Braxton Taylor
The Department of Veterans Affairs will no longer provide hormone therapy and other gender-related care to transgender veteran patients not already receiving those treatments in the VA or Defense Department health systems, officials announced Monday.
Effective immediately, VA patients with gender dysphoria who aren’t already taking hormones will not have access to that care. The department also will no longer provide new prosthetics, wigs or other medical devices or services such as voice or communication training to transgender patients.
Advocates said transgender veterans will not have access to the complete medical care they need due to the VA rollback of services — originally affirmed under a directive issued under the first Trump administration — and warned it could push more veterans into crisis, with potentially deadly outcomes.
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“VA’s rollback of crucial protections, specifically the elimination of Directive 1341, is a direct assault on the well-being of vulnerable LGBTQ+ veterans, jeopardizing their access to essential care,” Rachel Branaman, executive director of Modern Military Association of America, said in a statement.
The changes, which began Friday after the VA rescinded the 2018 directive on gender-affirming care for transgender veterans, are related to an executive order issued Jan. 20 by President Donald Trump declaring that the federal government recognizes only two sexes: male and female.
The order prohibited the use of gender identity on official documents and sought to prevent the use of taxpayer dollars for programs and services that support transgender people.
“I mean no disrespect to anyone, but VA should not be focused on helping veterans attempt to change their sex,” VA Secretary Doug Collins said in a statement Monday. “All eligible veterans — including trans-identified veterans — will always be welcome at VA and will always receive the benefits and services they’ve earned under the law. But if veterans want to attempt to change their sex, they can do so on their own dime.”
According to the announcement, the VA will not offer hormone therapy to veterans with a “current diagnosis or history of, or exhibit symptoms consistent with gender dysphoria, unless” they “are already receiving such care from VA” or “were receiving such care from the military as part of and upon their separation from military service and they are eligible for VA health care.”
The 2018 directive, issued during Trump’s first term in office, authorized VA providers to provide hormone therapy, mental health services and pre-operative evaluations for those considering surgery, as well as post-operative and long-term care.
In announcing the directive’s recission, Acting Under Secretary for Health Dr. Steven Lieberman said the VA will continue to provide care and treatment to “all veterans, including trans-identifying” veterans, that is “compatible with generally accepted standards of medical practice,” but he added the VA needed to conduct a comprehensive review of care “with respect to” those patients.
Minority Veterans of America Executive Director Lindsay Church said the decision will hurt transgender veterans and could result in “deadly outcomes.”
“This decision will exacerbate our already devastatingly high suicide rates and push more veterans into crisis for no reason other than hate,” Church said.
Earlier this year, a veteran died by suicide at the VA hospital in Syracuse, New York, draped in a pink, light blue and white flag — a banner that symbolizes transgender pride, according to an eyewitness.
“VA is abandoning those who have served, stripping us of critical health care protections, and sending a clear message that our lives and service to our country do not matter,” Church said.
Last month, the Defense Department issued a memo declaring that a diagnosis, symptoms or history of gender dysphoria are incompatible with military service, and transgender service members would be separated involuntarily from the military.
The services have started issuing policies for the discharges, with the Navy and Marine Corps saying sailors and Marines have until March 28 to receive separation pay twice the normal amount if they volunteer to leave before they are dismissed.
The Army and Air Force gave transgender soldiers and airmen until March 26 to decide to voluntarily separate.
A federal judge is expected to rule this week on whether the Pentagon’s policy to ban transgender individuals from serving is legal.
In addition to barring transgender individuals from serving, the Pentagon policy also prohibited medical coverage of gender transition surgeries and new hormone therapy prescriptions for those not already being treated.
The Defense Department has covered gender-affirming surgery, along with mental health care, hormone treatment and other services, for active-duty and activated Guard and reserve members since 2014.
According to the Pentagon, from 2015 to 2024, the Defense Department spent $52 million to care for 5,773 troops diagnosed with gender dysphoria, and roughly 1,000 received some type of surgery during that time frame.
The VA is prohibited, by law, from covering or providing gender transition surgeries.
In June 2021, then-VA Secretary Denis McDonough said the department was taking steps to cover such surgeries, but the VA was not able to complete the process necessary to change its medical benefits package before the end of President Joe Biden’s term.
In making his announcement, McDonough predicted that the change to the regulations would take two years; in 2023, however, he said he had outstanding questions that needed to be answered before implementing changes and later said that a review of the impact of the PACT Act needed to be complete before the VA could proceed on offering procedures.
Under the new directive, the VA’s ban on surgeries will remain in place.
“VA does not provide ‘gender-affirming’ surgeries in VA facilities or through non-VA care because VA regulation excludes them from the medical benefits package,” Lieberman wrote. “VA requires medical necessity for any surgical care offered to veterans; gender alteration surgery is not an authorized medical treatment.”
The VA said fewer than 9,000 of the 9.1 million veterans enrolled in VA health care identify as transgender. Advocates for Trans Equality, a nonprofit that supports transgender persons, estimates that 134,000 U.S. veterans are transgender.
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