Implementing Transgender Behavioral Health Care in the Military

women with thought bubbles, Role? Responsibility? Policy?
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By Holly N. O’Reilly, Ph.D.
June 5, 2017

In June 2016, a new policy was introduced allowing transgender service members to openly serve in the United States military. This policy creates changes for military mental health providers who are now responsible for new aspects of care with which many providers may have little familiarity.

Guidance on transgender personnel policy is available in the Transgender Service in the U.S. Military handbook (September 2016). Direction on medical care is found in the Guidance for Treatment of Gender Dysphoria for Active and Reserve Component Service Members Health Affairs memorandum (July 2016). Each service has provided service-specific guidance on implementation of the new policy:

Mental health providers are asking, “What do I need to know to provide care to this population?” This is the first in a series of blogs that will help clinicians implement the new policy and guidance. The series will include topics most relevant to provider efforts to integrate transgender care into clinical practice, starting with a brief overview of the policies and requirements relevant to mental health providers.

What do you need to know as a mental health provider?

  • Gender transition in the military starts when a behavioral health provider diagnoses gender dysphoria and determines that gender transition is medically necessary.Consultation with other types of providers will probably be needed, to include the patient’s primary care manager (PCM), and perhaps a surgeon.  A transition plan is developed and when complete, allows the service member’s gender marker to be changed in the Defense Enrollment Eligibility Reporting System (DEERS).

  • A service member’s command is required to approve the timing for the gender transition process in order for the service member to move forward with the transition treatment plan which may or may not include sex reassignment surgery (SRS).

  • Any civilian diagnosis of gender dysphoria must be confirmed by a military Transition Care Team.

What is your role as a mental health provider?

  • Provide assessment and diagnosis of gender dysphoria using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

  • Include in your evaluation information regarding the individual’s history of gender dysphoria, experiences with discrimination and harassment, engagement in the transgender community (future blogs will provide more details on the evaluation process), previous mental health treatment and current clinical status.

  • Depending on local policy and staffing issues, military mental health providers may help create a transition treatment plan.  The treatment plan will include the diagnosis of gender dysphoria, proposed transition timeline, and the likely impact on the service member’s readiness and deployability.

  • Provide consultation and a medical necessity letter as indicated.

Learn more about transgender mental health in the military on the DHCC website and stay tuned for future blogs on topics including guiding principles of trans-affirmative therapy, transgender narrative and common stressors, and assessment of gender dysphoria.

Dr. Holly N. O’Reilly is a contracted clinical psychologist and evidence-based practice subject matter expert at the Deployment Health Clinical Center.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


  • This certainly promises to pose significant challenges for behavioral health care providers.

    • MAJ Lynch- I definitely agree. New and challenging times but I am sure like all other challenges, we will make it work

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