021), the chaplain is not a viable option
due to the perception of sexual minority intolerance and the mental health provider is not viable
due to the fear of being classified as having a mental health problem and being deemed unable to
perform certain duties. Further, Nik-Ahd (2021), a physician, points out that the medical aspects
of being transgender are relatively recent, and medical professionals are ill-prepared to provide
effective healthcare. Highlighting the very limited amount of research on the transgender
population and their unique healthcare needs, the researcher points out that even newly
developed digital medical records are not set up with a mechanism to identify patients who are
transgender. The limited research on this facet shows that medical care, including mental health,
may be inadequate and further highlights the need research the transgender population
independent of the lesbian, gay, and bisexual community. With an understanding of how
transgender people experience the military health system, we will now look into the empirical
research regarding the mental and physical health of transgender military members.
Mental and Physical Health
Like most other topics regarding transgender people in the military, there is little
scholarly research on the mental and physical health of military members who identify as
transgender. The overarching theme of the reviewed literature indicates that transgender people
42

who serve in the military are often healthier than those who do not, and that transgender people
are no less fit mentally or physically than their cisgender counterparts. The research further
indicates that health outcomes are more favorable for transgender people who serve in the
military than for those who do not. A study by Hill (2016) aimed at assessing mental and
physical health (both a concern of military leaders) of transgender people in the military
determined that this population does not experience levels of health problems that should
preclude them from military service. The study further points out that the level of mental or
physical problems experienced by transgender people is no more substantial than that of
cisgender military members, rather different in nature, highlighting that there are no significant
differences in complexity of treatment when comparing the two groups. Further, in a study using
population-level data for 2014 through 2016, Downing et. al (2018) compared the health of
transgender veterans and civilians to that of cisgender people of the same populations. The study
revealed that very few differences in health exist between transgender and cisgender veterans,
but those who identified as transgender had higher odds of having some type of disability.
Moreover, Elders (2015) contests the notion that transgender military people present a
significant burden on the military health system. The researcher echoes that medical care
required by transgender people is in no way more difficult or specialized than the medical care
the military provides to cisgender members on a routine basis, pointing out that gender dysphoria
is far more treatable than many psychological disorders experienced by military members that do
not require discharge. Further, the study highlights an inconsistency between how the military
regulates all other psychological and medical conditions, pointing out that transgender conditions
are the only gender-based conditions treated substantially different, and considered substantial
enough to preclude continued military service.
43

In a quantitative survey aimed at assessing the associations between stigma experienced
by transgender people in the military and their health, Schvey (2020) points out that this
population experiences depression, stress, and anxiety more often than cisgender military
members, citing stigma related directly to gender identity as a cause. The researcher notes that
aside from this issue, the participants in the study demonstrate overall good mental and physical
health. This viewpoint is consistent with findings revealed in a study of veterans focused on
medical outcomes. In this study, Hoy-Ellis (2017) suggests that transgender adults who had
served in the military were found to be more resilient. This study revealed that 22% of
transgender people with prior military service are psychologically more stable and have lower
depressive symptomology, suggesting a positive correlation between military service and health-
related quality of life.
Conversely, while some scholarly research suggests military service enhances quality of
life for transgender people, studies have shown that lack of adequate medical resources,
discriminatory policies and behaviors limiting the ability of a member to be open about their
sexuality or otherwise marginalizing them may counteract these benefits. A study by Parco et al.
(2015) showed that transgender military members were subjected to an increased pressure to
exceed performance standards while experiencing barriers related to grooming, uniform wear,
and pronoun usage, positing that this may have a negative effect on mental health. Further, in a
study aimed at assessing stigma-related negative health outcomes, researchers found that 93% of
transgender military servicemembers reported being a victim of stigmatizing behavior.
According to researchers, these experiences lead to poorer mental health outcomes, greater
depression, and higher anxiety and stress (Schvey et al., 2020; Mark et al., 2019). Additionally,
in a report assessing total inclusion for members of the LGBTQ+ community, Alford (2016)
44

posits that transphobia likely causes service members to conceal their true identify, having a
negative effect on mental health and well-being over time. In a similar study, Hill (2016) found a
significant correlation between identity concealment and poor health. The same study further
revealed that transgender members often refrain from reporting levels of health issues they feel
could affect their ability to serve, further exacerbating their problems. The findings of this
research correlate with a study by Lefevor et al. (2019) revealing that poor access to medical
resources leads to poor mental health outcomes for transgender people. Overall, the research
available for review is largely inconsistent regarding health differences between transgender and
cisgender military members. While much of it suggests health outcomes may be largely
influenced by the work environment and culture, the limited nature coupled with the
inconsistency suggests an opportunity for future research regarding healthcare experiences as
well as effectiveness of outcomes.
Identity Expression, Authenticity, and Job Performance
Studies have shown that a transgender person’s decision to reveal their gender identity to
those who they work with is reliant on a complex psychological process, highlighting that they
make deliberate decisions regarding who they are open with based on social and contextual cues.
Further, scholarly research has shown that when transgender people serving in the military can
be open about who they are and they are able to serve authentically, they experience increased
job satisfaction, better health outcomes, higher performance levels, and unit effectiveness
increases. In 2021, when the DoD directed integration of transgender people into the military
ranks (Exec. Order No. 14004, 2021), some may have assumed this directive would reduce the
stress transgender military members experience. Research suggests that it may have introduced a
new set of stressful experiences for them due to fears of organizational resistance, unsupportive
45

coworkers' reactions to the directive, and increased harassment and victimization. Such fears
may have created a new dilemma for transgender members when considering whether to reveal
their sexual identity (Mc Namara, et al., 2021). According to a study by Van Gilder (2017),
transgender people deliberately manage when and how they disclose their gender identity, basing
their decision on how they believe their colleagues may react. In a mixed-method study of
currently serving military members aimed at exploring outness of sexual minority military
members, Mc Namara et al. (2021) revealed that barriers to disclosing one’s sexual identity in
the military, include rank, service, history of experiences, expected reaction, and a general
distrust of the system. The researcher further points out that, under certain conditions,
transgender people in the military are willing to be open to military friends, members of their
chain of command, and helping professionals, but were less likely to be open with military
chaplains about their gender identity. One such condition is the way the individual perceives
their work culture. Research by Bidix et al., (2013) indicated a strong correlation between a
military member’s comfort in revealing their sexual identity to their colleagues and whether they
feel the military cares about them as an individual. Further, to learn more about how transgender
people negotiate their identity at work, Jones (2020) conducted 10 extensive interviews with
transgender-identifying individuals. The interviews revealed that transgender people who were
allowed to reveal their authentic identity across all contexts (school, home, work, etc.) reported
higher feelings of self-worth and even euphoria at times. The research indicates that these
positive feelings stemmed from internal contentment, honesty with self, and a feeling that they
are recognized as who they really are by others. Moreover, in a study of Dutch lesbian, gay, and
bi-sexual participants, researchers revealed that those who hid their sexual identity at work
46

reported lower job satisfaction, lower feelings of belonging, and lower self-esteem (Quinn,
2017).
A transgender military member’s decision to disclose their sexual identify at work affects
their performance of assigned duties, and a correlation is thought to exist as a function of
comfort, the positive feelings identified by Jones (2020), and one’s ability to act in a genuine
manner without fear of being exposed. Research by Emmerich et al. (2017) and Elders et al.
(2015) showed a reciprocal relationship between work-related authenticity and psychological
functioning, pointing out that enabling authenticity at work increases well-being, promotes a
sense of self, and increases motivation. The researchers further point out that people who can be
their true self at work expand their ability to perform, leading to increased work ability,
positively affecting organizational performance and outcomes. While not specifically addressing
transgender people in the military, a study by Van Den Bosch (2014) produced results like those
of Emmerich (2017) and Elders (2015), identifying a definitive positive correlation between
one’s ability to be authentic and their willingness to engage at work and suggesting that one’s
level of authenticity can vary based on immediate work environment.
The relationship between a transgender military member’s environment and their
willingness to be authentic at work can further be explored by applying the concepts in Maslow’s
Hierarchy of Needs (Healy, 2016). This hierarchy, proposed by Abraham Maslow in 1943,
presents human needs arranged in a pyramid shape with each level of needs building off the
previous (lower) one. Maslow’s theory suggest that each level of needs must be met in a
sequential manner. The hierarchy consists of the following five levels: Physiological needs,
safety needs, love and belongingness needs, esteem needs, and self-actualization needs.
Applying this theory to the context of transgender people in the U.S. military highlights the need
47

for these servicemembers to feel secure in their job, feel valued, and feel like they belong before
they can move on to feel confident, respected, and be motivated to achieve more. Based on these,
this research is grounded in the following framework.
Conceptual Framework
The conceptual framework of this research project utilizes Bronfenbrenner’s Ecological
System’s Model (Shelton, 2018) to highlight the different ecological levels (systems) of a
transgender military person’s lived experience or reality that can be influenced by policy
regarding transgender military service. This model, developed by Urie Bronfenbrenner (1979),
was originally designed to evaluate individual development within four systems (microsystem,
mesosystem, exosystem, and macrosystem) and includes the individual at the center. The model
was later updated to include the chronosystem, providing space to evaluate changes over time.
Using this model to for this research project provided a framework that highlights influences or
experiences a different level (or systems) as well as interactions between the levels.
The framework also incorporates elements from Maslow’s Hierarchy of Needs (Healy,
2016; Poston, 2009) to highlight the levels of needs addressed in this research and demonstrate
the role that these needs play in outcomes for transgender military members and military
organizations. Abraham Maslow proposed this hierarchy in 1943, suggesting that human beings
have certain innate needs that must be filled in a specific order to achieve self-actualization and
personal growth. This hierarchy is depicted as a pyramid, with the most fundamental needs at the
base and the highest-level needs at the top. This hierarchy includes five levels of needs:
Physiological needs, Safety needs, Love and Belongingness Needs, Esteem needs, and Self-
Actualization (Healy, 2016; Poston, 2009). Maslow’s theory is that the most fundamental needs
48

must be met before an individual will be motivated to meet the next-higher level of needs.
(Poston, 2009).
This theory and model work well when evaluating transgender people in the U.S. military
because it highlights the levels of needs that are not being met for this populations, while also
providing a guide to explore that effects that not meeting these needs can have on the individual
and the organization.
Combining elements from Bronfenbrenner’s model and Maslow’s model provides a clear
framework to evaluate the experiences of transgender people in the U.S. military and identify the
needs deficits caused or satisfied by these experiences. Figure 1 depicts the hierarchical levels of
Bronfenbrenner's Ecological Systems Model (Shelton, 2018) on the left side. The Chronosystem,
situated in the background, illustrates the influence of policy changes over time on the other
levels. Moving towards the right, the model illustrates the aspects associated with the
experiences of transgender military members at each level. It emphasizes the significance of
policy history, support adequacy, individual experiences, and perception of acceptance within the
military organization as crucial components of the overall military experience. Continuing
further to the right, the model incorporates the "safety needs" and "love and belonging"
components of Maslow's Hierarchy of Needs (Healy, 2016). This association underscores the
dependence of meeting these needs on the quality of the aspects and its direct impact on
authenticity at work, performance, and health outcomes, which are displayed on the far right.
The yellow ovals represent the key concepts investigated in this research, which specifically
focus on the mesosystem, microsystem, and individual level. They serve to identify areas where
needs are being met or not, and highlight the subsequent effects on performance, authenticity,
and outcomes.
49

50

Figure 1. Conceptual Framework

Summary
Using Bronfenbrenner’s Ecological Systems Model as a framework, this review has
presented a comprehensive summary of the salient points derived from scholarly research and
other public policy documents. The greatest limitation of this literature review is the paltry
amount of scholarly research available specific to transgender people in the U.S. military.
Because of this limitation, to provide context and a more comprehensive review of available
literature, the author provides review information that is specific to other sexual minorities.
Doing so has enabled the author to identify gaps in the research more clearly and present
opportunities for future research.
A preponderance of the literature supports the position that military service by
transgender people was disallowed, whether directly or indirectly, before 2016 at which point the
policy clearly changed under President Obama. The literature also reveals both opposition and
support for transgender people in military service and indicates the reason for either is driven by
individual or collective values, beliefs, religion, political ideology, gender, and socially
51

constructed norms. Opposition is commonly presented as a concern for military readiness.
Moreover, there are indications that support for transgender people serving in the U.S. military is
becoming more wide-spread.
The literature also indicates there may be stigma surrounding the transgender population
and that this stigma may be prominent in U.S. military organizations despite the recent changes
in policy permitting transgender people to serve openly. Further, scholarly research has indicated
that this type of stigma may mediate transgender peoples’ behaviors, impacting their
performance at work and overall well-being, but there is no research indicating this is the case in
the U.S. military. This outlines a viable opportunity for research that this study will aim to take
advantage of, narrowing the gap in scholarly information about how transgender people
experience the military in current times and how their experience mediates their behavior and
affects their job performance. The following chapter outlines the method by which this study will
close that gap.

52

Chapter Three: Methodology
The purpose of this chapter is to introduce the research methodology for this qualitative
case study aimed at defining the experience of transgender people currently serving in the U.S.
military. In this chapter the reader will find the research questions that are at the center of this
project. Additionally, this chapter provides an overview of the research methodology used,
information about the researcher, data sources, and methods of data analysis. Further, this
chapter describes steps taken to maximize the credibility and trustworthiness of the research
project as well as ethical considerations.
Research Questions
This study has been designed to provide insight regarding the following questions:
1. What are the experiences of transgender servicemembers in the US Military?

2. What are the perceived challenges transgender servicemembers face in the US military?

Overview of Methodology
According to Merriam & Tisdell (2016), qualitative research is appropriate when the
researcher seeks to understand peoples’ experiences, the meaning they have constructed, and
how they make sense of their world. The unit of analysis in this study (members of the U.S.
military who identify as transgender) is defined as unique, as necessary for research to be
considered a case study. Because the purpose of this study is to define the experience of
transgender people currently serving in the U.S. military, a qualitative case study is most
appropriate.
This research proposal utilized a qualitative design; with the researcher as a key
instrument the data collected is in the form of interview transcripts and involved inductive
analysis (Creswell & Creswell, 2018). A qualitative design was the most appropriate because the
53

purpose of this study was to gain a holistic account of the reality transgender people experience
in the military, thereby creating a hypothesis as opposed to testing one.
Table 2

Data Sources

Research Question Interviews

What are the experiences of transgender servicemembers in the U.S. military?

X
What are the perceived challenges transgender servicemembers face in the U.S. military?
X

The Researcher
The paradigm of inquiry in this research project aligned with a constructivist
philosophical worldview. A researcher taking a constructivist approach believes the people try to
understand the world around them, make meaning of what they observe, and that those meanings
can be different from person to person (Creswell, 2018), largely based on individual
interpretation. The researcher for this project was a senior enlisted leader in a large organization
in the U.S. Air Force. He was also a gay male who had served in the military for over 22 years,
having served during the period when the DADT policy was in effect. The intersection of these
identities likely presented the possibility for bias, and the researcher understood this and took
deliberate measures to avoid these biases informing the study or the results of the project.
Data Sources
Interviews
Semi-structured interviews were used as the primary method of data collection for this
research project. These interviews included open-ended questions intended to elicit opinions and
views of the interviewee for the purpose of drawing out themes related to the research questions.

Participants
54

Participants for this study were purposefully selected; a sampling method based on the
assumption that the researcher should study the population that has the most to offer in terms of
the research (Merriam & Tisdell, 2016). Based on the criteria for research study participation
there was a narrow population of individuals to choose from, so the study involved only 10
participants. These participants were transgender military members who served between January
1, 2018, and January 1, 2023 and had recently separated or retired. Interviewing participants who
have served five years or more increased the richness of the data, since these members had
experienced two substantial policy changes during their tenure. Participants were recruited
through an organization called the Modern Military Association of America (MMAA). This
organization, comprised of thousands of members and allies, has long represented LGBTQ+
military members, even before they were allowed to serve openly. Participants were also
recruited through the Transgender American Veterans Association (TAVA), an advocacy group
for transgender U.S. military veterans. Participants were also recruited via snowball sampling, a
method where people are referred by other participants. Being a member of MMAA myself (not
a member in a power position), recruiting participants should not be difficult. Selecting only
transgender military veterans for the study provided the most efficacious responses, promoting
validity and credibility of the study. To participate in the study, members were required to (1) be
at least 18 years of age; (2) speak English; (3) be separated or retired from the Air Force,
Marines, Army, Navy, National Guard, or Air National Guard; (4) have served between January
1, 2018 and January 1, 2023; (5) self-identify as transgender; and (6) be willing and able to
provide consent.
Instrumentation
55

The interviewer used an interview protocol (Appendix A) for all interviews. The
interview questions were designed to bring about responses that overall describe how the
interviewee characterized their acceptance while serving in the military. Interviewees were asked
support and acceptance at different levels including leadership and other colleagues, about times
when they may have changed their behavior related to their gender identity, and how they felt
about current policies regarding transgender military service. Responses to these questions
helped to describe a transgender military member’s experience within their immediate
environment and identify challenges exclusive to this population.
Data Collection Procedures
The strategy of inquiry for this research was qualitative semi-structured interviews,
defined by Creswell and Creswell (2018) as interviews where the participants and researcher
both participate, and the questions are typically open-ended. The interviewer conducted eight
interviews virtually using the Zoom platform and recorded them to allow the researcher the
opportunity to revisit the interview for clarification. The interviewed also conducted two
interviews via phone with no recording capability available. Each interview lasted between 60
and 90 minutes. Recorded interviews were transcribed and the transcription was compared to the
video for accuracy. Telephone interviews were not transcribed, rather the researcher took notes
on an electronic device during the interview.
Approval from the Institutional Review Board was obtained from the University of
Southern California. Upon approval, the researcher contacted the Modern Military Association
of America to ask they publish a participant solicitation message on their Facebook page and on
their website. The purpose of this message was to solicit transgender military members currently
who met the aforementioned criteria and were willing and able to participate in the study.
56

Volunteers were asked to contact the researcher through email, and the researcher responded
with details regarding the study and further instructions to arrange an interview if the volunteer
so choses. All participants gave consent to use their responses for this study.
Data Analysis
Virtual interview recordings were transcribed using the transcription feature in the Zoom
platform. Analysis of interview responses and identification of themes began simultaneously
with data collection to help maintain a focus that thoroughly addressed the research questions
(Merriam & Tisdell, 2016). The researcher identified units of data and created codes that related
to ideas or information relevant to the research being performed (Creswell & Creswell, 2018).
The researcher entered these codes into ATLAS.ti Web (Version 3.15.0-2022-03-09) and
identified themes that emerged throughout the data sets, resulting in an inductive, thematic
content analysis.
Credibility and Trustworthiness
To maximize credibility and trustworthiness in this study, recorded interviews,
transcribed them, and compared the transcription with the video for accuracy. Additionally, the
researcher contacted any participant for clarification when the meaning or context of any point
was not clear. Further, the researcher took deliberate steps to eliminate personal biases and their
own axiology during the interviewing process.
This purpose of this research was primarily to serve the interests of the transgender
military population by bringing their experience to the forefront. Additionally, the outcomes of
the research serve the betterment of military organizations in that they provide recommendations
for improving unit cohesion and team performance. As the research questions listed above are
answered from the perspective of a transgender military person, the potential for harm existed
57

within the participants and could have resulted from reflection on and recalling of potentially
traumatic experiences. The researcher who designed these questions and framed the scope of this
research was a military leader and a member of the LGBTQ+ community, taking a constructivist
approach to defining the dynamics of a situation he had lived for over twenty years. The results
of this research may be published in journals and may be made available to military leaders.
Ethics
During the research study, the researcher read a statement to participants disclosing the
purpose of the study and asking the participant for their consent to use the information they
divulge in the study. The statement also included the notice of confidentiality, stating that their
name, military organization, time in service, and rank will not be disclosed in the final report. No
incentives for participation were offered and no promises of compensation were made. During
the interview process, the military position of the researcher was not disclosed, questions were
read succinctly without coercion or leading, and the participant was free to end the interview at
any time with no questions asked. The entirety of this study proposal, including consent form
and recruitment materials, was submitted to the IRB for approval.
Summary
The goal of this chapter was to provide the reader a comprehensive description of the
methodology employed in this research project, while also providing information that may be
helpful when individually assessing the trustworthiness, validity and generalizability of the study
and the results. Chapter IV will provide the results from the study and outline how the
methodology described in Chapter III was applied.

58

Chapter Four: Findings
This research aimed to explore the reality of transgender people in the U.S. military,
highlighting experiences exclusive to this population and identifying opportunities to improve
inclusion. The problem of practice was that transgender U.S. military members are marginalized
and subject to discrimination and harassment, which may affect their willingness to be authentic
at work. The following two research questions guided this study:
1. What are the experiences of transgender servicemembers in the US Military?
2. What are the perceived challenges transgender servicemembers face in the US military?
For this study, qualitative data were collected through semi-structured interviews. Eight
interviews were conducted virtually, and two were conducted over the phone. The researcher
printed transcripts from the virtual interviews and took notes during phone interviews. These
documents were then analyzed and thematically coded to identify themes. Experiences that
presented similarly in half or more of the interviews were codified into a corresponding theme
and reported in this report. Additionally, experiences that may have been referenced in less than
half of the interviews but were considered by the researcher to be more profound or impactful
were reported as well.
The purpose of this chapter is to describe the interview participants and describe the most
prominent findings from the participant interviews. Findings from this study are presented in
themes that emerged during interviews and discussions. Each theme is presented in a separate
subsection. Evidence for each of the findings is presented in direct quotations from the data to
assist the reader with an independent assessment of confirmability.
Participants

59

All 10 participants in this purposeful sample identify as transgender, served in the U.S.
military, and had separated from the military between September 2018 and March 2023, with
nine having retired or otherwise separated between 2021 and 2023. Table 4 indicates the relevant
individual demographic characteristics of the study participants. Three participants served in the
U.S. Air Force (USAF), three in the U.S. Army, two in the U.S. Navy, one in the U.S. Marine
Corps (USMC), and one in the Air National Guard (ANG). Five participants retired from the
military after at least 20 years of service; one served just over ten years, and four served nine
years or less. All participants had begun transition at the time of interviewing and were at various
stages. However, specific information regarding stages of transition was not logged as it is
irrelevant to the research. Due to the sensitive nature of this topic and the small size of this
population, to protect anonymity, the researcher refrained from collecting any demographic
information that was not directly pertinent to answering the research questions or needed to code
the data accurately. Pseudonyms have been assigned to the participants as indicated in the table;
these pseudonyms are used in discussing the findings throughout this chapter.
Table 1

Participant Demographics

Participant Branch
Years of
Service
Separation
Year
Gender
Identity

Martin
ANG 10 2022 Male
Emmeline
USAF 9 2023 Female
Harriet
USAF 20 2023 Female
Alexander
Army 6 2022 Male
Desmond
Navy 20 2022 Male
Joan
Army 23 2018 Female
Amelia
Navy 21 2023 Female
Clara
Army 20 2023 Female
Cathay
USAF 6 2023 Female
Berry
USMC 6 2021 Male

*Years of Service Rounded to the nearest year

*All were at various stages in their transition

60

Findings for Research Question 1: What are the experiences of transgender
servicemembers in the US military?
Research Question 1 was intended to elicit any examples or stories that would allow the
researcher and the reader to see the world through the eyes of a transgender person serving in the
U. S. military. Codifying and reporting on these examples and stories is important because it
provides insight on issues that may not otherwise be noticed. The two themes below associated
with this research question highlight both the negative and the positive experiences commonly
talked about during the interviews.
Theme 1: Transgender U.S. military members experience mental distress directly
correlated with harmful experiences, concealment of their identity, and uncertainty
regarding their future in the military.
The results of this study highlighted the prevalence of worry, anxiety, depression, and
other forms of mental distress experienced by transgender members of the U.S. military. These
distressing experiences stem from persistent discrimination, harassment, and other abuse linked
to being transgender encountered in the workplace. Moreover, the results show that this
population endures further psychological strain as they grapple with the need to modify their
behavior to conceal their true selves. These scenarios, coupled with uncertainty surrounding
policies that govern transgender military service, may further compound their mental distress.
While Clara was telling of their experience in the military and talking about using a locker room
to change, they said “when someone else walks into the locker room, we just keep saying to
ourselves ‘we have the right to be here, we have the right to be here’ as we mentally prepare for
whatever may come”. This response captures the essence of how transgender people in the
military must always be in contingency mode.
Discrimination, Harassment, and Abuse Based on Gender Identity
61

Eight out of ten participants reported being subjected to discrimination, harassment, or
abusive behavior based on their gender identity. The remaining two participants did not feel they
had been subjected to these behaviors in the military context. While all eight of these participants
gave multiple examples of these experiences, the essence of them in totality is represented by the
examples presented below.
When researching discriminatory experiences of this population, one would be reckless to
disregard military policies that discriminate against transgender people. Although each
participant did not cite the ban on transgender military service as a discriminatory experience,
this researcher acknowledges it as such and includes it by proxy for all 10 participants as they all
served during this time of exclusion. As a more specific, personal example of discrimination
experienced by this population, Martin described a time when a deployed member who was not
aware they were transgender expressed his feelings about transgender people serving in the
military:
…as soon as the ban was lifted, he [colleague] was saying, ‘I don’t want to see anybody
deployed with me, and we are outside the wire, and you know, they look like a man, but
they don’t have a [penis].
Of important note, four out of 10 participants revealed stories and experiences of this nature,
where colleagues were reluctant to welcome a transgender person into their organization or team.
Covert and Overt Harassment
Interpretation of interview responses and participant stories revealed experiences where
participants had been subject to harassment in the military setting. A trend emerged where the
researcher could categorize these harassing behaviors into one of two distinct categories: covert
and overt. To present a clearer picture of these experiences, the researcher uses the term “overt”
62

to describe the more commonly heard about incidents of harassment. This type of harassment
includes name-calling and other aggressive pressure, or intimidation aimed directly at the
individual within the experience. The interview responses indicate that transgender military
members may more often be subject to “covert” harassment. The researcher uses this term to
describe situations where the offender is not necessarily aware that the offended person was
transgender. These often presented as negative comments or behaviors aimed toward transgender
people while unknowingly in the presence of someone in this population. This can happen when
the transgender person has not expressed their true gender identity, or when they may have but
the offender is not aware. Clara made an important observation when describing their
experiences with harassment saying, “people really need to know who they are talking to or
talking in front of… it is not like we advertise [being transgender].” Martin further supported this
sentiment using themself as an example, saying “most people have no idea that I am transgender,
there are not really any signs that would tell when I am in my uniform.” Harassment, whether
overt or covert, played an instrumental role in how interview participants felt accepted within
their organization.
As an example of a time when they felt like a victim of harassment as a result of their
gender identity, Harriet recalled a situation where their commander referred to members of the
unit as “a bunch of immoral gays” during a conversation about an increase in rumors circling
throughout the unit; a topic that was not relevant to sexuality or gender identity. While this
behavior did not directly address transgender people, it was harassing in nature to the LGBTQ
community, offensive, and eroded the trust of this participant in their organization’s leadership.
Moreover, Clara, having transitioned to female later in life, described the impact of the
Trump-era transgender ban as one that encouraged harassing and discriminatory behaviors,
63

stating “all the protections were removed”. They recall that when “the tweets came out, some
people saw that as a green light from the top to hate and discriminate,” meaning that they were
then free to be overtly discriminatory, harassing, or abusing. They gave an example of a personal
experience where they experienced intentional harassment saying, “the First Sergeant began to
intentionally drop he/him pronouns into conversations whenever he could, referring to me.”
Clara explained how this behavior was offensive and they felt it relayed a message to other
members in the organization that this behavior was acceptable.
Further, Emmeline, having undergone gender-affirming surgery while in the military,
described a time when they were subject to sexual harassment because the effects of their
gender-affirming care were beginning to be evident to others. They stated, “I had developed a lot
in my chest and one day I was walking from the bathroom to the office without my cover and he
[colleague] stared at me and said ‘whoa, what’s up with your chest?’”, referring to their breast
development. Emmeline reported feeling as though this colleague felt like comments such as
these are acceptable if they are made to transgender people, saying “he would not have said that
to a cisgender female thinking he would get away with it.”
Other forms of harassment, discrimination, or abuse reported by the research participants seem
more intentional. As an example, Harriet recalled a situation where another colleague was
harassed due to their sexual identity (gay male):
…in my office, I noticed a packet of chicken bullion, and it said “cock” on it. They
[colleagues] had found it overseas somewhere, and they singled this guy out. They tossed
it at him and said, “well, we know you like sucking, so I bet you will like this.
Aside from covert and overt discrimination and harassment, one participant described a time
when they were the victim of sexual abuse because of being openly transgender. Berry described
64

a relationship between them and another US Marine Corps member who was three ranks higher
but not in a direct leadership role as abusive.
He would advocate for me to get treatment, but then at the same time he would make
remarks like ‘trans people shouldn’t be able to join the military because they are going to
scam the healthcare system’ or something like that.
Berry further describes that this person would manipulate them and eventually sexually abuse
them. They described feeling as though this person saw them as a vulnerable individual with
little credibility and took advantage of that. “I think he wanted to be able to say he had been with
a trans person, and I was an easy target.”
These examples of discrimination, harassment, and abusive behavior experienced by
transgender people in the military demonstrate a clear opportunity to make cultural
improvements and the need to foster greater inclusion for the transgender population in the U.S.
military.
Uncertainty and Skepticism regarding their Future
All 10 participants in this research study report experiencing uncertainty or skepticism
regarding whether they will continue to be able to serve, indicating that the U.S. military’s
history of discrimination against transgender people contributes to their skepticism. Desmond
described being “skeptical of where the military will go with transgender people” as they have
“seen plenty of policy confusion and change over the years.” Emmeline further described feeling
skeptical that the policy allowing transgender people to serve will remain in place, pointing to
both historical precedence and the lack of policy codification as a source of uncertainty:
65

…we are hoping that this ban doesn’t happen again because right now, the way the policy
is written, whichever president comes in has the authority to reinstate it. We felt it before.
We are hoping [the current policy] becomes a permanent thing.
Additionally, Clara talked about recent current events and how they further exacerbate
skepticism among the transgender population:
A few years ago, people would say well, that will never happen, but then we saw the
overturn of Roe v. Wade. We learned to stop saying that. Women could be removed from
combat roles again. Nobody is authorized by law to serve in the military; not women, not
African Americans, not gays, not transgender.
This concern was not exclusive to Clara; the experiences of the participants in this research
highlighted a relationship between historical precedence, current events, and expectations for the
future. They further highlight the effect that an unknown future in the military can have. For
instance, Amelia described how this uncertainty affects their feeling of stability or job security
within the military: “I could not exactly feel safe because this [ability of transgender people to
serve in the U.S. military] was not codified into law… is the rug just gonna [sic] be pulled out
from under me?”
Moreover, while all participants in this research expressed skepticism and uncertainty about
whether the policy would be changed to again prohibit transgender people from serving in the
U.S. military, two participants admitted deliberately leaving the military because they could not
be sure they would be able to keep their job well into the future if they chose to.
Behavior Modification

Transgender servicemembers often modify their behavior to conform to social norms to
avoid discrimination, harassment, detection (clocking), or because they do not feel like they
66

otherwise belong. Eight out of the ten participants said they would behave inauthentically to
avoid these uncomfortable or potentially harmful situations, with commonly cited behavior
modifications that include altering overt preferences to conform to social norms, changing the
way they walk or talk, and avoiding participating in work activities or roles. Notably, some
participants modified their behavior to avoid being discovered as a transgender person both
before and after receiving gender-affirming care, and some did so after gender-affirming care to
reinforce their gender identity. Two participants, Harriet and Desmond, served their entire
careers (20 years or more) without revealing their gender identity at work. Harriet had revealed
their transgender identity to their spouse but not to anyone in the military, and talked about their
experience suppressing their gender throughout their entire military career. They report
consistently modifying their behavior while at work to avoid being identified as a transgender
person while being able to live more as their authentic self at home. This interviewee mentioned
that they were not open to reveal their true gender identity at work after the ban was lifted
because of comments their commander had made referring to other members as “immoral gays”
and witnessing other abusive behaviors, saying, “I knew immediately then and there that coming
out at this unit was not a possibility.”
Martin, having received some gender-affirming care while in the military, described how they
avoided being in a situation where it may be obvious that they were transgender and had
undergone surgical changes after overhearing colleagues making disparaging comments about
transgender people:
If I was down in the pool, and they [colleagues] came out to the pool, I would get out,
and I would put, you know, my shirt back on and head up to my room. You have to be
hyper-aware.
67

Having transitioned from female to male, Martin went on to describe how they felt that they
needed to focus on being masculine to avoid being identified as a transgender person and, as a
result, subject to discrimination and stigma:
I was definitely focusing on, I don’t want to say, toxic masculinity, but like the hyper-
masculinity, you know. I was like, I can’t like this and can’t like that; I have to like
manly songs, colors. I have to be a typical man, you know.
Emmeline described experiencing similar feelings, but prior to transition. They recall feeling like
they needed to conform to gender standards to avoid causing anyone to suspect they may not be
cisgender:
I just basically had to fit these standards, and I wanted to fit other standards. …just
gender standards, societal gender standards of what it is to be a man. You know, men do
this, men don’t do that, men don’t cry. Men don’t say these things; men don’t eat these
things.
Alexander also reported feeling the need to act as masculinely as possible to avoid detection after
receiving gender-affirming care. “I want to be known as a person versus a transgender person”,
they said. Alexander further described a time when they deliberately refrained from taking a
leadership role and planning an event because they felt doing so may lead to being “outed” as a
transgender person saying, “I think my passion would give me away”, and because they
perceived that the event would not be accepted by the commander, and they would be
unsuccessful:
It was pride month [June], and I thought it would be beneficial to the unit if we held a
pride celebration or at least promoted something pride related. I wanted to step up and
68

take this on. I knew he [commander] would never be supportive and I would be marked
for the rest of my time here.
Similarly, Amelia reported suppressing anything that may “point to my actual gender because I
was made to feel so embarrassed about it.” They further recount that they “refrained from doing
a lot, because I didn’t feel like I belonged”.
While participants often cite changing their behaviors in an attempt to reinforce their social
normality, one participant describes how they also change behaviors to avoid consequences that
may be rooted in prejudice, bias, or transphobia. When describing their experience, they mention
the challenge of using communal locker rooms and bathrooms. Clara described how they try to
avoid any situation where they may be subject to false accusations, saying “We won’t be caught
alone because we don’t want to risk it. Sgt so-and-so was in the shower and then, you know, did
this or did that.” They go on to explain how they intentionally avoid these situations out of fear
of being accused and subsequently assaulted or arrested saying “…for all the fear that is out
there, what they don’t realize is that the fear is on the transgender person; they are terrified.”
Attempted Suicide and Suicidal Ideations

Four out of the ten participants reported having suicidal ideations or attempting suicide at
least once during their time serving in the U.S. military. These participants attribute their
struggle to stress associated with gender dysphoria, lack of acceptance, discrimination, and
barriers to transition-related healthcare.
Joan describes their experience after suppressing their identity as a transgender person for
many years and finally confiding in their medical provider, who gave them an openly
unsupportive response:
69

It was just like I was doing everything that I shouldn't have been doing to try and be
something I wasn't… it was so overwhelming and so overbearing, then I decided I just
couldn’t do it anymore. So I went and I got my gun. I sat down at the table and put it to
my head.
Martin talked about the struggle with suicidal ideations the transgender community experiences
recalling “I lost one of my best friends… he ended up committing suicide 2 months after being
out in the military.” They mentioned how military efforts to mitigate suicide among the ranks do
little to address the catalyst for this behavior among the transgender community. Clara also
talked about the significant emotional toll that transgender people in the military bear, saying
“Yes, we [transgender people] may experience higher rates of mental illness and struggles, but it
is caused by how we are treated and because we are never taken seriously”. They went on to say
“I am a suicide survivor”. Alexander describes how the consistent debate over whether
transgender people were fit to serve led to their diminished self-worth and self-efficacy:
…hearing all these debates and claims about how we are mentally ill and some kind of
monster, over time, really made me begin to believe it myself. It was almost like an
insidious onset of self-loathing and disbelief in myself over time. I started to believe
them. I couldn’t take it anymore and just wanted to be gone; to disappear. Not really like
to kill myself, but just not be here anymore.
Among the four participants who described experiencing attempted suicide or suicidal
ideations, all four describe feeling overwhelmed by suppressing their identity for an extended
length of time and feeling as if they could not assimilate into society as their true selves.
Similarly, all four described a “breaking point” where they could no longer suppress their
identity and, seemingly, had a choice to make between living authentically or not living.
70

Transgender U.S. military members experience a trove of harmful behaviors in the work
setting. The experiences described within the first theme have demonstrated how they endure
discriminatory, harassing, and abusive behaviors coupled with uncertainty surrounding their
careers. They further highlight how this population copes with or avoids these experiences by
modifying their behaviors and sometimes contemplating or attempting suicide. Exposing these
experiences and considering their magnitude and effect over time unveils a painting that depicts
a situation where a person of any gender be subject to debilitating mental distress. Moreover, this
highlights an essence that was present throughout this project that this population is stigmatized
due to perceived mental instability or challenges, when the very instability or challenges could
be caused by their existence in a world who is not ready to accept them. As can be seen in the
next theme, increased levels of support bring hope to a vision of more effective inclusion.
Theme 2: Transgender U.S. military members report being satisfied with the quality of
medical care and recent displays of support from people in leadership positions.

Despite the findings in Theme 1 that highlighted adverse experiences within the military
context, transgender military members reported positive experiences as well. Throughout the
interviews, participants routinely reported feeling as though their leadership had their back and
was working in their favor. Further, those who had experience with providers in the military
medical system consistently had praise for their primary care team. Their positive experiences
are detailed below.
Quality of Medical Care

When asked about the quality of medical care they received within the military medical
system, five out of ten participants responded favorably. The remainder of the participants were
impartial or had not received any gender-affirming medical care within the military health
system. Participants recall that medical care for transgender people serving in the military was
71

organized so that all gender-affirming care was initiated and managed at one of a few central
locations. Participants attribute this policy change to a history of lesser quality care from non-
specialized or uninformed primary care managers at the participant’s local treatment facility.
Many participants felt they were receiving high-quality care at these facilities.
Emmeline recalled that they had a PCM and Registered Nurse assigned as their treatment team at
one of the centralized treatment locations and that this team had given them their team seemed
very dedicated and gave them their personal cell phone numbers. Emmeline describes feeling
supported by their treatment team despite changes in policy:
There was a pause in my treatment, and then, during my deployment, in 2017 beginning
of that year, that's when President Trump reinitiated the ban, and shortly afterwards I get
a call from my mental health, provider and she asked me would I like to continue or
potentially get removed from the Air Force? Or would I like to not continue, and she will
not put the diagnosis in my record other than just saying, this person shows symptoms of
gender dysphoria, but is not officially diagnosed. I saw this as her looking out for me.
Leadership Support

The U.S. military is a large, complex hierarchical organization with many different levels
of leadership in any given chain of command. For this study, the researcher did not attempt to
identify from which level of leadership participants experienced support, and the researcher
infers that these examples are from different levels, not necessarily in the servicemember’s direct
chain of command. Seven transgender servicemembers in this study reported that they felt
supported by someone in their chain of command regardless of whether they had previously
disclosed their gender identity or if they were disclosing it for the first time. Support manifests in
the form of listening, mentoring, advocating, and help navigating the process of obtaining
72

gender-affirming care, and the level of leadership varied and may include the immediate
supervisor, an instructor in an academic situation, a commander, and people at other levels of
leadership. For an example at a higher level of leadership, Amelia, a Navy veteran who served
over 20 years who just recently retired recalled being pleased with a recent display of public
support. Amelia said “Oh, it’s good that Admiral Gilday came out in support of a non-binary
servicemember. That was kind and some much-needed visibility right there.”, describing a
feeling of strong advocacy when they witnessed the Chief of Naval Operations defend a non-
binary Navy officer during a Senate hearing where the subject was being debated. Emmeline,
who served nine years in the U.S. Air Force, described feeling supported as a transgender person
by their leadership at the unit level:
Fortunately, my leadership team has been very supportive and very quick to sign [ETP
paperwork] and they knew I was very scared because there are horror stories with other
leadership teams who refuse to sign due to personal biases.
Emmeline also described overt support from their leadership when they were subjected to sexual
harassment, saying “…my Chief jumped right in and called everyone in the unit in. She let
everyone know that sexual harassment of any type would not be tolerated, regardless of sex or
gender identity.”
Berry described feeling as though their commanders have been helpful and supportive of
their transition journey, saying they “have been supportive and always willing to help with
paperwork.” Martin further described feeling supported by people other than commanders in
leadership roles saying “He [First Sergeant] was just so open-armed and obviously supportive.
He made me feel like he was happy I was here in the squadron.”
73

While many members who addressed support from people in leadership roles described
feeling supportive, one participant described an experience with a commander where they felt
marginalized after he confided in them. Alexander, having separated in 2022 after serving six
years in the U.S. Army, said when they were deployed and had not disclosed their gender
identity to their commander:
…had a commander once go on a small tirade about how he didn’t care if people wanted
to be gay or trans or whatever, but they don’t have to push it in everyone’s face. He
didn’t want to see all the rainbow stuff everywhere, you know, pride celebrations stuff. I
knew then and there I wasn’t coming out here.
They further describe the commander as “very religious guy who also has something against
women and feminism. He was always making comments about how the problem with kids
nowadays is that many do not have fathers in the home and that many men are feminine now.”
While it is important to consider this experience as it is impactful and underscores the presence
of these harassing behaviors, this does not represent the experience of most participants when
dealing with their local leadership.
Findings for Research Question 2: What are the perceived challenges transgender
servicemembers face in the US military?

The intent of the second research question was to shift focus from the immediate
environmental experiences to common barriers that may be exclusive to this population. The
researcher viewed this question from the lens of obstructive policies or processes. As highlighted
below, findings related to barriers consistently pointed to the frustration this population endures
when trying to receive medical care, which has negative effects on their well-being.
Theme 3: Transgender U.S. military members experience challenges and barriers to
obtaining timely gender-affirming care, leading them to obtain care outside the military.
74

During the interviews, five participants mentioned that they were not in the military to
“take advantage of the system” or to get the military to pay for their transition, and three of them
did not obtain any gender-affirming care at the expense of the military. Seven out of 10 had
received some type of gender-affirming care ranging from HRT to surgery. There were several
common sub-themes related to the challenges transgender U.S. military members experience
when they try to obtain gender-affirming care including the lengthy process of obtaining
approval, the ability of a commander to make the sole decision on whether the person receives
the care, and the effect that receiving gender-affirming care can have on duty assignments and
careers.
Timeliness of Gender-Affirming Care

When asked how they would characterize the process of getting approval to transition, all
10 participants indicated that the process was slow, confusing, required a substantial amount of
documentation and paperwork, and an Exception to Policy (ETP) letter that must be routed to a
level that is beyond their local unit leadership. Due to differences in policy between the different
military services, ambiguity between responses, and minute relevance to the research questions,
the researcher did not clarify the entire process or specify one specific signatory level for the
ETP or approval. The below accounts of the transition process demonstrate that key areas
affecting the ease and speed of the process are centered around leadership knowledge of the
process, bureaucracy and timeliness when routing an ETP, and availability of timely
appointments with case managers.
Martin explained how beginning the transition process was “difficult” and “frustrating”,
recalling that their local leadership was very supportive and helpful, but the paperwork had to be
routed up the chain of command several times, taking several weeks and sometimes months each
75

time. They said, “I felt supported by my squadron leadership, but the [leadership at the Air
National Guard level] were like, you know, we need more, even though I physically could not
provide any more documentation.”
Amelia further described the process of obtaining approval as “glacially slow”,
explaining that they were “going back and forth, and basically teaching them as you go”,
referring to how they had to guide their local leadership and case manager through the process.
They further recall that getting an appointment with a case manager took them a few months,
explaining that one central location handles all transgender military members on the West Coast.
This participant also pointed out that some contents in the ETP package that gets routed expire in
90 days, so the extended processing time has caused them to have to re-initiate some steps. They
noted that collecting all the required documentation takes time but routing it through the chain of
command can take several months. In their experience, the routing process initially took four
months, just to be deferred so they could go on a deployment.
Berry described their process as “extremely frustrating and defeating at times”. They
explained that their ETP “had to go all the way up to the top leadership, and then it was sat on for
a year and a half”, pointing out that despite persistent inquiries regarding the status of the ETP,
the wait time was excessive.
Interview responses to questions regarding the process of obtaining gender-affirming care
in the U.S. military indicate an overall disdain for a process that is confusing to some people
involved and cumbersome. Moreover, interviewee responses highlight unit commander
involvement in the process of obtaining gender-affirming care that can often have a profound
effect on treatment availability.

76

Commander Involvement
All participants reported that current policy in the military allows commanders to decide
when transgender military members can obtain gender-affirming care without consultation with
the member’s medical team. This autonomy reportedly allows commanders to consider the
effects on the mission and choose whether a member can obtain care. While six participants
expressed frustration with this process, three participants reported they believe their commander
negatively affected their ability to receive timely gender-affirming care. The following accounts
describe the experience of two of the participants who stated their transition process was
interrupted by the commander due to mission demands. Emmeline said:
They have, say, and they have control. But at this point, especially from all the things I
see, I think they've given too much control to the command leadership, and I personally
believe all this power and authority, should stay with the medical team. I think if they
wanna [sic] be able to dress or grow out their hair or buzz it all off, or do whatever and
for their gender identity in further part, as part of their treatment, I do fully believe that
medical teams and your PCMs (Primary Care Managers) should be involved in that
decision.
Emmeline went on to describe their experience when their commander made the decision to send
them on a 365-day deployment before they could begin any aspects of their transition. Further,
Amelia explained that, after taking months to collect all the necessary documentation, their
commander made the decision to defer their transition until after their deployment ended.
Overall, participants expressed concern with the autonomy that commanders are given to
decide on their medical care. The majority of participants (six) purport that commanders are not
medical professionals, have not received any medical training regarding transgender care, and
77

are thereby ill-equipped to determine whether gender-affirming care is emergent or not. The
consensus is that commanders do not understand the effect delaying gender-affirming care has
on a member’s mental well-being and, therefore, the mission. The further consensus among
participants is that obtaining gender-affirming care, including HRT, has minimal to no effect on
their ability to perform their duties outside the recovery time for any type of surgery involved.
Effects of Gender-Affirming Care on Duty Assignment and Career
Responses to questions regarding how obtaining gender-affirming care can affect their
career, responses overwhelmingly support the notion that doing so often affects a member’s
position at work, sometimes resulting in them being removed from current positions or duties for
an extended period of time. While eight out of 10 participants expressed concerns about their
duty position or career being affected, three report being removed from their current duties or
being passed over for a deployment. These members explain that promotion relies heavily on
past performance and deployments, so this removal can have a negative effect on their career.
When describing the process of getting approval to transition, Amelia noted that they
were “basically put on limited duty” citing reasons that include concern about the effects of the
medication they are taking and ensuring availability for medical appointments.
Harriet described how they considered “coming out” and seeking gender-affirming care through
the military, but refrained to avoid being deemed unable to perform their duties in the aircraft
and be grounded until they could get a waiver. They also stated that waivers are not guaranteed.
Desmond echoed this sentiment, stating that she would not seek gender-affirming care through
the military because “they would have taken me out of my current position just to assess my
condition and my ability, even though I had done this job for almost two decades.” Desmond
commented that “I was a very high-performing person, and I was not about to be put on the
sidelines while the military figured out that I could still do my job”.
78

Clara described a general sense of frustration among the transgender community in the U.S.
military about being considered unable to perform duties such as flying on aircraft or deploying:
We do this over and over again, where we have to fight for someone’s ability to deploy
where they use the same arguments, and we use the same rebuttals. We get the same tired
arguments that ‘you cannot do this because you are trans’ or ‘you cannot do this because
you are taking certain medications’ that other people take all the time.
Clara further expressed confusion, noting that the military invests a substantial amount of money
and time into developing an experienced flyer, and when they come out as trans they are
suddenly not able to perform these duties any longer.
Interview questions surrounding specific duties and positions were not asked, and
therefore the responses make it impossible to associate any negative effects of obtaining gender-
affirming care with specific duties or even state that the effects are universal. Notwithstanding,
the responses within the interviews indicate that those members in specialized positions such as
flying, serving at sea, carrying a weapon, or deploying are affected more than those who perform
more traditional duties. The results of the interviews also indicate that when transgender U.S.
military members do not receive gender-affirming care sponsored through the military health
system, either because they are not allowed or they choose not to, they often seek care from non-
military medical sources.
Healthcare Outside the Military Health System
Seven out of 10 transgender servicemembers interviewed admitted they had received
gender-affirming treatment outside the military health system. Responses indicate some do so to
avoid exposing their gender identity, to avoid an interruption in their career or duties caused by
taking the medication (HRT), or because of a lack of timely access to gender-affirming care
79

within the military health system. Among those who did so due to lack of access cited either long
delays in obtaining approval for gender-affirming care, or long wait times to get appointments
for care at central treatment locations. Martin, a member of the Air National Guard since 2012
describes beginning HRT before the ban on transgender military service was lifted, and doing so
in the midst of changing duty locations so that changes in their appearance may not be so
evident:
When I started my transition in 2020 it was still very much out of regs, not even talked
about. We’re not talking about it; I didn’t tell my leadership anything about it. So, I
started taking hormones and, you know, have the physical changes. My body was starting
to change physically and when I [got to my next duty station] they didn’t know what to
do with me because the ban was about to be lifted…

Harriet, a veteran of the U.S. Air Force who served 20 years, describes beginning HRT during a
period when then-President Donald Trump had banned transgender military service:
… and so I actually started HRT without the military actually knowing. I found a doctor
that prescribed hormones on informed consent. And so basically you go and tell them I’m
an adult, I know what the risks of taking this medication are, and I’m accepting those
risks, and they will actually prescribe it to you. I started hormones not too long after
arriving here at the risk of me getting in a lot of trouble…
Desmond, a veteran who served over 20 years in the Navy, reports that they never disclosed their
gender identity to anyone in the Navy but had been taking gender-affirming medications for
several years, stating:
I knew I was trans early on but couldn’t talk to my doctor about it because we couldn’t be
in the military back then. Later down the road, I started seeing doctors who weren’t
80

affiliated [with the U.S. military] so that I could begin transitioning, you know, some of
it. Toward the end I had been taking meds for a while and it was beginning to show, but I
didn’t even care much anymore about whether someone noticed or not. I did get nervous
when I would go for my physical though. I mean, they weren’t very subtle changes at that
point.
Desmond recalls accepting this risk and taking these steps to transition to avoid being removed
from their duties for an extended period. They stated that going through the military medical
system would jeopardize their service in their current role.
Berry, having recently separated from the military after serving six years in the U.S. Marine
Corps says they had disclosed only to their mental health provider that they were transgender and
desired to transition, and recalls being formally punished for obtaining gender-affirming care
outside the military healthcare system after that individual shared this information with their
leadership.
…went out and got my own treatment, the OSCAR [Operational Stress Control and
Readiness] told my CO [Commanding Officer], broke HIPAA [Health Insurance
Portability and Accountability Act] and I received punishment under the UCMJ
[Uniformed Code of Military Justice]. This guy was a company grade officer, and he
wrote me up for it…
While most participants reported obtaining some sort of gender-affirming care outside the
military health system, the level and nature of each varied. This researcher did not inquire about
specific methods, procedures, or medications, most participants indicated they had undergone
some form of HRT. Two participants admitted to receiving aesthetic-type treatments such as
laser hair removal, collagen, or Botox outside the military healthcare system. There were no
81

indicators that any of the participants received any type of gender-affirming surgical procedures
outside the military health system, but the researcher did not clarify whether this was the case
with each.
Despite the general disdain for the process of obtaining gender-affirming care within the
military medical system, those who had received care expressed overall satisfaction with the
support they received from their medical teams and their commanders.
Summary of Findings
The findings from this research reveal three notable themes, highlighting three
overarching areas for improvement and two areas of notable satisfaction. First, the process that
transgender U.S. military members must endure to obtain gender-affirming care is slow and
cumbersome, which can prevent timely treatment. Further, transgender military members
experience elevated levels of mental distress exacerbated by harassing or otherwise abusive
behaviors toward them, uncertainty regarding their future in the U.S. military, and attempts to
conceal their identity to avoid the former. This mental distress often leads to attempted suicide or
suicidal ideations. Moreover, this research identified two areas in which participants expressed
high levels of satisfaction—support from some people in leadership roles and the quality of
medical care they have received through the military health system.

82

Chapter Five: Discussion and Recommendations
The purpose of this chapter is to provide discussion and recommendations based on the
findings. The results of this research study indicate that U.S. military leaders at various levels
understand their obligation to support transgender military members and that the U.S. military
has put forth substantial effort in accommodating these members’ medical needs. The results also
reveal a culture that was, perhaps, not prepared to accept openly serving members of the
transgender community. Below you will find discussion points the researcher found relevant to
the context of this population, recommendations for practice, limitations, and delimitations
related to this study, and recommendations for future research.
Discussion of Findings
Before discussion of specific findings in this research, it is important for readers to
understand the level of full-scale intimacy that was the essence of each interview. The
participants in this study willfully discussed some of their most private moments in life and
brought forward some of their most troubling, persistent struggles. These experiences didn’t stop
outside the military context. Although this research is aimed at exploring how transgender people
experience the U.S. military, the complex picture painted by participant responses was that
transgender people in and out of the military share similar experiences.
Data indicating that transgender military members experience mental distress as a result
of being subject to discrimination, harassment, abuse, and transphobia is consistent with minority
stress theory and past research on marginalized groups of people (Harrison & Michelson, 2018;
Meyer, 1995) and are likely remnants of past policies claiming transgender people are not fit to
serve. It is apparent that the U.S. military’s long-living history of discrimination and oppression
of certain groups of people (Wise, 2019) has left a legacy that remains today, and there are
83

several opportunities for improvement. A good insertion point for improvement is to address the
misperceptions about the fitness of transgender people to serve in the U.S. military.
Transgender people are often thought to be mentally unstable, one of the often-cited
reasons to disallow them from military service (Elders, 2015; Hill, 2016; Mizock, et al., 2016).
The results of this research have confirmed that transgender military members do experience a
substantial amount of mental distress. While GD does involve mental distress related to the
incongruence between the gender a person is assigned at birth and the gender they identify as
American Psychological Association, 2015), consistent with other recent research (Holman,
2018; Lefevor et al., 2019; Tucker et al., 2019) the data in this study suggest that the bulk of
stressful triggers reside within the member’s environment. Mental distress caused by GD can be
mitigated by providing timely gender-affirming care and allowing them to serve as their
authentic selves without fear of maltreatment based on their gender identity. Additional work
will be needed to address the environmental triggers that cause compound mental distress. While
nobody should be subject to harassment or abuse, whether overtly or covertly, the transgender
community is far more vulnerable to these behaviors (Harrison & Michelson, 2018), possibly
due to the ignorance of non-transgender people regarding transgenderism. One of the participants
in this study addressed this ignorance, talking about how they knew they were different at a very
young age, but did not have the vocabulary to describe it. They further explained that it is
completely reasonable that a cisgender person would not understand it. Deliberate action to
increase understanding of what it means to be transgender would likely be instrumental in
reducing behaviors harmful to transgender people.
Consistent with minority stress theory (Meyer, 1995) and research by Alford (2016), the
data from this study reinforce the notion that transgender people in the U.S. military regularly
84

modify their behavior to conceal their identity and avoid the above-mentioned behaviors. Studies
by Elders (2015), Emmerich (2017), Kahn, (1990) and Van Den Bosch (2014) identify a
significant positive correlation between the ability to be authentic at work and individual level of
engagement, sense of self, motivation, and organizational performance. Further, Past studies of
other sexual minority groups have uncovered a link between concealing one’s identity as a
protective posture with poor health outcomes, shame, low self-esteem, and decreased motivation
(Hill, 2016; Quinn, 2017), emphasizing the importance of creating an environment where
transgender people in the U.S. military can feel free to be their authentic selves at work. One
must also consider that the research by Bidix et al. (2013) that indicates a strong correlation
between a transgender member’s decision to reveal their true identity at work and their
perception of how much their employer cares about them. The data in this study has indicated
that transgender people in the U.S. military are skeptical about whether they will be allowed to
serve in the future, which may translate into feeling like the military does not care about them.
Reassurance that transgender people will not be banned again from military service in the U.S.
would likely be instrumental in creating a sense of caring which, when coupled with an
environment free of transphobic behaviors and misperceptions, would encourage authentic
agency at work. Moreover, it is reasonable to believe that these changes would also help mitigate
the increased incidence of suicidal ideations and attempted suicide identified in the data from this
research.
This research study also highlighted challenges and barriers transgender people
experience when obtaining gender-affirming care in the U.S. military, thereby uncovering
opportunities to improve access to gender-affirming care, by eliminating interruptions and
delays. This can be done through engagement with unit commanders. One can’t argue that the
85

mission of a military unit is not important, but the perception of many transgender people
involved is that the military commander will make decisions regarding their ability to obtain
gender-affirming care without considering all variables. Research has shown that gender-
affirming care for transgender people who desire it is a medical necessity and plays a significant
role in their mental and physical well-being (Byne et al., 2012; Committee on Healthcare for
Underserved Women, 2011; Go, 2018; Hembree et al., 2009). Commanders, usually not medical
professionals, are likely not aware of this necessity and may be under the impression that gender-
affirming care is simply an arbitrary choice the member is making.
This study also highlighted feelings or acts of support from leaders in the military. The
emerging theme that many transgender U.S. military members feel support from some levels of
leadership could be considered an indicator that this population is becoming more widely
accepted in the military space, and that they are closer to more effective inclusion, one must also
consider these responses in context. First, this equates to 70% of this population being supported.
In an organization that relies on strong leadership for mission accomplishment, would 70%
support suffice? Would it be acceptable if nearly one third of the force (30%) did not feel
supported? Further, one must also consider that the responses in this study identified that 70% of
transgender people felt generally supported by leadership and were able to cite examples at
different levels—not at all levels. All but one of the examples of support given were acts of
assistance where needed or when asked for as opposed to unsolicited allyship or advocacy. Does
this equate to simply not feeling unsupported? Is simple acknowledgement as a person or
military member being seen as being supportive because that has historically been absent?
Lastly, while one theme identified feelings of supported from leadership, another theme
identified indicates that most of them are frustrated with their commander’s involvement in the
86

process to obtain gender-affirming care, which begs the question of whether leadership is really
supportive and whether they have the tools to be fully supportive or not. This tension is an
indicator that further research is needed to clearly understand to what level the transgender
population in the U.S. military is supported by their leadership.
Further, the results of this study indicate that commanders often restrict transgender
members from performing certain duties such as carrying a firearm, flying on an aircraft, or
deploying while receiving gender-affirming care. Participants in this study report being told by
commanders that they don’t know how their hormone therapy will affect their ability to perform
these duties, while they assert that there is no effect on their abilities. This, too, should be a
decision that is made in close collaboration with the member’s medical team and involving the
member. Participants in this study purport that restricting duties in these positions for a lengthy
period has a negative effect on their careers and may also have a negative effect on their sense of
agency in the organization. If there are duties that, in fact, should not be performed while
receiving hormone replacement therapy or other gender-affirming care, the transgender member
should be part of the decision-making to strike a balance between timeliness of care and
restriction of duties or effect on career. Streamlining the process of obtaining gender-affirming
care by bringing all stakeholders and sources of knowledge around the decision-making table to
avoid unnecessary delays and interruptions may minimize the instance of members obtaining
care outside the military health systems without the knowledge of their leadership or medical
team while also reducing mental distress.
Although the data in this study reveal an overall satisfaction with the quality of medical
care transgender members receive in the military, this falls in contrast to a qualitative study
involving 174 gender-diverse active-duty military personnel (Schvey, 2020). In the data from
87

Schvey (2020), a trend emerged where transgender U.S. military members often report being
stigmatized by their medical providers. This trend may have been mitigated with the inception of
centralized medical care for this community, or the problem may be growing less prominent over
time as transgender military service becomes more commonplace in the U.S. Further research is
needed to clarify this disparity. Moreover, as identified previously, participants in this study
indicate that obtaining gender-affirming care through the military healthcare system can be a
slow, cumbersome process which highlights a persistent tension when it comes to overall care
for transgender people. Participants largely feel that medical care is quality, but they aren’t
always able to access it in a timely manner and their primary care team is often located hundreds
of miles away.
When considering recommendation to highlight from this study, the researcher found it
prudent to consider the current atmosphere along with scope of responsibility and to ensure
recommendations made are actionable. As such, reaching back to Bronfenbrenner’s Ecological
System’s model, changes that are closest to the individual and thereby have a more immediate
and direct effect fall within the microsystem and mesosystem. Those that fall within the
exosystem and macrosystem may be more difficult to obtain. For instance, as this paragraph is
being written, there are 359 active anti-transgender legislative bills that have been introduced
across the U.S. This year alone, there have been 561 introduced across 49 states, with 79 passing
and 129 failing (Trans Legislation Tracker, 2023). These numbers emphasize then need to
introduce legislation that will codify the right of transgender people to serve in the military and
to receive the healthcare they need and desire. These numbers also highlight the controversial
nature of this subject and, therefore, such a recommendation may not be actionable in the near
future. Therefore, this researcher introduces the following recommendations that fall within the
88

microsystem and mesosystem and can realistically be implemented at multiple leadership levels
and still be effective at improving inclusion.
Recommendations for Practice
[Recommendation 1: Create a training program for commanders that educates them on the
meaning of being transgender, the role that gender-affirming care plays in mental health
and performance outcomes, and common barriers to receiving this care].

All ten research participants reported that the process of attaining permission to receive
gender-affirming care was characterized by multiple delays, often spanning several months and
occasionally exceeding a year. In this process, commanders hold a central role and should be
equipped with a comprehensive understanding of the repercussions associated with timely access
to gender-affirming care for transgender military personnel. This understanding is crucial for
enabling commanders to make informed decisions regarding the allowance, postponement, or
prohibition of such care.
Specifically, commanders should be informed of the mounting body of evidence that
supports the notion that transgender individuals who obtain the gender-affirming care they desire
exhibit better mental health outcomes compared to those who are unable to do so. Lefevor et al.
(2019) and Alamazan et al. (2021) assert that prompt access to gender-affirming care, whether it
be hormone therapy, surgery, or both plays an instrumental role in enhancing mental well-being
and outcomes. In a study involving transgender individuals who aspired to undergo gender-
affirming surgery but had not yet done so, Alabaman (2021) found that the former group
exhibited significantly lower odds of experiencing suicidal ideations, alcoholism, and mental
health challenges when compared to the latter group. Furthermore, in a study aimed at assessing
the long-term effectiveness of gender-affirming surgery, Park et al. (2022) emphasized the
significance of gender-affirming care by demonstrating that patient well-being after gender-
89

affirming surgery persisted for four decades. Therefore, implementing measures to ensure that
transgender military members desiring gender-affirming care can promptly receive it would
enhance their mental health outcomes in both the short and long term, and conceivably
contribute to a reduction in suicidal ideations within the transgender community.
Moreover, commanders should be armed with a comprehensive understanding of the
relationship between a transgender individual's access to gender-affirming care, their willingness
to express their true selves in the workplace, and their organizational performance. It is crucial to
acknowledge that apart from the improved mental health outcomes, receiving gender-affirming
care has been shown to significantly enhance authenticity, motivation, and work performance
(Elders, 2015; Emmerich, 2017; Kahn, 1990; Van Den Bosch, 2014). Commanders ought to be
aware of all these effects when deliberating on such decisions. By educating commanders on the
vital importance of gender-affirming care, they can engage in a more informed assessment of the
needs of transgender military personnel alongside mission requirements, thereby facilitating
decisions concerning the initiation of care.
[Recommendation 2: Develop and employ bystander intervention training to mitigate
discriminatory, harassing, and abusive behaviors aimed at transgender military members].

Eight out of 10 participants interviewed reported being subject to discriminatory,
harassing, or abusive behaviors. Bystander intervention training can foster a culture that is
intolerable of these behaviors by significantly improving bystander attitudes and beliefs (Kuntz,
et al., 2023). It is important to focus the training on response to these behaviors as opposed to
placing blame; as Cunningham et al. (2021) point out, bystander intervention training can be
most effective at creating empathy and propelling bystanders to act if it is non-accusatory in
nature. Further, Kuntz et al. (2023) and Cunningham et al. (2021) suggest, the effectiveness of
the training can be optimized if the training is held in person, customized for the audience, and
90

based on interactions or role play with interdependent tasks. Further, members need to
understand why the learning experience is important, and the impact the discriminatory,
harassing, and abusive behaviors have on unit performance and cohesion. Research suggests that
non-marginalized members are more resistant to supporting inclusion initiatives for marginalized
groups when they have not been exposed to the impacts these behaviors have in the workplace
(Peltier-Huntley, 2022). Providing this training experience will empower individuals in the
organizations who may have otherwise sat idle when observing these behaviors, ultimately
resulting in a culture where these behaviors are not accepted, and the transgender member feels
valued and supported.
[Recommendation 3: Develop and employ strategies to foster a psychologically safe
environment for transgender military members].

Eight out of 10 participants reported a history of modifying their behavior to avoid being
“clocked” (identified as a transgender person) or revealing their gender identity. This is an
indication that these participants did not feel like their environment was psychologically safe
enough for them to be authentic. Therefore, military commanders and leaders should take a
multi-faceted approach to improving psychological safety within their units.
Kahn, (1990) posits that psychological safety correlates positively with one’s degree of
engagement at work, describing psychological safety as a cognitive state where organizational
members can exist and work as their authentic selves without fearing negative impacts on their
careers, status, or self-image. Research by Basit (2017) indicates that engagement is increased
when members feel psychologically safe because, in turn, they feel an obligation to reciprocate
by performing well. Further, research suggests that the comfort of psychological safety in the
workplace drives cooperative learning, a harmonious work atmosphere, creativity, and
innovation (Post, 2012; Wang et al., 2022).
91

Commanders and leaders can harness the power of a psychologically safe environment by
creating a more inclusive and supportive environment. Drawing from a study conducted by The
Pew Research Center (2021) we understand that nearly two-thirds of people have never
knowingly met a transgender person and may be basing their feelings about them off ideology
(Spindel & Ralston, 2020) or other social norms that can often be inaccurate or misleading.
Closing this knowledge gap by educating the general military populace could lend substantial
support to building a psychologically safe environment. Therefore, commanders and leaders
conduct regular education and training programs to increase awareness and understanding of
transgender issues among military personnel. This should include information on gender identity,
appropriate language use, respectful behavior, and debunking common misconceptions and
stereotypes.
Additionally, commanders and leaders at all levels should actively promote a culture of
respect and acceptance while deliberately working to create a more inclusive and supportive
environment for transgender people. This can be achieved by promoting diversity, equity,
inclusion, and belonging efforts and tailoring some of them to address transgender issues.
Additional methods of promoting inclusion include organizing support groups, resource groups,
or affinity networks specifically for transgender military personnel, increasing allyship and
advocacy withing the unit and between multiple units.
Lastly, commanders and leaders should interrogate current policies within their scope of
responsibility, ensuring policies that cross all aspects of military life including healthcare,
housing, recruitment, promotion, punishment, etc. foster an inclusive environment considering
experiences and challenges that may be exclusive to transgender people. For this initiative to be
efficacious, transgender members of the military should be at the table at every stage. Further,
92

they should be included when policies are developed in the future to foster consistent forward
momentum toward inclusion.
Limitations and Delimitations
Due to the scope and size of this research study, there were several limitations and
delimitations that must be considered. One major limitation was the small sample size, as having
only 10 participants may limit the generalizability of the findings to the larger population of
transgender members in the U.S. military. Additionally, the process of recruiting participants
through an advocacy organization and snowball sampling excluded members who were not
aware of or part of that organization and thereby may have limited the diversity and
representativeness of the population studied. Further, the results of this study are limited solely to
the responses of the participants. This created room for bias with the possibility that some may
have answered questions based on what they perceive as a socially desirable answer, or some
may have recalled experiences incorrectly or not at all. Lastly, the results are limited in that,
during the coding of interview transcripts, the researcher may have inadvertently introduced
unknown bias.
The scope and size of this research also presented delimitations that must be considered.
This study focused solely on transgender people who served in the U.S. military, which means
the findings may not be applicable to transgender people in the civilian setting or in other
countries. By using semi-structured interviews, the study delimited the data collection to
participants’ responses to predetermined questions and therefore may have restricted the
exploration of some points or perspectives that arose in the interviews. Lastly, ethical
considerations delimited this research project to promote confidentiality, privacy and ensure
informed consent.
93

Recommendations for Future Research
The limited scope of research involving transgender people in the U.S. military highlights
the need for further research. Researchers should consider that transgender people, while socially
categorized as part of the LGBTQ community, should be studied independently as their
situations and experiences are vastly different. One such study may explore the intersectionality
of transgender identity with other aspects of an individual’s identity such as socioeconomic
status, race, ethnicity, disability, etc.
One may also consider conducting longitudinal research to examine the experiences of
transgender military members over time. This would provide valuable insight into the long-term
effects of policies, support systems, and cultural variables on career progression and overall
integration within the military. Similarly, a comparative study of transgender military members
from different countries may help researchers understand how varying policies, support systems,
and cultural attitudes impact well-being, retention rates, and career advancement. Further, this
researcher suggests further research examining the mental health and well-being of this
population, including coping mechanisms and other factors that promote resilience. Lastly, this
research has highlighted the need for improved knowledge about what being transgender means
and the researcher has recommended bystander intervention training specifically tailored to
protecting transgender people. Therefore, further research should include the efficacy of these
programs and include the effectiveness of any diversity training programs in reducing harmful
behaviors and creating a more comfortable, inclusive atmosphere for transgender U.S. military
members.

94

Researcher Reflection
Throughout this research journey, my admiration and respect for the transgender research
participants grew exponentially with every interview. Their willingness to come forward and
share their intimate stories with me was an act of immense courage and vulnerability. However,
it was their unwavering determination and strength to live their lives authentically, despite a
world that seems unsupportive and unwilling to recognize their truth, that truly inspired me.
Hearing the daily battles they face and witnessing the resilience they embody was both humbling
and awe-inspiring. Their stories illuminated the myriad challenges they confront, yet they persist,
pushing every day against societal barriers and forging their own paths. I felt privileged to learn
of their journeys, and their courage is an inspiration that emphasizes the importance of
compassion, understanding, and advocacy. The uncrushable spirit that these individuals
displayed serves as a reminder of the power of authenticity and a value that can be found in a
world that embraces everyone regardless of their gender identity. I am forever grateful for this
opportunity.
Conclusion
I chose this problem of practice to study based on my positionality as a member of the
LGBTQ community who served in the U.S. military for over 22 years, nearly half of which were
under the Don’t Ask Don’t Tell policy. Each year under that policy, I and every other U.S.
military member was required to complete training that reinforced the military’s stance that
homosexual people were not compatible with military service, thereby reinforcing a
classification as “others” and second class servicemembers. After this policy was repealed, there
was no integration of gay people into the military. One must believe that allowing gay people to
serve was good enough. More should have been done and can still be done to fully include gay
95

people. Moreover, allowing transgender people to serve is not enough. Years of acknowledging
that I was good enough the way I was and would not be included was very damaging to me in the
long run, and the same may be said for our transgender servicemembers. The U.S. military needs
to take steps to effectively include transgender people and all LQBTQ people.
This chapter has provided a discussion surrounding the findings from this research,
including consistencies and inconsistencies with other research, and outlined three actionable
recommendations for practice. Past research suggests that implementing these recommendations
will bring about changes that support more effective inclusion and integration of transgender
people in the U.S. military. Moreover, comprehending the experiences of transgender individuals
within the military is crucial, particularly given the timing of this study. Understanding these
experiences not only sheds light on the challenges faced by transgender service members but also
emphasizes the importance of fostering a more inclusive environment within the military. The
main takeaway from this research is the urgent need to actively work towards enhancing
inclusion and acceptance of transgender individuals in the military. By doing so, we can improve
their overall health outcomes, help them reach their full potential by empowering them to bring
their authentic selves to work, and harness that potential as they are force multipliers for military
organizational missions. Embracing diversity and promoting equality will not only benefit
transgender individuals but also strengthen the military. Lastly, the researcher has provided
recommendations for future research, based on that which was learned while administering this
study. Research in these areas would serve the military community by providing much-needed
data on which to base further inclusion initiatives.

96

97

References
Agnes, G. S., Iyengar, R., Kadiyala, S., Kavanagh, J., Engel, C. C., Williams, K. M., . . . Kress,
A. M. (2016). Assessing the implications of allowing transgender personnel to serve
openly RAND Corporation. doi:10.7249/j.ctt1d4txv6
Alford, B., & Lee, S. J. (2016). Toward complete inclusion: Lesbian, gay, bisexual, and
transgender military service members after repeal of don't ask, don't tell. Social Work
(New York); Soc Work, 61(3), 257-265. doi:10.1093/sw/sww033
Almazan, & Keuroghlian, A. S. (2021). Association Between Gender-Affirming Surgeries and
Mental Health Outcomes. Archives of Surgery (Chicago. 1960), 156(7), 611–618.
https://doi.org/10.1001/jamasurg.2021.0952
American Medical Association House of Delegates (2015). Military medical policies affecting
transgender individuals. Resolution 011 (A-15).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
ATLAS.ti Scientific Software Development GmbH [ATLAS.ti 22 Windows]. (2022). Retrieved
from https://atlasti.com
Baer, S. (1992). Clinton reaffirms his promise to end military’s ban on gays. The Baltimore Sun.
https://www.baltimoresun.com/news/bs-xpm-1992-11-12-1992317161-story.html
Basit. (2017). Trust in Supervisor and Job Engagement: Mediating Effects of Psychological
Safety and Felt Obligation. The Journal of Psychology, 151(8), 701–721.
https://doi.org/10.1080/00223980.2017.1372350
Belkin, A., Ender, M. G., Frank, N., Furia, S. R., Lucas, G., Packard, G., . . . Segal, D. R. (2013).
Readiness and DADT repeal: Has The New Policy of Open Service Undermined the
Military? Armed Forces and Society, 39(4), 587-601. doi:10.1177/0095327X12466248
Biddix, J. M., Fogel, C. I., & Black, B. P. (2013). Comfort levels of active duty gay/bisexual
male service members in the military healthcare system. Military Medicine, 178, 1335–
1340. doi:10.7205/MILMED-D-13-00044
Bowers, M. M., & Whitley, C. T. (2020a). What Drives Support for Transgender Rights?
Assessing the Effects of Biological Attribution on U.S. Public Opinion of Transgender
Rights. Sex Roles, 83(7-8), 399–411. https://doi.org/10.1007/s11199-019-01118-9
Bowers, M. M., & Whitley, C. T. (2020b). Assessing Voter Registration Among Transgender
and Gender Non-conforming Individuals. Political Behavior, 42(1), 143–164.
https://doi.org/10.1007/s11109-018-9489-x
Britannica, T. Editors of Encyclopedia (2022). Don’t Ask, Don’t Tell. Encyclopedia Britannica.
https://www.britannica.com/event/Dont-Ask-Dont-Tell
98

Bronfenbrenner U. (1979). The ecology of human development: Experiments by nature and
design. Harvard University Press.
Bronfenbrenner, U; Morris, P. (2007). "The Bioecological Model of Human
Development". Handbook of Child Psychology. doi:10.1002/9780470147658.chpsy0114
Brown, M. T. (2013). Military service and lesbian, gay, bisexual, and transgender lives. In Life-
Course Perspectives on Military Service (pp. 97-118). Taylor and Francis.
https://doi.org/10.4324/9780203079744
Brown, & Jones, K. T. (2016). Mental Health and Medical Health Disparities in 5135
Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A
Case–Control Study. LGBT Health, 3(2), 122–131.
https://doi.org/10.1089/lgbt.2015.0058
Brown, Kucharska, J., & Marczak, M. (2018). Mental health practitioners’ attitudes towards
transgender people: A systematic review of the literature. The International Journal of
Transgenderism, 19(1), 4–24. https://doi.org/10.1080/15532739.2017.1374227
Bunn. (2010). Straight talk: The implications of repealing “don’t ask, don’t tell” and the rationale
for preserving aspects of the current policy. Military Law Review, 203, 207–283.
Burks, D. J. (2011). Lesbian, gay, and bisexual victimization in the military: An unintended
consequence of “Don't ask, don't tell”? American Psychologist, 66(7), 604-613.
doi:http://dx.doi.org/10.1037/a0024609
Burrelli, D. (2010). “Don’t Ask, Don’t Tell:” The Law and Military Policy on Same-Sex
Behavior. Current Politics and Economics of the United States, Canada and
Mexico, 13(1), 27–47.
Caputo J. (2017) Should Transgender Persons Serve. Proceeding, 143(12) U.S. Naval Institute.
Retrieved from https://www.usni.org/magazines/proceedings/2017/december/should-
transgender-persons-serve
Coon, D., Neira, P. M., & Lau, B. D. (2018). Threats to united states fully reviewed and strategic
plan for integration of transgender military members into the armed forces. American
Journal of Public Health (1971); Am J Public Health, 108(7), 892-894.
doi:10.2105/AJPH.2018.304454
Coppola. (2021). The Social Construction of Transgender Individuals and U.S. Military
Policy. Journal of Homosexuality, 68(12), 2024–2046.
https://doi.org/10.1080/00918369.2020.1717838
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed
methods approaches. Thousand Oaks, CA: Sage.
Cunningham, D., M. E., & Foster, K. W. (2021). Networks of complicity: social networks and
sex harassment. Equality, Diversity and Inclusion, 40(4), 392–409.
https://doi.org/10.1108/EDI-04-2019-0117
99

Darling. (2007). Ecological Systems Theory: The Person in the Center of the Circles. Research
in Human Development, 4(3-4), 203–217. https://doi.org/10.1080/15427600701663023
Davis, L., Grifka, A., Williams, K., Coffey, M. (2016). 2016 workplace and gender relations
survey of active duty members.
https://sapr.mil/public/docs/reports/FY17_Annual/FY_Annual_Report_on_Sexual_Assau
lt_in_the_Military_Full_Report_Part2_4.pdf
Department of Defense [DoD] (2016), Secretary of Defense Ash Carter Announces Policy for
Transgender Service Members, Press Release. Retrieved from
https://www.defense.gov/Newsroom/Releases/Release/Article/821675/secretary-of-
defense-ash-carter-announces-policy-for-transgender-service-members/
Department of Defense [DoD], (2019). 5 Things to Know About DOD's New Policy on Military
Service by Transgender Persons and Persons With Gender Dysphoria. Retrieved from
https://www.defense.gov/News/News-Stories/Article/Article/1783822/5-things-to-know-
about-dods-new-policy-on-military-service-by-transgender-perso/
Department of Defense (1993). Defense Directive 1304.26: Qualification Standards for
Enlistment, Appointment, and Induction. Retrieved from
https://biotech.law.lsu.edu/blaw/dodd/corres/html2/d130426x.htm
De Witte. (2005). Job insecurity : review of the international literature on definitions, prevalence,
antecedents and consequences. SA Journal of Industrial Psychology, 31(4), 1–6.
https://doi.org/10.4102/sajip.v31i4.200
Dietert, M., & Dentice, D. (2015). The transgender military experience: Their battle for
workplace rights. SAGE Open, 5(2), 215824401558423. doi:10.1177/2158244015584231
Dietert, M., Dentice, D., & Keig, Z. (2017). Addressing the needs of transgender military
veterans: Better access and more comprehensive care. Transgender Health, 2, 35–44.
doi:10.1089/trgh.2016.0040
Divan, V., Cortez, C., Smelyanskaya, M., & Keatley, J. (2016). Transgender social inclusion and
equality: a pivotal path to development. Journal of the International AIDS Society, 19(3
Suppl 2), 79–n/a. https://doi.org/10.7448/IAS.19.3.20803
Downing, J., Conron, K., Herman, J. L., & Blosnich, J. R. (2018). Transgender and cisgender US
veterans have few health differences. Health Affairs; Health Aff (Millwood), 37(7), 1160-
1168. doi:10.1377/hlthaff.2018.0027
Dunlap, Holloway, I. W., Pickering, C. E., Tzen, M., Goldbach, J. T., & Castro, C. A. (2020).
Support for Transgender Military Service from Active Duty United States Military
Personnel. Sexuality Research & Social Policy, 18(1), 137–143.
https://doi.org/10.1007/s13178-020-00437-x
100

Eagly, A. H., & Wood, W. (2011). Social role theory. Handbook of theories in social
psychology, 2, 458-476.
Elders, Brown, G. R., Coleman, E., Kolditz, T. A., & Steinman, A. M. (2015). Medical Aspects
of Transgender Military Service. Armed Forces and Society, 41(2), 199–220.
https://doi.org/10.1177/0095327X14545625
Emmerich, A. I., & Rigotti, T. (2017). Reciprocal relations between work-related authenticity
and intrinsic motivation, work ability and depressivity: A two-wave study. Frontiers in
Psychology; Front Psychol, 8, 307. doi:10.3389/fpsyg.2017.00307
Feder, J. (2013). Don’t Ask, Don’t Tell: A Legal Analysis. Congressional Research Service.
https://sgp.fas.org/crs/misc/R40795.pdf
Alex, Fjellman Wiklund, A., Lundman, B., Christianson, M., & Hammarström, A. (2012).
Beyond a Dichotomous View of the Concepts of “Sex” and “Gender” Focus Group
Discussions among Gender Researchers at a Medical Faculty. PloS One, 7(11), e50275–
e50275. https://doi.org/10.1371/journal.pone.0050275
Gallup (2020). LGBT Identification Rises to 5.6% in Latest U.S. Estimate.
https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
Ganson, Tsai, A. C., Weiser, S. D., Benabou, S. E., & Nagata, J. M. (2021). Job Insecurity and
Symptoms of Anxiety and Depression Among U.S. Young Adults During COVID-
19. Journal of Adolescent Health, 68(1), 53–56.
https://doi.org/10.1016/j.jadohealth.2020.10.008
Gates, G. (2010). Lesbian, gay, and bisexual men and women in the US military: Updated
estimates.
Gates, & Herman, J. (2014). Transgender Military Service in the United States. The Williams
Institute. https://escholarship.org/uc/item/1t24j53h
Goldbach, & Castro, C. A. (2016). Lesbian, Gay, Bisexual, and Transgender (LGBT) Service
Members: Life After Don’t Ask, Don’t Tell. Current Psychiatry Reports, 18(6), 56–56.
https://doi.org/10.1007/s11920-016-0695-0
Goodwin, M., & Chemerinsky, E. (2019). The transgender military ban: Preservation of
discrimination through transformation. Northwestern University Law Review, 114(3),
751-807.
Haider-Markel, D., Miller, P., Flores, A., Lewis, D. C., Tadlock, B., & Taylor, J. (2017).
Bringing "T" to the table: Understanding individual support of transgender candidates for
public office. Politics Groups and Identities, 5(3), 399–417. https://doi.org/10.1080/
21565503.2016.1272472
Halpenny, A. M., O’Toole, L. & Hayes, N. (2017). Introducing Bronfenbrenner: A Guide for
Practitioners and Students in Early Years Education. Taylor and Francis.
https://doi.org/10.4324/9781315646206
101

Hatzenbuehler ML, Rutherford C, McKetta S, Prins SJ, Keyes KM. (2020). Structural stigma
and all-cause mortality among sexual minorities: differences by sexual behavior? Soc Sci
Med 244:112463
Hatzenbuehler, M. L. (2016). Structural Stigma: Research Evidence and Implications for
Psychological Science. The American Psychologist, 71(8), 742–751.
https://doi.org/10.1037/amp0000068
Harrison, & Michelson, M. R. (2018). Gender, Masculinity Threat, and Support for Transgender
Rights: An Experimental Study. Sex Roles, 80(1-2), 63–75.
https://doi.org/10.1007/s11199-018-0916-6
Hayes H., O’Toole L., Halpenny A. N. (2017). Introducing Bronfenbrenner: A guide for
practitioner and students in early years education. Routledge, Taylor & Francis Group.
Healy. (2016). A Theory of Human Motivation by Abraham H. Maslow (1942). British Journal
of Psychiatry, 208(4), 313–313. https://doi.org/10.1192/bjp.bp.115.179622
Heinecken, L. (2022). Women and military service. In Handbook on Gender and Public
Administration. Edward Elgar Publishing.
Henry, J. L. (2017). A Transgender Military Internist’s Perspective on Readiness for Treating
Patients With Gender Dysphoria. JAMA Internal Medicine, 177(5), 729–730.
https://doi.org/10.1001/jamainternmed.2017.0140
Hill, B. J., Bouris, A., Barnett, J. T., & Walker, D. (2016). Fit to serve? exploring mental and
physical health and well-being among transgender active-duty service members and
veterans in the U.S. military. Transgender Health; Transgender Health, 1(1), 4-11.
doi:10.1089/trgh.2015.0002
Holman. (2018). Theoretical Extensions of Minority Stress Theory for Sexual Minority
Individuals in the Workplace: A Cross‐Contextual Understanding of Minority Stress
Processes. Journal of Family Theory & Review, 10(1), 165–180.
https://doi.org/10.1111/jftr.12246
Hoy-Ellis, C., Shiu, C., Sullivan, K. M., Kim, H., Sturges, A. M., & Fredriksen-Goldsen, K.
(2017). Prior military service, identity stigma, and mental health among transgender older
adults. The Gerontologist; Gerontologist, 57, S63-S71. doi:10.1093/geront/gnw173
Johnson, W. B., Rosenstein, J. E., Buhrke, R. A., & Haldeman, D. C. (2015). After “Don’t Ask
Don’t Tell”: Competent Care of Lesbian, Gay and Bisexual Military Personnel During
the DoD Policy Transition. Professional Psychology, Research and Practice, 46(2), 107–
115. https://doi.org/10.1037/a0033051
Jones, S. E. (2020). Negotiating Transgender Identity at Work: A Movement to Theorize a
Transgender Standpoint Epistemology. Management Communication Quarterly, 34(2),
251–278. https://doi.org/10.1177/0893318919898170
102

Joslyn, M. R., & Haider-Markel, D. P. (2016). Genetic attributions, immutability, and
stereotypical judgments: An analysis of homosexuality. Social Science Quarterly, 97(2),
376–390. https://doi.org/10. 1111/ssqu.12263
Kahn, W. (1990). Psychological Conditions of Personal Engagement and Disengagement at
Work. Academy of Management Journal, 33(4), 692–724. https://doi.org/10.5465/256287
Kameg. (2020). Gender dysphoria in united states veterans and military personnel: Historical
context and current policies. Journal of Psychosocial Nursing and Mental Health
Services, 58(8), 5–8. https://doi.org/10.3928/02793695-20200403-01
Kamarck, K. N. (2019). Diversity, inclusion, and equal opportunity in the armed services:
Background and issues for congress (CRS R44321). Washington, DC: Congressional
Research Service
Kang, M., Lessard, D., & Nordmarken, S. (2017). “5. Social Constructionism” In Introduction to
Women, Gender, Sexuality Studies.

Kauth, M.R., Blosnich, J.R., Marra, J. et al. Transgender Health Care in the U.S. Military and
Veterans Health Administration Facilities. Curr Sex Health Rep 9, 121–127 (2017).
https://doi.org/10.1007/s11930-017-0120-7

Kerrigan. (2012). Transgender Discrimination in the Military: The New Don’t Ask, Don’t
Tell. Psychology, Public Policy, and Law, 18(3), 500–518.
https://doi.org/10.1037/a0025771

Kime, P (2015). DoD Spends $84M a yar on Viagra, Similar Meds. Military Times. Retrieved
from https://www.militarytimes.com/pay-benefits/military-benefits/health-
care/2015/02/13/dod-spends-84m-a-year-on-viagra-similar-meds/

Kime, P. (2021). Here’s How Much the Pentagon has Spent So Far to Treat Transgender Troops.
Military Times. Retrieved from https://www.military.com/daily-news/2021/06/18/heres-
how-much-pentagon-has-spent-so-far-treat-transgender-troops.html
Koenig, A. M., & Eagly, A. H. (2014). Evidence for the Social Role Theory of Stereotype
Content: Observations of Groups’ Roles Shape Stereotypes. Journal of Personality and
Social Psychology, 107(3), 371–392. https://doi.org/10.1037/a0037215
Kuntz, & Searle, F. (2023). Does Bystander Intervention Training Work? When Employee
Intentions and Organisational Barriers Collide. Journal of Interpersonal Violence, 38(3-
4), 2934–2956. https://doi.org/10.1177/08862605221104530
LaGrone, S. (2013). Updated: History of U.S. Policy and Law on Gays in the Military. USNI
News, March 27, 2013. https://news.usni.org/2013/06/26/a-history-of-gays-in-the-
military (accessed October 14, 2021.
Lefevor, Boyd-Rogers, C. C., Sprague, B. M., & Janis, R. A. (2019). Health Disparities Between
Genderqueer, Transgender, and Cisgender Individuals: An Extension of Minority Stress
103

Theory. Journal of Counseling Psychology, 66(4), 385–395.
https://doi.org/10.1037/cou0000339
Lewis, D. C., Flores, A. R., Haider-Markel, D., Miller, P. R., Tadlock, B. L., & Taylor, J. K.
(2017). Degrees of acceptance: Variation in public attitudes toward segments of the
LGBT community. Political Research Quarterly, 70(4), 861-875.
doi:10.1177/1065912917717352
Lewis, D. C., Tadlock, B. L., Flores, A. R., Haider-Markel, D., Miller, P. R., & Taylor, J. K.
(2019). Public attitudes on transgender military service: The role of gender. Armed
Forces and Society, , 0095327X1986173. doi:10.1177/0095327x19861737Malle, B. F.
(2011). Attribution theories: How people make sense of behavior. Theories in social
psychology, 23, 72-95
Marano, Louis, M. R., & Coon, D. (2021). Gender-Affirming Surgeries and Improved
Psychosocial Health Outcomes. Archives of Surgery (Chicago. 1960), 156(7), 685–687.
https://doi.org/10.1001/jamasurg.2021.0953
Mark, McNamara, K. A., Gribble, R., Rhead, R., Sharp, M.-L., Stevelink, S. A. M., Schwartz,
A., Castro, C., & Fear, N. T. (2019). The health and well-being of LGBTQ serving and
ex-serving personnel: a narrative review. International Review of Psychiatry (Abingdon,
England), 31(1), 75–94. https://doi.org/10.1080/09540261.2019.1575190
McKinley, J. (2015). Critical Argument and Writer Identity: Social Constructivism as a
Theoretical Framework for EFL Academic Writing. Critical Inquiry in Language
Studies, 12(3), 184–207. https://doi.org/10.1080/15427587.2015.1060558
McNamara, K. A., Lucas, C. L., Goldbach, J. T., Castro, C. A., & Holloway, I. W. (2021a).
“Even if the policy changes, the culture remains the same”: A mixed methods analysis of
LGBT service members’ outness patterns. Armed Forces and Society, 47(3), 505-529.
doi:10.1177/0095327X20952136
Neal, & Neal, Z. P. (2013). Nested or Networked? Future Directions for Ecological Systems
Theory: Nested or Networked? Social Development (Oxford, England).
https://doi.org/10.1111/sode.12018
Meade. (2021). Patriotism as a Construct for Understanding Military Service Among LGBTQ+
Veterans: A Call for Research Grounded in Institutional Oppression. Journal of Veterans
Studies, 7(3), 38–45. https://doi.org/10.21061/jvs.v7i3.261
Meadows, S. O., Engel, C. C., Collins, R. L., Beckman, R., Cefalu, M., Hawes-Dawson, J.,
Waymouth, M., Kress, A. M., Sontag-Padilla, L., Ramchand, R., Williams, K. M.
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative Research: A guide to design and
implementation (4th ed.). San Francisco, CA: Jossey-Bass.
Meyer. (1995). Minority Stress and Mental Health in Gay Men. Journal of Health and Social
Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
104

Mizock, L., & Lundquist, C. (2016). Missteps in psychotherapy with transgender clients:
Promoting gender sensitivity in counseling and psychological practice. Psychology of
Sexual Orientation and Gender Diversity, 3(2), 148-155. doi:10.1037/sgd0000177
Nik-Ahd. (2021). Beyond “Don’t Ask, Don’t Tell:” Our Role as Physicians, Scientists, and
Urologists in the Care of Transgender Patients. European Urology, 79(5), 593–594.
https://doi.org/10.1016/j.eururo.2021.02.028
Okros, A., & Scott, D. (2015b). Gender identity in the canadian forces: A review of possible
impacts on operational effectiveness. Armed Forces and Society, 41(2), 243-256.
doi:10.1177/0095327X14535371
Onwuegbuzie, Collins, K. M. T., & Frels, R. K. (2013). Foreword: Using Bronfenbrenner’s
ecological systems theory to frame quantitative, qualitative, and mixed
research. International Journal of Multiple Research Approaches, 7(1), 2–8.
https://doi.org/10.5172/mra.2013.7.1.2
Parco, J. E., Levy, D. A., & Spears, S. R. (2015). Transgender Military Personnel in the Post-
DADT Repeal Era: A Phenomenological Study. Armed Forces and Society, 41(2), 221–
242. https://doi.org/10.1177/0095327X14530112
Park, Liu, Y.-T., Samuel, A., Gurganus, M., Gampper, T. J., Corbett, S. T., Shahane, A., &
Stranix, J. T. (2022). Long-term Outcomes After Gender-Affirming Surgery: 40-Year
Follow-up Study. Annals of Plastic Surgery, 89(4), 431–436.
https://doi.org/10.1097/SAP.0000000000003233
Peltier-Huntley. (2022). A case for advancing psychological health and safety along with equity,
diversity, and inclusion. CIM Journal (Online), 1–15.
https://doi.org/10.1080/19236026.2022.2119067
Peng, & Potipiroon, W. (2022). Fear of Losing Jobs during COVID-19: Can Psychological
Capital Alleviate Job Insecurity and Job Stress? Behavioral Sciences, 12(6), 168–.
https://doi.org/10.3390/bs12060168Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg,
C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide
attempts among transgender adults. Behavioral Medicine (Washington, D.C.); Behav
Med, 41(3), 164-171. doi:10.1080/08964289.2015.1028322
Post. (2012). Deep-Level Team Composition and Innovation: The Mediating Roles of
Psychological Safety and Cooperative Learning. Group & Organization
Management, 37(5), 555–588. https://doi.org/10.1177/1059601112456289
Poston, B. (2009). Maslow’s hierarchy of needs. The surgical technologist, 41(8), 347-353.
Prakash, O. (2009). The efficacy of “Don’t Ask, Don’t Tell.” Joint Force Quarterly, 55, 88–.
Quinn, D. M. (2017). Issue introduction: Identity concealment: Multilevel predictors,
moderators, and consequences: Issue introduction: Identity concealment. Journal of
Social Issues, 73(2), 230-239. doi:10.1111/josi.12213
105

Reinke S, et al., (2011). Out and Serving Proudly: Repealing “Don’t Ask, Don’t Tell.” Politics &
Policy, 39(6), 925–948. https://doi.org/10.1111/j.1747-1346.2011.00331.x
Rostker, et al. (2000). Changing the Policy Toward Homosexuals in the U.S. Military, RAND
Corporation, RB-7537. Retrieved from
https://www.rand.org/pubs/research_briefs/RB7537.html
Saleem, Malik, M. I., & Qureshi, S. S. (2021). Work Stress Hampering Employee Performance
During COVID-19: Is Safety Culture Needed? Frontiers in Psychology, 12, 655839–
655839. https://doi.org/10.3389/fpsyg.2021.655839
Schaefer, Iyengar, R., Kadiyala, S., Kavanagh, J., Engel, C. C., Williams, K. M., & Kress, A. M.
(2016). Assessing the Implications of Allowing Transgender Personnel to Serve Openly.
RAND Corporation. https://doi.org/10.7249/j.ctt1d4txv6
Schneider, A., & Ingram, H. (1993). Social construction of target populations: Implications for
politics and policy. The American Political Science Review; Am Polit Sci Rev, 87(2), 334-
347. doi:10.2307/2939044
Schneider, A. L., Ingram, H., & DeLeon, P. (2014). Democratic policy design: Social
construction of target populations. In P. A. Sabatier & C. M. Weible (Eds.), Theories of
the policy process (pp. 105–149). Boulder, CO: Westview Press.
Schneider, M. C., & Bos, A. L. (2019). The Application of Social Role Theory to the Study of
Gender in Politics. Political Psychology, 40(1), 173–213.
https://doi.org/10.1111/pops.12573
Schvey, N. A., Klein, D. A., Pearlman, A. T., Kraff, R. I., & Riggs, D. S. (2020). Stigma, health,
and psychosocial functioning among transgender active duty service members in the U.S.
military. Stigma and Health (Washington, D.C.), 5(2), 188-198. doi:10.1037/sah0000190
Spindel, & Ralston, R. (2020). Taking Social Cohesion to Task: Perceptions of Transgender
Military Inclusion and Concepts of Cohesion. Journal of Global Security Studies, 5(1),
80–96. https://doi.org/10.1093/jogss/ogz045
Trans Legislation Tracker, 2023. Translegislation. Retrieved July 17, 2023 from
https://translegislation.com/.
Trump, D. (2013). Presidential Memorandum for the Secretary of Defense and the Secretary of
Homeland Security Regarding Military Service by Transgender Individuals.
https://trumpwhitehouse.archives.gov/presidential-actions/presidential-memorandum-
secretary-defense-secretary-homeland-security-regarding-military-service-transgender-
individuals/
Trump, D. J. [@realDonaldTrump] (July 26, 2017). Our military must be focused on decisive
and overwhelming victory and cannot be burdened with the tremendous medical costs
and disruption that transgender in the military would entail. Tweets [Twitter profile],
Twitter. Retrieved on August 27, 2020.
106

Trump, (2017b). Presidential Memorandum for the Secretary of Defense and the Secretary of
Homeland Security. Retrieved from https://trumpwhitehouse.archives.gov/presidential-
actions/presidential-memorandum-secretary-defense-secretary-homeland-security/
Tucker, Testa, R. J., Reger, M. A., Simpson, T. L., Shipherd, J. C., &
Lehavot, K. (2019). Current and Military‐Specific Gender Minority Stress
Factors and Their Relationship with Suicide Ideation in Transgender
Veterans. Suicide & Life-Threatening Behavior, 49(1), 155-166.
https://doi.org/10.1111/sltb.12432
U.S. Department of Veterans Affairs. (2016). LGBT veteran health care—male veterans: Gay
and bisexual health care [PDF]. Retrieved June 24, 2022 from
https://www.patientcare.va.gov/LGBT/docs/va-pcs-lgbt-factsheet-gay-bisexual.pdf
U.S. Government Accountability Office (2017). Improvements Needed in the Management of
Enlistees’ Medical Early Separation and Enlistment Information. Retrieved
from https://www.gao.gov/assets/690/685843.pdf
Van Den Bosch, R., & Taris, T. W. (2014). The authentic worker's well-being and performance:
The relationship between authenticity at work, well-being, and work outcomes. The
Journal of Psychology; J Psychol, 148(6), 659-681. doi:10.1080/00223980.2013.820684
Wise, J. E. (2019). Loss of moral high-ground: The Transgender Ban, a Military Psychiatrist's
Perspective and Call to Action. Journal of Gay & Lesbian Mental Health, 23(2), 114-
116. doi:10.1080/19359705.2019.1579037
Xu, Wang, H., & Suntrayuth, S. (2022). Organizational Climate, Innovation Orientation, and
Innovative Work Behavior: The Mediating Role of Psychological Safety and Intrinsic
Motivation. Discrete Dynamics in Nature and Society, 2022, 1–10.
https://doi.org/10.1155/2022/9067136
Yerke, & Mitchell, V. (2013). Transgender People in the Military: Don’t Ask? Don’t Tell? Don’t
Enlist. Journal of Homosexuality, 60(2-3), 436–457.
https://doi.org/10.1080/00918369.2013.744933

107

Appendix A: Interview Protocol
Research Questions
RQ1. What are the experiences of transgender servicemembers in the U.S. military?
RQ2. What are the perceived challenges transgender servicemembers face in the U.S. military?
Introduction
Hi! How are you doing today!? My name is Mike Stegen and I am a student at USC, working on
my dissertation. Thank you for agreeing to meet with me and help me learn about your
experience as an LGBTQ member in the military. The purpose of this interview is to inform my
research study, and the purpose of the study is to define the lived experience of transgender
people currently serving in the military. I will begin the interview with some structured
demographic questions, the answers to which will be used for analysis purposes only. Your
information will be kept confidential and none of your personal or identifying information will
be revealed in any of the results of my research. To help ensure accuracy of the content, I would
like to record this interview so I can transcribe it verbatim, only to use the transcription for
analysis. I will send you a copy of the transcription for review and clarification before I use it,
will that be okay with you? You may decline answering any questions and may also choose to
end the interview at any time. I need to gain your consent to proceed with this interview, do I
have that? Do you have any questions for me before we begin the interview?
Interview Questions
Demographics
1. In what branch of the U.S. military did you serve?
2. How long did you serve?
3. What date did you separate or retire from the military?
108

4. What was your assigned sex at birth?
5. What is your gender identity?
Experiential Questions
1. How would you characterize your acceptance in the U.S. military as a transgender person?
2. How did you feel servicemembers in your immediate work environment viewed your ability to
perform your military duties as a transgender person?
Probe: Can you describe a specific event or events that led you to this conclusion?
3. How did you perceive your immediate chain of command’s opinion of transgender people’s
ability to serve in the military?
Probe: Can you describe a specific event or events that led you to this conclusion?
4. If applicable, describe ways your work environment changed because of policy changes
regarding transgender military service.
5. Describe a time or times when you may have felt supported as a transgender military
servicemember.
Probe: How did you react to this?
6. Describe a time or times when you may have felt marginalized as a transgender military
servicemember.
Probe: How did you react to this?
7. Can you recall a time when you refrained from participating or otherwise changed your
behavior at work because of your gender identity?
109

Probe: How did this affect you?
Probe: What would you like to see different? What would you like to remain unchanged?
8. How would you describe your unit leadership's response to changes in policy regarding
transgender people serving openly in the military?
Probe: What would you like to see different? What would you like to remain unchanged?
Conclusion
That is all the questions I have; do you have any follow-up questions for me? I would like to thank you
for your time today, and for providing your candid response to my interview questions. As I mentioned
earlier, I will send you a transcript for your approval before I analyze the information you have provided.
If I have any follow-up questions, would it be okay if I contact you for a follow-up interview? Lastly, I
would be happy to send you an abstract of the final study when it is complete, would you like me to do
that? Again, thank you so much for meeting with me, I appreciate your time and insight!

Abstract (if available)

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Gender beyond the binary: transgender student success and the role of faculty

PDF

Evaluating the effectiveness of global residence in improving resident cultural intelligence

PDF

Underrepresentation of women in the U.S. banking industry’s top executive roles: why doesn’t the CEO look like me?

PDF

Evaluation of mental health support and needs for emergency department providers

PDF

Organizational design for embedding corporate social responsibility

PDF

Uncovering promising practices for providing vocational opportunities to formerly incarcerated individuals

PDF

Workforce system collaboration

PDF

Experience of belonging for full-time hybrid physical therapy faculty

PDF

The perspectives of community organizers on advocating for environmental justice related to transportation air-pollution

PDF

Indonesian teachers' adoption of technology in the K-12 classroom: a TAM-based quantitative study

PDF

Perceptions of U.S. Army first-line supervisors on first-term soldier attrition

PDF

Transgender patients’ perceptions of healthcare: A study of gender minority stress and resilience factors in predicting healthcare behavioral intentions

PDF

Bridging the employment gap for students of color: evaluating the effectiveness of internship programs and the level of engagement from employers

PDF

Preparing Asian American leaders in higher education: an exploration study using Bronfenbrenner's ecological model

PDF

Evaluation of a post work related injury total wellness program designed for fire and police department employees

PDF

Integrating the industry sector in STEM learning ecosystems: a multicase study

PDF

Raising tenure: a case study of fundraiser retention in higher education

PDF

Teachers' voices: SEL perceptions in a grade 9-12 school

PDF

Toxic leadership and U.S. Army special forces: a qualitative, phenomenological Study

PDF

Brick by brick: exploring the influential factors on the capacity building of instructional coaches

Asset Metadata

Creator Stegen, Michael (author)

Core Title Transgender experience in the U.S. military: opportunities for effective inclusion

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2023-08

Publication Date 07/25/2023

Defense Date 07/12/2023

Publisher University of Southern California. Libraries (digital)

Tag gender dysphoria,LGBTQ,Military,OAI-PMH Harvest,servicemember,transgender

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Stowe, Kathy (committee chair), Canny, Eric (committee member), Malloy, Courtney (committee member)

Creator Email mrobstegen@gmail.com,stegen@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113288993

Unique identifier UC113288993

Identifier etd-StegenMich-12139.pdf (filename)

Legacy Identifier etd-StegenMich-12139

Document Type Dissertation

Rights Stegen, Michael

Internet Media Type application/pdf

Type texts

Source 20230725-usctheses-batch-1073 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA

Repository Email cisadmin@lib.usc.edu