Transgender Veterans

In early 2013, the VA implemented processes and procedures on how to provide quality health care to the nation’s transgender and intersex Veterans. Since then, the existing policy has been updated to address the more recent developments in transgender health. For more information, you can check out VHA Directive 1341(2), Providing Health Care for Transgender & Intersex Veterans, dated May 23, 2018. At the bottom of this page, you can find FAQs and answers taken from the directive.

Guidance

Changing The Name on Your DD Form 214
For most non-transgender people, a service record showing a former names does not communicate any sensitive information, for transgender people, disclosure of the former name can be equivalent to disclosure of transgender status. This can be considered an injustice, and will be the strongest basis for your request to update your name on the DD Form 214.

Changing Your Name/Gender in DEERS
In order to change your name and gender in DEERS, the DEERS/RAPIDS Service Project Office for your military department must submit a request to Defense Human Resources Activity (DHRA) for review and implementation. A gender (or name) change in DEERS will not affect the eligibility of any of your existing dependents for military benefits.

Upgrading the Character of Your Discharge
There are many avenues one can go about changing the character of one’s discharge. The following is a listing of resources from organizations nationwide.

Local Resources

Gender Health Center (GHC)
Significant Others, Family Friends & Allies of Trans People
2020 Street, Suite 201, Sacramento, CA 95817
A Trans/PoC-led, grassroots, nonprofit that provides programs, trainings, and direct services that center on Queer and Transgender People of Color (QTPOC).
☎ Phone: (916) 455-2391

Lavender Library Archives & Cultural Exchange
Community Groups
1414 21st Street, Sacramento, CA 95811
A lending library and archive housing lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) books and magazines, various media, and archival materials. It is an integral part of the Sacramento cultural community and it is open to the general public. The Lavender Library serves patrons in the greater Sacramento Valley and Northern California.
☎ Phone: (916) 492-0558

Planned Parenthood B Street Health Center
Gender Affirming Hormone Therapy
201 29th Street, Suite B, Sacramento, CA 95816
Planned Parenthood is one of the nation’s leading providers of high-quality, affordable health care, and the nation’s largest provider of sex education. With or without insurance, you can always come to us for your health care.
☎ Phone: (916) 446-6921

River City Gems
Sacramento’s Social Group for Transgender Women
Email: info@rivercitygems.org

Sacramento LGBT Community Center | COVID-19
Transgender Services
1015 20th Street, Sacramento, CA 95811
The Sacramento LGBT Community Center works to create a region where LGBTQ+ people thrive. It supports the health and wellness of the most marginalized, advocates for equality and justice, and works to build a culturally rich LGBTQ+ community.
☎ Phone: (916) 442-0185

Sutter Gender Identity Support Group
An open, non-profit, non-sexual social group serving the Greater Sacramento area for those who are serious about their gender identity.  The group provides a safe and secure place where they can interact with others with similar experiences and meet, visit and exchange information. The group serves the educational, emotional, and recreational needs of the gender variant, transgender and intersex community, their significant others, parents, children, allies and helping professionals.
Email: contact@pflagsacramento.org

Trans Families Sacramento
A group of transgender families in the Sacramento area, which includes transparents (transgender parents), parents with transgender children, spouses and families with or without children.
Email: TransFamilies@sactgc.org

VA Resources

Department of Veterans Affairs (VA)
Patient Care Services
Veterans with Lesbian, Gay, Bisexual and Transgender (LGBT) and Related Identities
“LGBT and related identities” is an inclusive term for sexual and gender minorities. Veterans may have other ways of describing themselves, so the term “LGBT and related identities” is used to inclusively recognize the full range of sexual orientation and gender identity minorities. All Veterans are welcome at VA, even those who identify as a sexual or gender minority. Sexual and gender minority Veterans have faced stigma and discrimination, which can affect health. As a healthcare institution, we need to work to make sure that Veterans with LGBT and related identities know that they are welcome at VA.

VA Northern California Health Care System (NCHCS)
LGBTQ+ Veteran Care
10535 Hospital Way, Mather, CA 95655
VA Northern California seeks to promote the health, welfare, and dignity of LGBT Veterans and their families. They are committed to making sensitive and high quality health care accessible. Their policies and practices focus on ensuring a safe, welcoming, and affirmative environment of care for LGBT Veterans.
☎ Phone: (916) 843-7000 or (855) 771-9321

National Resources

American Veterans for Equal Rights (AVER)
PMB 416, 15127 Main Street E., Suite 104, Sumner, WA 98390
A non-profit, non-partisan, chapter-based Veterans Service Organization of active, reserve, and veteran service members dedicated to full and equal rights and equitable treatment for all present and former members of the U.S. Armed Forces, especially the Lesbian, Gay, Bisexual, and Transgender current and prior military personnel who have been historically disenfranchised by armed forces policy and discriminatory laws governing military service and benefits.
☎ Phone: (718) 849-5665

Trans Lifeline | ☎ 1-877-565-8860
A grassroots hotline and microgrants non-profit organization offering direct emotional and financial support to trans people in crisis – for the trans community, by the trans community.

GLMA – Health Professionals Advancing LGBT Equality
A national organization committed to ensuring health equity for lesbian, gay, bisexual, transgender, queer (LGBTQ) and all sexual and gender minority (SGM) individuals, and equality for LGBTQ/SGM health professionals in their work and learning environments.  To achieve this mission, GLMA utilizes the scientific expertise of its diverse multidisciplinary membership to inform and drive advocacy, education, and research.

LGBT National Help Center
2261 Market Street #296, San Francisco, CA 94114
Serving the lesbian, gay, bisexual, transgender, queer & questioning community by providing free & confidential peer-support and local resources.
☎ LGBT National Hotline: 1-888-843-4564
☎ LGBT National Youth Talkline: 1-800-246-7743
☎ LGBT National Senior Hotline: 1-888-234-7243

Modern Military Association of America (MMAA)
1725 I Street NW, Suite 300, Washington, DC 20006
Formed through the merger of the American Military Partner Association and OutServe-SLDN, the Modern Military Association of America is the nation’s largest non-profit organization dedicated to advancing fairness and equality for the LGBTQ military and veteran community. Through education, advocacy and support, we are making a real difference in the lives of LGBTQ servicemembers, military spouses, veterans and family members.
☎ Phone: (202) 328-3244

National Center for Transgender Equality | COVID-19
1133 19th Street NW, Suite 302, Washington, DC 20036
The National Center for Transgender Equality advocates to change policies and society to increase understanding and acceptance of transgender people. In the nation’s capital and throughout the country, NCTE works to replace disrespect, discrimination, and violence with empathy, opportunity, and justice.
☎ Phone: (202) 642-4542

SPART*A – Service Members, Partners, Allies for Respect & Tolerance for All
A group of transgender people who currently serve or have served in the military. Membership is open to transgender (to include non-binary and gender-nonconforming) individuals currently serving in the United States Armed Forces. SPART*A also offers smaller groups for families of transgender service members, veterans, and allies.

Transgender American Veterans Association (TAVA)
2020 Pennsylvania Avenue NW, Suite 465, Washington, DC 20006
Founded in 2003, the Transgender American Veterans Association is a grassroots organization that advocates for the equality of transgender veterans and active duty service members to receive fair and equal treatment in areas such as healthcare, benefits, and open transgender military service. TAVA helps veterans change their name and gender within the Department of Veteran affairs, update their DD 214 name and characterization of discharge, and provide services such as our transgender support locator, which offers local support for transgender persons. TAVA is committed to equal rights for all veterans.
☎ Phone: (516) 828-2911

Transgender Law & Policy Institute
A non-profit organization dedicated to engaging in effective advocacy for transgender people in our society. The TLPI brings experts and advocates together to work on law and policy initiatives designed to advance transgender equality.

Transgender Law Center
P.O. Box 70976, Oakland, CA 94612-0975
The largest national trans-led organization advocating for a world in which all people are free to define themselves and their futures. Grounded in legal expertise and committed to racial justice, TLC employs a variety of community-driven strategies to keep transgender and gender nonconforming people alive, thriving, and fighting for liberation.
☎ Phone: (510) 587-9696
☎ Collect Line for People in Prison & Detention: (510) 380-8229

FAQs

Are transgender Veterans allowed to use public accommodations of their choice?

Yes. VA policies on access to facilities (for example, bathrooms, locker rooms, or room assignments) apply to all VA facilities across the country, regardless of local or state laws or regulations regarding use of facilities based on birth sex. To ensure the safety and respect of Veterans in cities and states with policies restricting access to bathrooms, locker rooms, etc., extra education, signage, and safety precautions could be needed to guarantee the safety of transgender people using the facilities of their choosing.

Are transgender Veterans allowed to use the bathroom of their choice?

Yes. Transgender Veterans who self-identify as women are allowed to use bathrooms for women. Likewise, those who self-identify as men are allowed to use bathrooms for men. This is irrespective of the Veteran’s appearance or whether the Veteran has had surgical interventions. Some transgender people may prefer to use single stall bathrooms, typically labeled “unisex,” or something similar. If a transgender person requests a single stall bathroom, they should be directed accordingly, though they remain welcome to use any and all facilities that correspond to their self-identified gender identity.

What about room assignments, including shared rooms?

Room assignments are made in accordance with the Veteran’s self-identified gender, irrespective of the Veteran’s appearance or whether the Veteran has had surgical interventions, and in consideration of the needs of other Veterans. Privacy and confidentiality dictate that staff may not share any information about one Veteran with another Veteran without express permission. If a room assignment leads to distress for either Veteran, then efforts need to be made to move the distressed Veteran to a different semi-private room. If both Veterans are distressed, staff should use current policies about resolving roommate disputes to determine if/when and how a room change should happen. NOTE: Ethics consultations are encouraged when concerns arise related to the provision of respectful care for transgender and intersex Veterans
and other Veterans.

Will VA provide gender confirming/affirming surgeries or plastic reconstructive surgery if needed?

VA does not provide gender confirming/affirming surgeries in VA facilities or through non-VA care. In addition, VA does not provide plastic reconstructive surgery for strictly cosmetic purposes in VA facilities or through non-VA care. However, transgender Veterans cannot be denied access to surgical interventions that are medically indicated for other medical conditions simply because the procedure is also consistent with transition goals. NOTE: Some transgender Veterans may elect to have one or more medical or surgical procedures over their lifetime to bring their bodies into a closer alignment with their experienced gender. Only a minority of transgender Veterans will undergo gender confirming/affirming surgeries outside VA. Some Veterans receiving care at a VA medical facility may have had gender confirming/affirming surgeries somewhere else. VA does provide health care to pre- and post-operative transgender Veterans, including treatment of surgical complications.

Will VA provide feminizing or masculinizing hormone therapy?

Yes, if it is consistent with the Veteran’s wishes, the treatment team’s clinical recommendations, and VA treatment guidance.

Transgender and intersex Veterans are presenting to VA providers with
prescriptions for hormones from outside sources, such as from another provider, the Internet, or illicit sources. Should we stop these medications while we do a full evaluation or should a VA provider rewrite the prescriptions so they can be filled in a VA pharmacy and continued?

Under VHA Directive 2009-038, VHA National Dual Care Policy, dated August 25, 2009, VA providers are not permitted to simply rewrite prescriptions from an outside provider, unless the VA provider has first made a professional assessment that the prescribed medication is medically appropriate. NOTE: It may be appropriate for a VA provider to provide temporary prescriptions based on each Veteran’s unique situation and a weighing of risks/benefits in order to avoid negative physical and psychiatric consequences while a VA evaluation is in progress.

Is hair removal (electrolysis/laser hair removal) covered by the VA for transgender Veterans?

Permanent hair removal can be medically necessary, such as for pre-surgical hair removal for genital surgery. VA provides pre-operative and long term post-operative care for gender affirming surgeries. For non-cosmetic medically necessary hair removal, laser hair removal is appropriate to prevent major complications following genital surgery. For Veterans who are not candidates for laser hair removal due to hair color (white/gray/ blonde), electrolysis may be provided. Currently, each VA decides if hair removal is indicated on a case-by-case basis after an evaluation of medical necessity. Some VA facilities have the equipment to perform laser hair removal and/or electrolysis, while others will need to access community care when this procedure is medically indicated.

Will VA provide medically necessary prosthetics (e.g., wigs, chest binders, dilators, etc.) to eligible transgender and intersex Veterans?

Yes.

Will VA provide medically necessary vocal coaching to transgender and intersex Veterans?

Yes. VA speech pathologists can offer this care, or if this service is not available at your facility, it can be offered through non-VA community-based care.

Can a transgender Veteran request a change of birth sex in Computerized Patient Record System (CPRS) before having gender confirming/affirming surgery?

Yes. Surgery is not a prerequisite for amendment of birth sex in the Veteran’s record. Amending the birth sex of the Veteran in CPRS is based on the Veteran making a written amendment request to the facility’s Master Veteran Index Coordinator (often the Privacy Officer). The request must be accompanied by official documentation as described in the Identity Management Fact Sheet, dated November 2016. However,
self-identified gender identity can be changed without documentation by the Veteran or by any VA staff who routinely update demographic data. Changing birth sex will result in loss of information for preventive health screenings, and may complicate medication dosing and medical reports.

What do I do if I become aware of possible discrimination or harassment of a transgender Veteran?

VA is founded on respect of Veterans and does not tolerate discrimination or harassment. To report concerns, you may work with the LGBT Veteran Care Coordinator, your supervisor, and/or the patient advocates. The VA Medical Facility Director is responsible for implementing corrective actions and training.