Restrictions on Transgender Health Care Slipped into Senate's Must-Pass Defense Bill

The military would not be able to pay for surgeries for transgender troops under the Senate's version of the must-pass annual defense policy bill, legislative text released Monday evening revealed.

Transgender military kids could also lose access to hormone therapy, puberty blockers and other medication if the treatment "could result in sterilization" under another provision that was also added to the bill during the Senate Armed Services Committee's closed-door consideration of the measure last month.

Inclusion of those amendments, which passed with the support of every committee Republican and independent Sen. Joe Manchin of West Virginia, in the Senate's version of the National Defense Authorization Act, or NDAA, could increase the odds that restrictions on gender-affirmation care for transgender troops and family members become law after the House filled its version of the bill with similar efforts to curtail services for LGBTQ+ troops.

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The GOP-led House's efforts to ban coverage of gender-affirmation care for transgender service members garnered considerable attention, but Republicans' successful amendments in the Democratic-controlled Senate Armed Services Committee have so far flown under the radar. While the committee released a summary of its NDAA and staffers briefed reporters on some of its contents last month, there was no mention of the bill including anti-transgender amendments until the bill text and an accompanying report were released Monday night.

Transgender troops have faced whiplashing policies for years amid GOP efforts to bar them from serving openly or, short of that, prohibit the Pentagon from covering their health care. After the Obama administration allowed transgender troops to serve openly in 2016, former President Donald Trump reinstated the ban on open transgender service in 2017.

When President Joe Biden took office in 2021, he quickly rescinded Trump's ban. But Republicans have continued to try to pass bills targeting transgender troops, and major conservative voices, including the conservative think tank collaboration known as Project 2025 that hopes to shape a second Trump term if he wins November's presidential election, are calling again for banning transgender troops.

"I understand that this is an election year and that, in many ways, people in the military fall victim to at times a strategic compromise that often people will make in order to appease both sides of the aisle," Kara Corcoran, vice president of transgender service member group SPARTA Pride and an Army infantry major, told Military.com when asked about the Senate NDAA. "One thing that should not be a compromise is health care for our service members."

Official data on the number of transgender troops is scarce, but a 2016 Rand Corp. report commissioned by the Pentagon estimated that somewhere between 1,320 and 6,630 service members identified as transgender. Gender-affirmation health care is estimated to cost a small fraction of the overall defense budget, with the Pentagon spending $3.1 million for surgeries from 2016 to 2021, Military.com previously reported.

The amendments added to the Senate's NDAA would bar Pentagon funding to "perform or facilitate sex change surgeries," as well as the use of Defense Department facilities for those purposes, according to the bill text.

Tricare would also be prohibited from covering "affirming hormone therapy, puberty blockers, and other medical interventions for the treatment of gender dysphoria that could result in sterilization" for beneficiaries under 18.

Outside the military, gender-affirming care for children has been a particular target of conservatives. The American Civil Liberties Union lists 78 bills introduced in state legislatures this year focused on restricting health care by age.

While the American Academy of Pediatrics acknowledges that research into long-term risks of puberty blockers on fertility is "currently limited and provides varied results," the association still recommends that transgender youth have access to "comprehensive, gender-affirming and developmentally appropriate health care that is provided in a safe and inclusive clinical space." The group also recommends that insurance plans "offer coverage for health care that is specific to the needs of youth who identify as [transgender], including coverage for medical, psychological and, when indicated, surgical gender-affirming interventions."

In addition to the amendments to bar gender-affirmation care, the Senate Armed Services Committee voted on an amendment that would have banned service members from changing their gender in Defense Department records. That amendment failed as Manchin voted with Democrats against it, according to the bill report.

Spokespeople for Manchin, who recently left the Democratic Party but still caucuses with Democrats, did not respond to a request for comment on his support for the two other amendments.

It is unclear which committee member sponsored the Senate amendments. The bill report does not specify who the sponsors of each amendment were, and a committee spokesperson did not respond to a request for comment Tuesday.

While both the House and Senate versions of the NDAA now include provisions to restrict transgender health care, anti-LGBTQ+ measures have traditionally been a red line for Democrats, injecting uncertainty into the outcome of negotiations on the final version of the bill that will become law. After the House passed its version of the bill last month, Senate Majority Leader Charles Schumer, D-N.Y., blasted the House bill for being "loaded with anti-LGBTQ, anti-choice, anti-environment, and other divisive amendments guaranteed not to pass the Senate."

"As we move forward with this year's NDAA process, both sides will have to work together to pass bipartisan legislation that honors and respects all who serve in defense of our nation," Schumer said in a statement last month.

Regardless of the outcome of the bill, Corcoran from SPARTA vowed that transgender service members “will continue to fight for our right to live in a free America where every citizen and service member has inalienable human rights.”

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