It is estimated that the U.S. military is the single largest employer of transgender people in the world with about 15,500 active-duty personnel, yet whether these members of the military will be allowed to serve—and serve openly—remains a matter tied up in federal courts. A physician, combat veteran, and elected AMA leader addressed this and other pressing topics during a recent presentation at the AMA’s Chicago headquarters.

The AMA has long stood up on the policy side and in advocacy work for the needs of both service members and veterans, said that physician, AMA Chair-elect Jesse M. Ehrenfeld, MD, MPH.

During his talk, Dr. Ehrenfeld discussed the work the AMA is doing to help improve life in the military for the LGBTQ population.

One example of the AMA’s advocacy on LGBTQ issues was its action at the 2018 AMA Interim Meeting to address head on news reports about potential federal action to narrow the definition of gender.

The AMA House of Delegates adopted policy to:

Educate state and federal policymakers and legislators on and advocate policies addressing the medical spectrum of gender identity to ensure access to quality health care.

Oppose any efforts to deny an individual’s right to determine their stated sex marker or gender identity.

Affirm that an individual’s genotypic sex, phenotypic sex, sexual orientation, gender and gender identity are not always aligned or indicative of the other, and that gender for many individuals may differ from the sex assigned at birth.

Dr. Ehrenfeld is the Joseph A. Johnson Jr. Distinguished Leadership Professor of Anesthesiology, Surgery, Biomedical Informatics and Health Policy at Vanderbilt University School of Medicine.

A combat veteran who deployed to Afghanistan during Operation Enduring Freedom and Resolute Support Mission, Dr. Ehrenfeld has a unique perspective on how military medicine has impacted the nation—and continues to do so.

“My experience in the military made me a better doctor,” said Dr. Ehrenfeld, an anesthesiologist who previously served as the anesthesiology division officer at the NATO Role III Multinational Medical Unit—a forward-deployed trauma hospital in Kandahar, Afghanistan.

“Working in combat situations taught me how to work more effectively in teams in ways that even through all of my medical training, residency and working at a civilian trauma facility I still didn’t get—there is something very special about that,” he said.

While deployed, Dr. Ehrenfeld ended up caring for a transgender airman who was also serving in Afghanistan. Dr. Ehrenfeld found himself in a “unique position” to “stand up for those who could not” by advocating for that servicemember, his needs and the greater needs of the LGBTQ community.

While deployed, Dr. Ehrenfeld helped document the experiences of that airman. He contributed to a documentary, “TransMilitary,” that follows six transgender individuals in the military and the challenges they continue to face. The documentary premiered Nov. 15 on the Logo cable TV station.

Fight for open service in the military

“When I joined the military, I came in under the ‘don’t ask, don’t tell,’ policy,” said Dr. Ehrenfeld. “As a gay man, I encountered some very difficult situations until that policy was ended.”

Under the “don’t ask, don’t tell” policy, if Dr. Ehrenfeld had disclosed that he was gay, he would have been discharged. The AMA was a strong advocate for allowing gay and lesbian people to serve openly in the military, and the “don’t ask, don’t tell” policy was ended in 2011. But while that policy was repealed, the ban on transgender service was not—and it remains a moving target.

“Transgender people continue to experience discrimination and until 2016 would be discharged if diagnosed with gender dysphoria or identified as a transgender person,” said Dr. Ehrenfeld. “There is a particularly courageous transgender physician who I have come to know named Dr. Jamie Lee Henry and she is an AMA member.

“Dr. Henry is the first openly transgender active duty physician. She works at Bethesda Walter Reed and gave testimony at an AMA meeting in June of 2015 about the military’s transgender ban,” he added. “Her courage to speak up was an important part of our AMA’s decision as an association to take a stand to support transgender service members by saying that there was no medically valid reason to exclude transgender people from serving.”

The Pentagon eventually reversed the policy that banned transgender service. However, the current administration under President Trump reinstated that ban in 2017—and then implemented a different form of the ban in March 2018, albeit with an allowance for Defense Secretary James Mattis to let transgender members of the military serving openly to continue doing so. A federal appeals court in July blocked the administration from reinstituting its ban. And the Trump administration in November petitioned the U.S. Supreme Court to consider the matter, which remains in legal limbo.

“There is no medically valid reason to exclude transgender individuals from military service,” then-AMA President David O. Barbe, MD, said in response to news of the ban in 2017. “Transgender individuals are serving their country with honor, and they should be allowed to continue doing so. ... We should be honoring their service—not trying to end it.”

Dr. Ehrenfeld also highlighted the AMA’s work with helping to secure care for those suffering from post-traumatic stress disorder and traumatic brain injury. He also discussed the AMA’s role in education physicians on caring for veterans and telemedicine.

“There’s always more that can be done,” said Dr. Ehrenfeld. “The AMA is a place that has a noble mission, an incredibly rich history and does—every day—impact the lives of Americans very positively.”