Increasing Number of Military Dependents Receiving Transgender or Gender Diverse Medical Care Interview with:
Dr. David Klein MD MPH

Associate Program Director
National Capital Consortium (NCC) Family Medicine Residency
Fort Belvoir Community Hospital

Dr. Elizabeth Hisle-Gorman MSW, PhD
Assistant Professor, Uniformed Services University What is the background for this study? 

Response: Our study, “Transgender Children and Adolescents Receiving Care in the U.S. Military Healthcare System: A Descriptive Study,” sought to analyze the number of military dependent children and adolescents who have a transgender or gender-diverse identity and receive medical care in the Military Health System (MHS), recognizing that the number has been increasing, but not knowing to what extent. Ultimately, in studying this data, we hoped to document the needs of transgender children in military families to support provision of adequate and appropriate high-quality care.  What are the main findings?

Response: Using data from the MHS Data Repository, we looked at records of military dependents between October 2009 and April 2017, tracking individuals for an average of 7.5 years. During that time period, approximately 2,500 children and adolescents received transgender-related care over the course of about 6,700 separate visits, to include medical appointments and mental health or counseling appointments. The incidence of those seeking transgender-related care increased over 300%, from 135 in 2010 to 644 in 2016 (and 528 in the first part of 2017), with patients going to an average of 10 medical appointments for transgender-related care. New prescriptions for gender-affirming hormones also increased from 24 in 2010 to 332 in the first part of 2017.

These numbers could be underestimated because of shifting enrollment time frames and under-reporting of care prior to a change in Department of Defense policy in 2016. The new policy allowed children and adolescents to begin receiving full coverage of non-surgical transgender-related healthcare in the MHS. What should readers take away from your report? 

Response: An increasing number of military dependent children who identify transgender or gender-diverse receive medical care, including hormone therapy, related to their gender identity.

The research also suggests that transgender persons have individualized needs, as suggested by the proportion of youth not on hormone therapy (67%). Clinicians who care for children and adolescents, including youth with insurance provided by the Military Health System, should be knowledgeable about the basic health care needs of transgender and gender-diverse persons and familiar with local resources for referral, as well as remote consultation sources within the larger military health system. This study shows that transgender care, which was only officially available to military dependents in 2016, is used and needed.  Meeting the healthcare commitment to our military families includes providing appropriate quality transgender care to military dependent children. What recommendations do you have for future research as a result of this work? 

Response: We hope to explore how changes in availability of transgender related care can impact the overall health and well-being of military connected children.  We also think it is important to understand how other factors related to military life including parental deployment, and frequent moves may affect these children and adolescents. Is there anything else you would like to add?

Response: Approximately 500 children presented to care during early puberty between the ages of 10 and 14; however, the median age of puberty suppression was 14.7 years, which is generally after the initial stages of puberty. Because the sex characteristics associated with puberty can be particularly troublesome for transgender and gender-diverse adolescents, clinicians caring for such children should promptly refer these children to healthcare professionals who are familiar with gender development for consideration of fully reversible treatment to suppress puberty. This treatment provides time to determine the most appropriate next steps, which may include additional gender affirming therapy.


Klein DA, Roberts TA, Adirim TA, et al. Transgender Children and Adolescents Receiving Care in the US Military Health Care System. JAMA Pediatr. Published online March 25, 2019. doi:10.1001/jamapediatrics.2019.0105

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Last Updated on March 25, 2019 by Marie Benz MD FAAD