Transgender and Intersex Healthcare at the Veterans Healthcare System

After a tweet by President Trump advocated a ban on transgender individuals from serving in the United States military set off an alarm across the world, various news stories emerged with information about the more than 15,000 transgender service members who are currently serving in the United States military. In addition to widespread concern that the tweet could become policy, confusion surfaced about how such a ban could not only affect transgender service personnel who are already serving in the military, but also transgender veterans of the United States military who receive their healthcare at veteran healthcare facilities throughout the nation.

While the ban against transgender service personnel serving in the military was lifted by the Department of Defense on June 30, 2016, the Department of Veterans Affairs Veterans Health System had been on an inclusive track years before with an initial Department of Veterans Affairs directive created in 2011, and updated in 2013, that mandated specific health care treatment for transgender and intersex military Veterans (VHA Directive 2013-003). The published policy of Veterans Affairs Lesbian, Gay, Bisexual and Transgender (LGBT) healthcare on the U.S. Department of Veterans Affairs website states, “LGBT Veterans face increased health risks and unique challenges in accessing quality healthcare. The VA strives to be a national leader in the provision of health care to LGBT Veterans and assure that care is provided in a sensitive, safe environment at VA health facilities nationwide.” According to Licensed Clinical Social Worker, Heather Cherry, who is the LGBT Veteran Care Coordinator at the Miami VA Healthcare System, many of the VA Healthcare System personnel are veterans. Cherry reported that there has never been a distraction from the work that healthcare providers and support personnel are doing in the VA Healthcare System. When asked if she could provide any insight as to why the Department of Veterans Affairs pursued a transgender and intersex inclusive path sooner than the Department of Defense, Cherry responded, “I can’t specifically say what the catalyst was on a national level to create the mandates, but the mandates paved the path. I know as a provider, and as a veteran, I am drawn to make sure that “no veteran is left behind.”  I believe the innate culture of the VA also holds this to be true.  “We serve all who served” is a core belief and as a system, we are always looking to increase the quality of our services and to make sure that all eligible veterans receive that highest standard of care.” 

In addition to the general services any eligible veteran would be provided, the VA Healthcare System provides eligible transgender and intersex veterans with gender counseling, hormone therapy, speech-language pathology, pre-surgical evaluations, and medically necessary postoperative care related to complications from gender-affirming surgery.  The current policy does not provide gender-affirming surgeries with VA benefits. The VA Healthcare System has a national training program that involves computer trainings, classroom trainings and a national consultation team to provide guidance and training for VA healthcare providers on transgender and intersex healthcare topics. There are trainings related to mental health, endocrinology, medical concerns, and concrete services such as assistance with documentation changes.  In addition, trainings on language, respect, and cultural awareness are also offered at the VA Healthcare System to build understanding.  According to Cherry, “there is consistent ongoing training for providers and staff.  It is vital that continued education is provided to individuals for development, understanding and compassion.  The mandates are also very clear about appropriate pronouns, name usage, room preference, bathroom preference and overall respect for any veteran who comes to the VA for services.”

According to the Department of Veterans Affairs Veterans Healthcare System website, an estimated amount of 5,000 transgender and intersex veterans are served at the Veterans Healthcare System. On her work at the Veterans Healthcare System, Cherry states, “ I am exceedingly proud of the work that I get to do every day. I love coming to work and watching veterans not simply survive but learn to grow and thrive.  Veterans have resilience about them. At times they may feel lost but to watch it be regained, and for people to get their lives re-started, there is no job that could be more rewarding.” 

Beginning in 2013, the Veterans Healthcare System facilities started participating in the voluntary Human Rights Campaign’s (HRC) Healthcare Equality Index (HEI) that measures policies, trainings and a LGBTQ positive healthcare environment. For four consecutive years, the Miami VA Healthcare System received a score of 100, earning them the designation as a “Leader in LGBTQ Healthcare Equality” from HRC.

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