Trans veterans were promised access to gender-affirming surgeries — but it never happened

Originally published by The 19th

It’s been three years since President Joe Biden signed an executive order overturning the Trump administration’s ban on transgender people serving in the military. Months later, the secretary of the U.S. Department of Veterans Affairs (VA) announced that the agency would provide gender-confirmation surgery. But that change has not happened, so the Transgender American Veterans Association (TAVA) filed a lawsuit on Thursday against the VA over its failure to act.

Rebekka Eshler, a transgender veteran and president of TAVA, said the Biden administration had made promises without any concrete action, and transgender veterans feel like they are being “used for political showmanship.”

“We’re filing the lawsuit because we’re kind of stuck,” Eshler said. “We still haven’t heard anything. Every time we’ve asked about the change, it’s next week or the next week. We know it’s on the desk of the secretary, but they haven’t given us any reasons why it hasn’t moved any further. We just want to know why. We want to build trust back.”

The lawsuit calls for the VA to respond within 30 days. The administration has not yet responded to requests for comment.

In 2016, TAVA submitted a formal petition requesting that gender-confirmation surgeries be recognized as “medically necessary” and provided to veterans. The VA currently provides other non-surgical gender-affirming care, including hormone therapy, voice training and gender-affirming prosthetics.

Eshler said that transgender people serve in the military at higher rates than their cisgender counterparts, but are far less likely to use VA facilities for health care due to harassment, stigma and a lack of resources. Though data is incomplete, studies estimate that trans men and women are two to three times more likely to join the military. Yet, Eshler said only 6.25 percent of transgender veterans use the VA health care system.

“We don’t have trust in the VA,” Eshler said. “They don’t even follow their own directives. There’s countless stories: the VA misgendering people, no consistency in care across facilities, no national line where they take or even track complaints.”

Natalie Kastner, a Texas-based transgender veteran, said she could have died on March 5, 2022, because she felt like there were no other options for her: The VA did not provide gender-confirmation surgery, and civilian care would have cost about $60,000 out-of-pocket. So she took matters into her own hands.

“I woke up, and I was feeling gender dysphoric,” Kastner said. “I walked into my bathroom with a paring knife and a pair of scissors, laid myself in the tub,” and attempted to perform surgery on herself.

She cleaned up the bathroom and went back to bed, only to be woken up later by her cat. Seeing that she was still bleeding profusely, despite feeling no pain, Kastner said she drove herself to the closest emergency room, where it was discovered she had cut through an artery.

“I did this to fix my body,” said Kastner, who served from 2006 to 2008 before she was honorably discharged due to a back fracture. “I didn’t want to die. I have an ex-wife and two children that I care for deeply, and I never want to leave them like that. But that night, my gender dysphoria became too much, and I broke.”

Transgender veterans are more at risk of suicide than the transgender community and the veteran community at large. Veterans already have a suicide rate more than 57 percent higher than civilians, according to the Centers for Disease Control and Prevention. And about 40 percent of transgender people in the United States attempt to take their own lives at least once in their life, compared to .07 percent of all adults. But transgender veterans are more than 20 times more likely than other veterans to experience “suicide-related events,” according to a 2023 peer-reviewed study published in The Cureus Journal of Medical Science.

“Surgeries save lives,” said Kastner, now 39 and a member of TAVA. “With access to the surgery, I would have waited. I would have had hope.”

She emphasized the difference that would have made for her health – and why it matters to veterans.

“The VA says they will serve those who have served,” Kastner said. “By not providing these surgeries, they’re letting us die. How is that serving those who have served?”