Veterans Health Administration

Transgender Vets, the VA, and Respect

There are currently about 5,000 transgender Veterans receiving their healthcare from VA.

“That is certainly an undercount because not all transgender Veterans want to identify themselves to their provider,” noted Dr. Michael Kauth, co-director of VA’s National LGBT Program (Lesbian, Gay, Bisexual and Transgender).  Kauth is also a psychologist at the Houston VA and a professor in the Psychiatry Department at Baylor College of Medicine in Houston. 

Transgender people, according to Wikipedia, are people who have a gender identity or gender expression that differs from their assigned sex.

Kauth said VA provides gender transition counseling, evaluations for hormone therapy, and evaluations for gender transition surgeries.

“VA doesn’t perform those surgeries, and doesn’t pay for them,” he said. “But we’ll be there to help the Veteran out if somethings happens to go wrong after transition surgery.  If complications occur following surgery, VA will provide the Veteran with medically necessary care.”

And for Veterans who are still in the process of transitioning, there’s counseling.

Following Your Path

“A VA counselor will talk to the Veteran about their transition goals, and how to achieve them safely,” Kauth said. “Our job is to help the Veteran successfully navigate their gender transition pathway, and to support them.”

Making sure transgender Vets get the support and understanding they deserve is the job of Dr. Jillian Shipherd, co-director of VA’s National LGBT Program and a clinical research psychologist at the Boston VA.  She said a big part of her job is making sure providers throughout the VA system are properly trained in how to interact with this very special segment of the Veteran community.

“We live in a largely gender binary world where we want things to be one way or another. But life is vastly more complex than that.”

“As a transgender person you’re accustomed to dealing with all sorts of issues on a daily basis,” she explained. “But when you walk into a VA facility you shouldn’t have to worry about that.  So here at VA we need to work extra hard to overcome any fear or anxiety you might be experiencing.  We want to make sure that you, as a transgender Vet, are getting the healthcare you need and the respect you have earned.”

Shipherd said transgender Veterans, like other minorities, tend to have considerably more stress in their lives than the rest of us.

“Veterans are at increased risk for suicide relative to the general population,” she observed, “and transgender Vets are 20 times more likely to attempt suicide than other Veterans.  This statistic highlights the level of daily stress some of our transgender Vets are experiencing.”

So… Why so Much Stress?

“As a transgender Vet one of your biggest battles is discrimination, which can take many forms--some subtle and some not so subtle,” Shipherd explained. “As a transgender Vet you might face discrimination where you work, or you might have trouble finding a job at all. You might face discrimination when you try to rent an apartment or purchase a home, or a car, or even a pair of shoes. You might face discrimination from your own family –your parents, your brothers and sisters, even your own children. That’s a lot of stress.”

She continued: “Being transgender can affect every aspect of your life. When you go to the bank to get a loan, you might experience some problems due to a lack of credit history under your new name. When you go to a new dentist for the first time, you might be worried about explaining why you’re on certain medications or hormone therapy.”

       Dr. Jillian Shipherd

Is There a Problem, Officer?

And then there’s the dreadful event that tends to generate anxiety in all of us, but especially members of any minority group:  getting pulled over by a police officer.

“Any encounter you might have with law enforcement can be stressful, or downright scary,” Shipherd said. “Can you imagine being stopped by a police officer late one evening?  What are you feeling as the officer gets out of their cruiser and approaches your vehicle?  Are you nervous?  Are you afraid?  What will the officer say when they look at your driver’s license and it says John Doe, only you look like Jane Doe?”   

Shipherd said the unfortunate reality is that most transgender Veterans live with fear every day of their lives. “Just walking out of your house can provoke anxiety,” she said. “Chances are people on the street may roll their eyes when they see you, or actually snicker or laugh.  Some might verbally harass you.  And of course, there is the risk of physical violence.  It’s not an easy life.  This is why we work so hard at VA to make our transgender patients feel welcomed, and respected.  We want them to know that when they come to VA they’re coming to a safe place.” 

To make sure VA is a safe and welcoming place, the Department offers three levels of nation-wide training to help VA healthcare providers get up to speed on how to successfully interact with their transgender patients and how to address their sometimes unique healthcare concerns.  (For more info on what kind of LGBT training VA is providing to its personnel, visit http://www.patientcare.va.gov/LGBT/index.asp

And Everything In Between

Shipherd said this kind of sensitivity training is essential, since even well-meaning VA staff can experience anxiety when interacting with a transgender patient — thus causing the patient to feel anxious.

“Sometimes even a well-intentioned healthcare provider can mishandle their encounter with a transgender Vet,” she said. “It’s not that they’re trying to be insensitive or callus; they’re simply not educated in culturally appropriate care.  So it’s our job to provide that education, to make sure our healthcare staff and providers are trained in how to communicate and connect with transgender patients.”

She added: “We all need to understand that gender is more complicated than what we like to think.  Male and female are not the only options.  Gender identity exists on a continuum, with male and female being the extreme endpoints.  Then you have everything in-between.” 

To learn more about LGBT services offered at the Boston VA, visit http://www.boston.va.gov/services/Lesbian_Gay_Bisexual_and_Transgender_Veterans.asp

To learn more about some of the services VA is providing to transgender Veterans nationwide, visit http://www.patientcare.va.gov/LGBT/index.asp