Citing Trump’s Order, V.A. Halts Most Transgender Care

The Department of Veterans Affairs is phasing out gender-affirming medical treatments for veterans, including hormone treatment for patients newly diagnosed with gender dysphoria, the V.A. announced on Monday.

The V.A. will continue hormone treatment for veterans who currently receive it or were receiving it when they separated from the military. The rationale is that abrupt cessation can be harmful to patients’ health.

The policy change was made to comply with an executive order by President Trump, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government,” the V.A. said in a news release.

That order states that the United States recognizes only two sexes, male and female, which “are not changeable.”

“I mean no disrespect to anyone, but V.A. should not be focused on helping veterans attempt to change their sex,” said Doug Collins, the V.A. secretary.

Transgender veterans will continue to be welcome at the V.A., he added, “but if veterans want to attempt to change their sex, they can do so on their own dime.”

The V.A. has been providing treatment for gender transition to veterans since 2011. It has never provided surgeries, but it has offered supportive services. In addition to hormone therapy, these have included mental health care, preoperative evaluations and letters supporting the need for procedures, as well as postoperative and long-term care.

Fertility services, prosthetic devices like wigs, and voice coaching were also offered. Those services had been authorized under a V.A. directive on guiding health care for transgender and intersex veterans know as 1341(4), which has been rescinded.

Many mental health providers at the V.A. have had concerns about their ability to continue providing adequate care to transgender patients after they were ordered to remove rainbow flags and lanyards, pamphlets describing services offered to L.G.B.T.Q.+ veterans, and wall posters that read “All are welcome here” and “We serve all who have served.”

Mary Brinkmeyer, a psychologist who coordinated care for L.G.B.T.Q.+ veterans at the Hampton V.A. Medical Center in Virginia, refused to remove signs and fliers. She recently resigned, fearing that mental health care for transgender veterans would be compromised.

“Our code of ethics is, ‘First do no harm,’ and if you’re caught between an institutional demand and your ethical code, you have to resolve it in favor of the ethics code,” Dr. Brinkmeyer said.

The cessation of hormone treatment, along with the recent designation of V.A. bathrooms and inpatient rooms by biological sex, “will have a real chilling effect on veterans’ willingness to seek care for gender dysphoria,” she said.

Studies indicate that gender dysphoria is much higher among veterans than among the general population and that the risk of suicide-related events is as much as 20 times higher among veterans with gender dysphoria than in the general Veterans Health Administration population.

“If veterans don’t have other health insurance — and many transgender veterans are homeless or underemployed — will they not seek care if they’re suicidal rather than go to the V.A.?” Dr. Brinkmeyer asked.