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Donald Trump recently said on Twitter that the US

... cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.

What are the medical and disruption costs of having transgender people in the military?

I am not talking just about the much-quoted Rand study, since that talks about the current costs, but naturally those costs will increase once more and more transgender people "come out" or join the military in later years due it becoming more accepted.

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    Related at politics.SE: What medical costs burden the military enough to warrant banning all transgender people?. And please do not add attempts at an answer to your question (not even partial answers), as it discourages actual answers, and also opens your answer up to discussion in other answers, which isn't really the format that is encouraged here. – tim Jul 26 '17 at 18:12
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    "Economically justified" is a political opinion, not an empirical question. If a transgendered person costs just $1 more per year [and I shouldn't even assume the amount is positive without evidence, but moving on], whether that is "justified" to be paid by the military is still a political question. – Oddthinking Jul 27 '17 at 0:33
  • @Oddthinking A question like, "Is it worth taking this medicine for this disease" sounds like a personal or subjective question; but it can be answered with relevant facts (e.g. about efficacy). Similarly this question sounds political, but I think it too can be answered with relevant facts: the claim in question is that "medical costs" would be "tremendous", which can be answered by a good quantitative estimate of the "medical costs". After an answer says what the costs are, then it's up to the reader to decide whether to characterize those costs as "tremendous" or as "justified" or whatever. – ChrisW Jul 27 '17 at 0:46
  • @ChrisW: Agreed. Let's fix the question to ask that. – Oddthinking Jul 27 '17 at 0:48
  • I think he added 'medical costs' to divert focus, when it's disruption he's attempting to stop. I can think of some fairly major disruption caused by a transgender soldier relatively recently. – mcalex Jul 27 '17 at 2:33
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There's a Scientific American article, Cost of Medical Care for Transgender Service Members Would Be Minimal, Studies Show, which cites two studies:

  • One from the RAND Corporation:

    The study also estimated that the cost associated with medical care for gender transition would only increase military health care expenditures by between $2.4 million and $8.4 million each year — an increase of between 0.04 and 0.13 percent.

  • Another published in the New England Journal of Medicine:

    A September 2015 study published in the New England Journal of Medicine reached similar cost estimates.


The summary of the RAND report includes the estimated number of transgender service members (1,320–6,630), the estimated number per year of those who would seek transition-related healthcare treatment (129 or 2%): from which one can determine their estimated cost per treatment (I reckon about $60K), and average cost per transgender service member (I reckon about $1200).

The corresponding estimates from the New England Journal of Medicine article are:

  • Number of transgender service members (who are eligible for health care): 12800
  • Number who would seek transition-related treatment: 188
  • Cost per treatment: $30K over 6.5 years

It says,

Having analyzed the cost that the military will incur by providing transition-related care, I am convinced that it is too low to warrant consideration in the current policy debate. Specifically, I estimate that the provision of transition-related care will cost the military $5.6 million annually, or 22 cents per member per month. Of course, the cost will depend on how many transgender personnel serve and utilize care, and estimates are sensitive to certain assumptions, such as the expectation that the military will not become a “magnet” employer for transgender people seeking health care benefits. Though my utilization and cost estimates are quite close to actual data provided by an allied military force, it seems clear that under any plausible estimation method, the cost amounts to little more than a rounding error in the military's $47.8 billion annual health care budget.

... the "actual data" being data from Australia:

As an accuracy check, consider the Australian military, which covers the cost of transition-related care: over a 30-month period, 13 Australian troops out of a full-time force of 58,000 underwent gender transition — an average of 1 service member out of 11,154 per year.3 If the Australian rate were applicable to the U.S. military, the Pentagon could expect 192 service members to undergo gender transition annually.

Incidentally it also says (and includes as a factor in its estimate) that,

However, transgender persons are overrepresented in the military by a factor of two

In other word, transgender persons are already more likely than average to volunteer for service.


Another article Inside Trump’s snap decision to ban transgender troops claims that the real cost was that the issue was (for political reasons) threatening funding for the border wall with Mexico:

House Republicans were planning to pass a spending bill stacked with his campaign promises, including money to build his border wall with Mexico.

But an internal House Republican fight over transgender troops was threatening to blow up the bill.

It quotes a Republican congressman as saying,

“It’s not so much the transgender surgery issue as much as we continue to let the defense bill be the mule for all of these social experiments that the left wants to try to hoist on government,”

Rep. Trent Franks (R-Ariz.), a conservative supporter of the Hartzler proposal, said last week.

... so perhaps their motive too wasn't that the economic cost is significant.

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    The studies only seem to look at the cost of the medical care for the transition, but they don't consider the possibility of those people feeling better and as such performing better. Which in turn could lead to less costs as well. Possibly the studies didn't consider it because it is hard to estimate? Still, seems like an oversight to me. – stijn Jul 26 '17 at 19:42
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    It seems odd that, if it was just an issue with paying for 'gender transition' procedures, the best solution would be to get rid of transgender servicemen, rather than just not paying for the transition. Not an issue with your answer, the argument just doesn't seem to make sense. – DaaaahWhoosh Jul 26 '17 at 20:26
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    @DaaaahWhoosh Based on the linked article, simply not paying for such transitions was the goal. Trump, however, will be Trump. – JAB Jul 26 '17 at 21:54
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    Indeed, the White House today described the decision as necessary for "military readiness and unit cohesion," which has nothing to do with cost of medical care. So yes, there's ample reason to doubt it's about costs. – Zach Lipton Jul 27 '17 at 0:09
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    Since the stated rationale is already changing, it's pretty obvious that the goal here is to make trans people a wedge issue on the left. – Russell Borogove Jul 27 '17 at 3:02

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