When U.S. Army Capt. El Cook started as a freshman at West Point in 2009, he enrolled as a woman. At the time, Cook knew he was transgender, but he also knew that if he came out, he would never be able to pursue his dream of serving in the U.S. Army.
Despite his fears, Cook decided in his junior year in 2012 to start his medical transition, but because trans people were still banned from the military, he kept it a secret. He drove an hour and a half from West Point to New York City every couple of months to see a civilian doctor, paying out-of-pocket for hormone replacement therapy.
Although his physical appearance was changing every day, he tried not to bring extra attention to himself and continued to wear a female uniform and go by female pronouns at school. No one at West Point asked any questions.
Five years later, Cook, now 30, is a captain in the U.S. Army based at Fort Campbell in Kentucky. He’s completed two combat tours: one in Kuwait in 2015 before his gender confirmation surgery and another afterward in Iraq in 2016.
“Your battle buddies to your left and right — they know exactly who you are, they know exactly what you are, and all they care about is how well you can shoot, move, and communicate.”
“Your battle buddies to your left and right — they know exactly who you are, they know exactly what you are, and all they care about is how well you can shoot, move, and communicate,” Cook said in an interview with VICE News.
The military first announced its plans to allow transgender troops to serve openly in 2015 and a year later, in June 2016, President Obama officially lifted the ban. But when President Trump reversed that with a memorandum in July banning trans people from the U.S. military, it threw Cook’s life, and that of an estimated 15,000 trans service members into limbo.
A question of “deployability”
The order cited “military effectiveness and lethality” and “unit cohesion” as reasons to exclude openly transgender people from serving. It also focused on the idea that transition-related medical needs — like the hormone therapy and chest surgery Cook underwent — hinder service members’ ability to do their jobs and go to war, what the military calls “deployability.”
Trump and Secretary of Defense Jim Mattis have also cited the costs associated with transition-related medical care. When Trump first tweeted about the transgender ban in July, he mentioned trans troops’ “tremendous” medical costs.
The order prohibited new trans recruits and cadets — including those in service academies like West Point — from joining the military. Trump directed Mattis to take the next five months to study the issue of transgender “deployability” and make a decision on what to do about those already serving, like Cook.
Mattis responded to Trump’s directive a few days later with a statement announcing his plan to build a panel of experts who “will bring mature experience, most notably in combat and deployed operations, and seasoned judgment” to study trans military service. Until the panel makes its recommendations, expected in February, currently-serving trans service members can remain in the military.
Sixty percent of Republicans support banning trans military service, according to an August Quinnipiac University national poll. Missouri Republican Rep. Vicky Hartzler was one of the most vocal supporters of the ban. “Military service is a privilege, not a right,” she said in a statement to VICE News. “I’m pleased to see the president putting military readiness first and making sure our defense dollars are spent keeping us safe.”
“Military service is a privilege, not a right.”
California Republican Rep. Duncan Hunter is also a strong supporter of the ban and issued a statement the day after Trump signed the memo. “The president’s decision was the absolute right decision. National security should trump social experimentation, always,” he said. “It’s about time that a decision is made to restore the warrior culture and allow the U.S. military to get back to business.”
But broader public opinion is mixed. The Quinnipiac University national poll also found that 55 percent of voters in military households and 68 percent of all American voters think that transgender troops should be allowed to serve in the military.
A handful of Republican lawmakers are fighting alongside Democrats to protect the transgender troops who are currently serving. In the Senate, Arizona Republican John McCain is co-sponsoring a new bill with New York Democrat Kirsten Gillibrand, Maine Republican Susan Collins, and Rhode Island Democrat Jack Reed to ensure that current transgender troops can continue to serve.
The issue of trans soldiers’ “deployability,” or readiness to be sent into battle at a moment’s notice, has been studied before, and the results informed the Obama administration’s decision in 2016 to open the military to trans members.
In 2015, the Department of Defense asked the RAND Corporation to study the impact of trans soldiers on readiness. The firm found that only a small number of trans soldiers — between 29 and 129 per year out of 1.3 million active-duty service members — elect to have gender-confirmation surgeries.
“Given the small numbers that we estimated, there’s going to be an even smaller number [of trans soldiers who] actually choose to have medical treatments that would impact deployability,” said Anges Schaefer, a political scientist who co-authored the study.
The most common surgery — chest reconstruction like Cook underwent — typically keeps a soldier from being deployed for 75 days, according to RAND.
“No compelling medical rationale”
RAND estimated the transition-related medical costs of trans service members were between $2.4 million and $8.4 million of the Pentagon’s annual $6.2 billion healthcare spending. By comparison, the military spends $84 million a year treating erectile dysfunction, according to an analysis by the Military Times.
The results from RAND echoed a 2014 study by the Palm Center authored by former Surgeon General Dr. Joycelyn Elders, which estimated up to 230 trans soldiers would have transition-related surgery in a given year and found “there is no compelling medical rationale for banning transgender military service.”
“Transgender military service has already been studied in depth, and every study has found the same thing.”
“Transgender military service has already been studied in depth, and every study has found the same thing,” said Aaron Belkin, director of the Palm Center. “If the secretary conducts a comprehensive, fair study, he will once again find the same conclusion: that inclusive policy promotes readiness, lethality, and cost savings — much more than discharges and closeted service do.”
Some argue that driving trans service members into the closet will be detrimental to readiness. “There is extensive literature showing that forcing service members to live a lie makes it harder for them to do their job,” Belkin added. “So the impact of being forced to live a lie isn’t just on deployability but also on overall ability to do the job.”
But while the Department of Defense studies the impact on readiness of trans troops yet again, those currently serving don’t know whether they’ll be discharged and left to find new careers in February — or what discrimination they’ll face if they’re allowed to stay.
Two combat tours
When the military first announced its plan to allow transgender service members to serve openly in 2015, Cook was in the middle of a nine-month tour in Kuwait. Even though the policy hadn’t yet changed, the announcement made Cook comfortable enough to come out as trans to his unit. He started going by male pronouns, initiated the paperwork to change his gender within the military system, and, with his commander’s approval, scheduled top surgery to complete his medical transition.
During his unit’s break after coming back from Kuwait in October 2015, he had chest reconstructive surgery, a $6,000 procedure he paid for out-of-pocket.
Within four weeks, Cook had fully healed, and he headed to his new unit in Fort Campbell. Six months later, he deployed again to Iraq for an advise-and-assist mission with the Iraqi Army. Cook said he didn’t experience any medical issues after his surgery; a co-worker said his unit continued to respect him as a core member of their team.
“No one in our [unit] was affected or impacted by [Cook’s] process, at that time, during our deployment,” said an Army sergeant who worked under Cook in Iraq but asked to remain anonymous. The sergeant described Cook as humble, loyal to his fellow soldiers, and “dedicated to his job.”
After Cook came out, some soldiers in their unit did start asking questions about his gender identity and were unsure how to address him, the sergeant said, but ultimately focused on the mission at hand. “We had bigger fish to fry,” the sergeant said.
Trump’s ban has already invited two federal lawsuits from civil rights groups that argue the directive makes the country less safe, partly by excluding dedicated and capable troops from the military.
The American Medical Association says there’s no medical reason for trans people not to serve. “The science indicates there is no medically valid reason to exclude transgender individuals from military service,” Navy veteran Jesse Ehrenfeld, now an AMA board member, told VICE News in an email.
Ehrenfeld said that during his 10-year career as a Medical Corps officer, part of his job was conducting periodic health assessments to determine whether a service member could deploy after an illness, surgery, or other medical situation. Soldiers are declared unfit to deploy for any number of health reasons, and the trans soldiers he cared for tended to have comparatively few medical issues.
“I was frankly a little surprised at the significant medical conditions of some of the soldiers, sailors, and airmen: things like chronic pain, cardiac problems, respiratory issues,” Ehrenfeld said. Compared to typical soldiers, he said, trans members of the military “have relatively minimal medical issues.”
The Department of Defense’s guidance on “Individual Medical Readiness” defines a deployment-limiting healthcare condition as “a physical or psychological condition that may interfere with a service member’s ability to perform duties while deployed.” The guidance also describes this condition as “established and not resolvable.” The DoD mandates that every soldier has “periodic” health assessments to ensure readiness.
If a soldier has a medical need or condition, they’re required to prove it’s stable and that they can manage it without electricity or readily available medical care, Ehrenfeld said. Treatments like insulin for diabetes and machines for sleep apnea, which often require electricity, sometimes disqualify a soldier from a deployment. Hormones used during gender transitions, however, do not.
In 2015, 10 percent of the U.S. Army — active-duty, reserve, and National Guard — were on medical leave and unable to deploy, according to The Army Times. That could happen for a whole host of reasons, according to Brynn Tannehill, a transgender Navy veteran and director of advocacy at SPART*A, an organization that advocates for LGBT service members, veterans, and their families.
“We have people who are non-deployable for brief periods within their military careers all the time. We don’t kick out every service member who tears their ACL playing softball on a Friday at the Squadron Picnic,” Tannehill explained. “We don’t toss out women who decide to have families. We don’t toss out people who decide to get elective surgery because they’ve got a slipped disc and it’s causing them pain.”
During Cook’s four-year career as an active-duty soldier, the only time he had been classified as non-deployable was in 2013, when a bad knee injury kept him home for a year. And although he’s been reinstated, he still has to have his knee looked at every month by a military doctor, what’s called in the military a “medical profile.”
“So I am on a permanent profile for my knee. I’m not on a permanent profile for being a trans soldier. I’m just flabbergasted. I can’t believe it’s the excuse that they’re giving,” Cook said.
Earlier this year, he also had a series of dental surgeries after an accident during a competitive volleyball game with his unit in Iraq. He had the most urgent surgery oversees and waited until the deployment was over to have the second one. The procedures set the Army back about $30,000, and he still needs a few more to fully fix his jaw.
While Trump’s order was disheartening, Cook got some good news in September. After four months of waiting for paperwork to be signed by his commanders, Cook’s gender was officially changed in the military’s identification system, meaning that finally, in the eyes of the military, Captain El Cook is a male soldier in the U.S. Army. His fellow service members and commanders have used male pronouns to address him since he came out as trans in 2015, but he can now wear a male uniform.
Cook is well aware that even though he is male in the eyes of his unit, his commanders, and now the military itself, the mere fact that he’s trans means he might have to leave the Army when Mattis decides how to carry out Trump’s order.
“Regardless of gender marker, there is no kind of guarantee whatsoever for trans service members at any stage of the process,” he said. “We’re just kind of the minority of the minority.”