BURSTMilitary veterans, families and active-duty service members with transgender children say a provision added to Congress’s annual defense policy bill targeting some medical treatments for trans minors is a “slap in the face” rooted in misinformation and misunderstanding about the trans community.
The provision in the compromise version of the National Defense Authorization Act (NDAA) negotiated by the House and Senate would prevent TRICARE, the military’s health program, from covering gender dysphoria treatments “that could result in sterilization” for children under 18.
A more specific provision adopted by the Senate Armed Services Committee in its defense bill in July would have explicitly barred coverage for “affirming hormone therapy” and puberty blockers, as well as medical interventions for gender dysphoria — distress that stems from a mismatch between a person’s gender identity and sex at birth — for minors that “could result in sterilization.”
Hormone treatments, typically involving doses of testosterone or estrogen, have mixed effects on fertility, and puberty-blocking drugs, which stave off physical changes like the development of breasts or a deepening voice, are not known to substantially impact fertility on their own.
“With policies like this, and we’ve seen them in states and at the federal level, legislators and politicians and leaders within our system of government are not listening to experts,” said Branden Marty, a Navy veteran with a transgender daughter.
“What is gender-affirming care? It's working with healthcare professionals who have expertise in this area to help support parents so that transgender or nonbinary child understands themselves and gets to the place of being able to live their daily life in school and at home and have a positive self-appreciation of themselves,” he said.
Major medical groups have said gender-affirming health care for transgender adults and minors is medically necessary and can be lifesaving. They reject efforts by state and federal governments to restrict treatment.
Other GOP-backed proposals to reverse the Pentagon’s abortion travel policy and prohibit TRICARE from covering gender-affirming care for transgender service members were dropped from the final bill, suggesting Republicans believe the ban on care for minors isn’t enough to prevent most members from approving the measure as is.
At least one Democrat, House Armed Services Committee Ranking Member Adam Smith (D-Wash.), has said he will vote against the NDAA over the prohibition, and others, including Rep. Seth Moulton (D-Mass.), refused to move the bill forward Tuesday, citing “ideological riders” in legislation that typically enjoys bipartisan support.
On Tuesday, House Armed Services Committee Chair Mike Rogers (R-Ala.) said he did not agree with — and was not involved in — the decision to include the health care provision in the final NDAA but stopped short of opposing the $883.7 billion package.
The White House has not indicated whether President Biden, who has repeatedly promised to veto legislation that discriminates against transgender people, would sign the bill in its current form.
During a news conference on Tuesday, Speaker Mike Johnson (R-La.) touted the provision barring TRICARE coverage for gender-affirming care for youth as a win “for our troops and for our country.”
“We spent a lot of time and effort working on it,” Johnson said of the negotiated NDAA text, “because our service members and their families deserve our best efforts.” In a statement on Sunday, Johnson said “woke ideology” had infiltrated the military, and “permanently banning transgender medical treatment for minors” would help restore its focus on “lethality.”
An Air Force chief who asked to be identified only by his first initial because he is actively serving said he saw no link between the provision and restoring the “lethality” of U.S. armed services.
“As someone who has served for over 20 years now and is involved in the decision-making process at senior levels for the morale, health, welfare, training, readiness and equipping of service members to prepare them to go to war — or, in certain cases, while in conflict — I cannot link those two things,” the Air Force chief, J, told The Hill.
“I don't understand how he comes to terms with that because, in my mind, that doesn't make sense at all. Taking away something that families are relying on distracts us from the mission and the task at hand in order to be and remain as lethal as we are,” said “J,” whose teenage daughter is transgender and receives medical care that is currently covered under TRICARE.
“You can’t say that this is going to help our military when you’re scaring military families,” said “H,” “J”’s spouse, who also requested she be identified only by her first initial.
In case the NDAA passes in its current form, “J” and “H,” who live on the West Coast, are looking into supplemental health insurance or paying out-of-pocket for their child’s care, moves that could strain the family’s finances. With more than two decades of military service under his belt and two-and-a-half years left in his commitment, “J” is also rethinking his future.
“I have a strong desire and propensity to continue to serve, but this will definitely weigh on my and my family's decision to continue serving — and that's difficult, but my family's got to come first,” he said.
Ann, a military veteran and spouse whose teenage son is trans, said the latest NDAA adds another layer of complexity to the family’s ability to move. She requested that she be identified only by her middle name because her husband, a senior officer at the Pentagon, is actively serving.
“The country is kind of closing in on us, like, we’re running out of places to go, especially with something like the NDAA and just seeing the writing on the wall about a national ban on gender-affirming care,” she said, referring to one of President-elect Trump’s campaign promises. “The little safety bubbles are getting smaller and smaller and smaller.”
More than half the nation since 2021 has either heavily restricted or banned some transition-related care for minors — and adults, in some cases — and the Supreme Court appears primed to uphold a Tennessee law prohibiting gender-affirming care for youth.
Ann served eight years in the military, including a 15-month combat tour in Iraq. Her husband, a four-time combat deployer, fought in Iraq and Afghanistan. Together, the couple has spent roughly five years apart.
Now relocated to Virginia, Ann said her trans child is “thriving" with the help of gender-affirming care accessed through TRICARE. He loves fencing, watching sports and playing in his school’s band. He has excelled academically, though a geometry class this year has been “humbling,” Ann said.
“Trans kids are kids. They are, the overwhelming majority, thriving and doing well and contributing to their community,” she said. “They're happy and they're healthy, and that's like all that parents want, right?”
Ann’s husband, she said, is not ready to retire, but if coverage for their son’s health care is taken away, “that’s pretty much marking the end of the road.”
“If that’s the way we’re going to be treated ... if that’s the tone that Congress and the government wants to set, then that’s pretty unfortunate because you’re going to lose combat experience; you’re going to lose leaders with decades of valuable experience that the military needs,” she said. “It’s a scary world out there, so it’s a pretty sad state of affairs for our national security that you’re going to ask folks to make that decision and not support their families.”
“C,” a veteran spouse whose husband served in the military for 26 years, called the NDAA’s gender-affirming care provision “an enormous slap in the face.” She asked that she be identified only by her first initial because her transgender child, who is now an adult, is not publicly out as trans.
“C” and her husband both come from military families, and their child is planning on a military career of their own, she said. But with a ban on TRICARE coverage for trans health care in the latest NDAA and the likelihood that Trump will reinstate a policy barring transgender people from serving openly once he takes office in January, “C” worries whether the military will be a safe place for her child.
“It’s all they've ever wanted — to be like their dad, to carry on a family tradition of service to the country,” she said. “I don't think I can truly even express how devastating it would be for them to not be able to fulfill those dreams.”
“B,” a military spouse living in the Southwest, similarly said that while the NDAA provision prohibiting coverage for gender-affirming care for trans youth would not affect her own daughter, an 18-year-old college student, she worries about the precedent passing such a measure would set. She requested that she be identified only by her first initial because her husband, an airman, is actively serving.
“This is kind of a slippery slope where if this becomes the first federal law that's going to prevent transgender youth from getting this health care, what's to prevent [Congress] from now removing TRICARE coverage for trans people of all ages?” she said. “I do get concerned about that moving forward, that this could impact my daughter, this could impact older trans adults. I don't know where this ends, so I think it's a really dangerous road to start down.”
“B”’s daughter, who accesses gender-affirming care through TRICARE, came out to “B” and her husband when she was 12. “It was a very steep learning curve for us ... I had never even heard the word ‘cisgender’ before,” said “B,” referring to the word for individuals whose gender identity does not differ from their birth sex.
They sought out advice from medical professionals, mental health providers and other parents before eventually deciding to allow their daughter to begin her medical transition. “This wasn't something that we went into blindly or quickly,” she said.
Then, in 2021, while living in Texas, the family was forced to split up when the state began investigating parents who provide their children with gender-affirming medical treatments, which Republican Gov. Greg Abbott had called abusive. “B” fled Texas with their daughter, who had to restart her senior year of high school, while “B”’s husband, unable to leave the state where he was stationed, stayed behind.
The family has since reconnected. “B” declined to say which state she currently lives in, citing safety and privacy concerns.
“My spouse is active-duty military. If these lawmakers saw him in the hallway in Congress, they would shake his hand and thank him for his service,” she said. “They trust him with sensitive information, and they trust him with the security of the nation, but somehow they can’t trust him with making informed medical decisions for his own child?”