Gender dysphoria treatment of ADF personnel: Informed and calm discussion needed

Media coverage concerning ADF personnel undergoing gender dysphoria treatment tends to adopt emotive, sensationalist and sometimes prurient themes. Only by noting the facts and context applying can we have commonsense discussion of any implications for the operational effectiveness of our defence force and for the medical care of the individuals concerned.


Whenever this subject attracts media attention both that coverage and public feedback tends to miss or misunderstand the facts and actual context involved.

Particularly the laws and government policies applying to all Australians, how modern defence forces actually operate and are funded, and what conditions of service and citizenship rights defence force personnel have long been entitled to.

The position of the Australia Defence Association on this issue is based on the same principles we apply when newspapers or television programs occasionally purport to be outraged by breast reconstruction surgery for female defence force personnel (which occurs at a rate of about three a year).

The ADF workforce is effectively an adult one with male representation significantly greater than other professions and industries.

Current medical research indicates that of the 0.02 to 0.05 per cent of the population that suffer a degree of gender dysphoria not all undertake a gender transition but, of those who do as adults, this ends up involving around three times more male-to-female transitions than female-to-male ones. 

With a full-time strength of around 60,000 all ranks, the tiny numbers of defence force personnel affected by gender dysphoria reflect these statistics.


Commonwealth has always provided medical & dental care for ADF personnel

The basis for any debate about an aspect of healthcare in the ADF needs to begin by noting that all full-time members of our defence force have always received medical and dental treatment for wounds, injuries and illnesses at public expense.

This is both a condition of service for the individual and a prudent investment by the nation in ensuring we have a healthy, fit and usable defence force.

Whether it is a gunshot wound, a physical illness such as measles, or a psychological illness with few or no physical symptoms or readily apparent effects, the principle is the same.

If the wounds, injury or illness prevents continued service in the defence force then a medical discharge may be necessary in the interests of both the individual and the ADF.

If the reason for a medical discharge was caused by military service, then the person concerned is entitled to continuing treatment and/or compensation at public expense under relevant legislation – as occurs in civilian life through rehabilitation and workers’ compensation arrangements.

As with other medical conditions that affect an individual's health and ability to undergo ADF recruitment, training and subsequent service, applicants for enlistment already suffering gender dysphoria are unable to enlist until the condition has been successfully treated at their and/or medicare expense.


Unfair to second-guess treating medical specialists

When defence force personnel suffer a recognised medical condition, such as gender dysphoria, this is diagnosed and treated by an appropriate combination of physicians, psychiatrists and psychologists.

It is simply invalid for others to second-guess such professional diagnoses and treatment. Or query the need for it, when they do not have the professional expertise required and do not know any of the specific diagnoses, facts or circumstances involved.


Surgery not undertaken for cosmetic reasons

We note the longstanding precedent of surgery to reconstruct the breasts of female ADF personnel for reasons of injury or illness (both physical and psychological).

Reducing breast size for OH&S reasons (chiefly to help heal injuries or illnesses, or to enable egress through escape hatches when wearing operational equipment), or increasing it for psychological confidence ones, is not "cosmetic surgery" as some media are wont to claim.

Similarly, if treating gender dysphoria involves gender reassignment surgery, such medical treatment is for a recognised psychological (and at times physical) condition. The surgery is not a procedure supposedly undergone for reasons of personal choice, whim, vanity or to satisfy purported individual "perversity".


ADF personnel have the same rights as other Australian citizens

Defence force personnel do not somehow lose their rights and entitlements as Australian citizens when they put on an ADF uniform.

As with breast reconstruction surgery, gender dysphoria treatments involving reassignment surgery undertaken for genuine medical reasons is one of the 16 psychological conditions requiring surgery covered wholly or partially for all Australians by Medicare anyway.

Contrived media and associated talkback-radio or web-borne outrage at the supposed "waste of taxpayers' money involved" is invalid.

In the case of ADF personnel, the defence force is effectively only acting as the taxpayers' agent for Medicare.


Danger of denying the existence of psychological illnesses

The Australia Defence Association is also always wary when some splashy headline, or talkback radio comment, claims or insinuates that psychological conditions are somehow not an illness and "do not deserve" medical treatment.

This attitude, for example, stopped Post-Traumatic Stress Disorder (PTSD) among war veterans being treated properly for years.

We are also very uncomfortable with how the psychological or physical recovery of the ADF personnel involved is ignored, often contemptuously, when inaccurate and insensitive media beat-ups about psychological conditions are aired.


Defence force operational capability is the priority

The ADF's core role is deterring and winning wars.

Maximising defence force utility in operational and financial terms must therefore be the focus of any debate about defence issues.

Australia has a small population and a very small defence force. Sustaining the ADF means maximising both its recruiting base and the availability and retention of its personnel.

It is generally much cheaper, and certainly much quicker, to retain someone in the Services than it is to discharge them and then have to recruit, train and develop their replacement over many years.

The more experienced and qualified the person retained, the more money and time are saved, and wider operational inconveniences (through teamwork dislocation or capability displacement) avoided.

In the case of possible discharges for medical reasons, if the cost of the medical treatment needed to retain the person is less than the financial, time and foregone operational flexibility costs of replacing them, then it would be an actual gross waste of the taxpayer’s investment in that person – and in the defence force as a whole – not to at least explore the option.


Continued ADF service depends on operational requirements, not personal wishes

Finally, there is the matter of continued defence force service after any medical treatment is completed. 

Several factors specific to our defence force need to be considered:

  • Does the person wish to remain in the ADF?
  • Is their defence force experience and skills, or their age, an issue – especially if treatment needs to be protracted?
  • Would their continued service fall inside or outside established medical, psychological, physical-fitness and deployability parameters?
  • How might their current operational specialisation and day-to-day employability be affected by a gender change?
  • What might be the effects of the gender change on military teamwork, small-group dynamics, wider unit cohesion and operational effectiveness?
  • What types of unit and deployment would be involved?
  • Would the operational capabilities, conditions and readiness requirements of such units be affected?

Both during and after completion of medical treatment, consideration of each person and their particular circumstances needs to be undertaken on a case-by-case basis.

Such consideration should not be influenced by ill-informed or prejudiced opinions espoused by some members of the public, particularly when sensationally whipped up in the media for commercial, careerist or politically-partisan reasons.


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