Caring for Military-Affiliated Transgender and Gender-Diverse Youths: A Call for Protections

In the United States, 1.4% of youths between the ages of 13 and 17 years (or approximately 300 000 adolescents) identify as transgender or genderdiverse (TGD),1 indicating that their gender identity, expression, or perception does not conform to the traditional gender roles and stereotypes associated with their assigned sex.2 The recent increase in adolescents and young adults reporting a TGD identity is thought to be due to increased awareness of the full range of gender identities, social acceptance, and improvements in medical care.1-4 Greater acceptance supports wellness.2 Indeed, in a study examining the health of those referred to care between 2000 and 2016, those recently referred seemed to have better psychological functioning than those referred previously, whereas a similar proportion across the study time period chose to initiate gonadotropin-releasing hormone agonists (GnRH-a; used for puberty suppression) or gender-affirming hormones.4Similar trends have occurred in the Military Health System (MHS). The number of new pediatric-age patients presenting for gender-affirming care in the MHS increased from 109 individuals a year in 2010 to over 600 a year in 2016.3 In 2017, when gender-affirming medical care was included in the list of TRICARE benefits for about one year, at least 2500 children actively sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities, and 900 received GnRH-a or gender-affirming hormones