The Department of Veterans Affairs in Phoenix.Matt York/AP
On Monday, citing Donald Trump’s “Defending Women” executive order, the federal Department of Veterans Affairs announced that it would “phase out treatment for gender dysphoria” by discontinuing hormone replacement therapy for patients not already in treatment.
The agency provides health care and benefits for about nine million veterans, tens of thousands of whom—by the VA’s estimate—identify as trans. Its press release says that the agency’s LGBTQ+ veteran care coordinators, who run its LGBTQ Health Program, would not be affected by the changes. But Pete Hegseth, Trump’s secretary of defense, has been vocal about his ire toward the LGBTQ community and his support for cutting VA health care.
Although the VA has never provided gender-affirming surgeries, it has been able to provide letters in support of veterans seeking them. That’s now on the chopping block.
“It’s infuriating,” a medical professional with the agency, speaking on condition of anonymity, told Mother Jones. “To be honest, I don’t understand how it’s allowed—how are they able to tell providers what they can and cannot treat?”
The announcement follows reporting in the Advocate on a Veterans Health Administration memo with similar provisions circulated on March 14, which rescinded the agency’s 2018 directive establishing health care standards for transgender and intersex veterans. In response to subsequent coverage by National Public Radio, VA press secretary Peter Kasperowicz told NPR that there had been no policy change—but by Saturday night, the agency officially published the memo, which showed otherwise.
The VA’s press release claims that funds spent to treat transgender veterans will be redirected to treatment of paralyzed veterans and amputees, a supposed annual savings of $2.4 to $8.4 million, according to the RAND Corporation, or 0.04 to 0.13 percent of military health expenditures.
Notably, the memo rescinded VHA Directive 1341(4), “a policy for the respectful delivery of health care” for transgender and intersex veterans.The policy provides background on the transgender and intersex veteran populations and their healthcare needs, defines the “respectful delivery” of that care, and outlines what the VA benefits package covers. It can no longer be found on the VA’s website.
The department’s new memo rescinding those standards claims to apply to intersex veterans, in addition to transgender ones, though it isn’t clear to what extent they will. Intersex people, who make up approximately 1.7 percent of the population, have sex characteristics outside of the binary of female and male. Those variations can present in external genitalia, gonads, hormone production, internal reproductive organs, and chromosomes. Intersex people can be prescribed hormone replacement therapy to aid with gonadal function or help masculinize or feminize secondary sex characteristics, among other uses.
Some intersex folks require HRT because of non-consensual surgeries as infants—as intersex activist Alicia Roth Weigel said to NPR, “By removing my testes, they basically put my body into artificial hormone withdrawal and didn’t give me new hormones until a certain age.”
Right now, the VA’s former policy supporting intersex healthcare is moot, but the agency hasn’t outlined a direction for its future.
According to the new policy, anyone without previous Veterans Affairs health coverage is “not eligible for cross-sex hormone therapy.” But what constitutes “cross-sex” hormone therapy for intersex veterans? Is it based on the sex they were assigned at birth? What happens when that conflicts with what the current administration defines as sex—based on the production of certain sizes of reproductive cells?
In fact, what is cross-sex hormone therapy for anyone? Everyone has both testosterone and estrogen at varying levels. It is increasingly common for cisgender people to take hormones associated with the other sex.
The VA health care professional who spoke to Mother Jones said that the agency now seems to have “no official stance on the treatment of intersex people.” The source takes that to mean that, “in theory,” things won’t necessarily change—though “it can definitely lead to confusion for providers attempting to treat patients,” they acknowledged.
It’s not the first time intersex folks have been swept up in anti-trans policies and legislation.
The VA, the memo states, “provides care and treatment…compatible with generally accepted standards of medical practice.” Hormone replacement therapy falls into that category: Every major medical association in the United States supports gender-affirming care for transgender people.
The VA staffer who spoke to Mother Jones said it felt “frustrating that the party that pushes against the idea of government involved in your health care [is] taking the opportunity to define for care providers what they can and cannot treat.”
The department did not respond to a request for clarification about its current policy dictating care for intersex veterans.
Additional reporting by Anna Merlan.
