Joshua Smalley, DO
Medical Director, AF Transgender Medical Multi-Disciplinary Team
United States Air Force
San Antonio Uniformed Services Health Education Consortium, San Antonio TX
Nothing to disclose
Background : In 2016, the United States Armed Forces reversed prior policies disqualifying transgender service members from serving. For the first time, military branches were required to arrange healthcare for transgender members for the purpose of gender transition, while minimizing impact to military readiness. The military developed a requirement for each transitioning member to have a medical treatment plan (MTP) that outlines the recommended medical interventions for transition and also communicate any mission-impacting interventions to the member’s leadership. The Air Force (AF) formed the Medical Multidisciplinary Team (MMDT) to provide medical oversight for all airmen with gender dysphoria seeking in-service transition. Unfortunately, many airmen lacked necessary medical resources near their bases, resulting in delays in treatment. Furthermore, successful approval of MTPs required multiple visits to various local providers with resulting differences in policy interpretation. To address this, the MMDT launched a one-week comprehensive education and evaluation program for the purpose of streamlining the process and establishing a treatment strategy with subject-matter experts in transgender care. The MMDT then evaluated whether the one-week program provided patients with sufficient clinical and administrative direction to initiate gender transition at their home bases and improve efficiency of MTP approval.
Methods : Airmen who participated in the program received information on AF policies and guidance to accomplish official gender-marker changes. They were provided with briefs on various medical treatments for gender dysphoria by hormone specialists, surgeons, and speech therapists. They also had individual encounters with various subspecialty providers to confirm their diagnosis, ensure medical eligibility for hormone treatment, and document a treatment plan including any anticipated effects on the member’s military readiness. At the end of their visit, airmen returned to their home bases with the required MTP documentation, as well as a firm medical follow-up plan coordinated with their home military treatment facilities. Anonymous post-visit surveys were administered to assess patient satisfaction with the program.
Results : 92 participants completed post-visit surveys. 98% of the respondents reported the program was an efficient means to complete the policy-required MTP. 98% of the participants indicated they would recommend this program to other airmen with gender dysphoria.
Conclusions : The MMDT’s one-week program is an efficient way to evaluate the mental health and medical needs of transgender airmen, as well as provide guidance for airmen to navigate medical, military and administrative requirements. This program has been particularly beneficial to transgender airmen stationed in locations lacking necessary mental health and medical services to initiate gender transition.