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September 30, 2016

Transgender Service in the U.S. Military

An Implementation Handbook

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Table of Contents

Background.............................................................................................. 8

Introduction ......................................................................................... 9

Policy ........................................................................................................... 10

Terms and Definitions .................................................................... 11

The Basics................................................................................................... 13

Gender Transition Approval Process Overview............................................. 14

For the Transgender Service Member.................................. 17

In-Service Transition ..................................................................................... 17

Communication ............................................................................................ 20

Finding a Mentor .......................................................................................... 20

Considerations............................................................................................... 21

Period of Adjustment ................................................................................. 21

Impact Transitioning May Have on Your Career ....................................... 21

Assignments............................................................................................... 21

Individual Medical Readiness (IMR)......................................................... 22

Physical Readiness Testing (PRT) ............................................................. 22

Privacy........................................................................................................ 22

Military Records ........................................................................................ 22

Expectation Management .......................................................................... 23

Tips for Transitioning Service Members ....................................................... 23

For the Commander.......................................................................... 25

The Commander’s Impact ............................................................................. 25

Commander’s Roles and Responsibilities....................................................... 25

In-Service Transition.................................................................................. 25

What You Should Expect From the Military Medical 

Provider (MMP) ........................................................................................... 28

Policy Implications......................................................................................... 28

Non-Military Medical Care........................................................................... 28

Military Personnel Uniform and Grooming Standards ................................. 28

Deployment ................................................................................................... 29

Physical Fitness.............................................................................................. 29

Privacy Accommodations............................................................................... 29

Military Personnel Drug Abuse Testing Program.......................................... 29

Tips for Commanders ................................................................................... 30
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For All Service Members.................................................................. 31

Understanding Gender Transition ................................................................. 31

Harassment and Bullying............................................................................... 32

Respect for Personal Information .................................................................. 32

Tips for Service Members.............................................................................. 33

Privacy ........................................................................................................... 33

Acronyms................................................................................................... 34

Bibliography........................................................................................... 35

Annex A: Questions and Answers ................................................................... 36

The Basics ..................................................................................................... 36

Health Care Issues ........................................................................................ 37

In-Service Transition Policy Issues ................................................................ 37

New Accession Policy Issues.......................................................................... 39

Recruiting................................................................................................... 39

Military Service Academy (MSA)/

Reserve Officers’ Training Corps (ROTC)................................................. 40

Annex B: Gender Transition Roadmap for U.S. Military Personnel.................. 42

Service Member Responsibilities................................................................... 42

Before Initiating Gender Transition........................................................... 42

Reserve Considerations.............................................................................. 42

During Gender Transition ......................................................................... 43

When Gender Transition is Complete....................................................... 43

After Gender Marker Change in the Service Personnel Data System ....... 43

Commander Responsibilities......................................................................... 44

Before Initiating Gender Transition........................................................... 44

During Gender Transition ......................................................................... 45

When Gender Transition is Complete....................................................... 46

After Gender Marker Change in the Service Personnel Data System ....... 47

Annex C: Scenarios........................................................................................ 48

Readiness....................................................................................................... 48

Scenario 1: Inability to Meet Standards during Transition ........................ 48

Scenario 2: Physical Standards................................................................... 49

Scenario 3: Pregnancy ................................................................................ 50

Career ............................................................................................................ 52

Scenario 4: Specialized Career Limitations................................................ 52

Scenario 5: Entry-Level Training............................................................... 53

Reserve Component....................................................................................... 54

Scenario 6: Individual Ready Reserve......................................................... 54
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Scenario 7: Standards and Exceptions to Policy ......................................... 55

Scenario 8: Satisfactory Reserve Participation............................................ 56

Scenario 9: Medical Compliance................................................................ 57

Scenario 10: Unauthorized Medical Care .................................................. 59

Privacy and Cohabitation............................................................................... 60

Scenario 11: Use of Shower Facilities......................................................... 60

Scenario 12: Urinalysis............................................................................... 61

Good Order and Discipline ........................................................................... 62

Scenario 13: Living Quarters ..................................................................... 62

Scenario 14: Proper Attire during a Swim Test.......................................... 63

Scenario 15: Living Quarters ..................................................................... 63

Real Life Experience (RLE).......................................................................... 65

Scenario 16: Attending a Unit Social Event............................................... 65

Scenario 17: Off Duty................................................................................ 66

Overseas......................................................................................................... 67

Scenario 18: Liberty Call and Personal Safety............................................ 67

Scenario 19: Assignment Considerations................................................... 68

Annex D: Additional Resources and Links ...................................................... 70

DoD Public and CAC-Enabled Websites..................................................... 70

Foreign Clearance Guide: ............................................................................. 70

Passport.......................................................................................................... 70

Service Boards for Correction of Military Records........................................ 70

Service Central Coordination Cells (SCCCs) ............................................... 71
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Transgender Service 

in the US Military: 

An Implementation Handbook

Our mission is to defend this country, and we don’t want barriers 

unrelated to a person’s qualification to serve preventing us from 

recruiting or retaining the Soldier, Sailor, Airman, or Marine 

who can best accomplish the mission. We have to have access 

to 100 percent of America’s population for our all-volunteer 

force to be able to recruit from among them the most highly 

qualified—and to retain them...Starting today: Otherwise 

qualified Service members can no longer be involuntarily 

separated, discharged, or denied reenlistment or continuation 

of service just for being transgender.

—Statement by Secretary of Defense Ash Carter 1

1 U.S. Secretary of Defense Ash Carter, “Secretary of Defense Ash Carter Remarks Announcing 

Transgender Policy Changes,” June 30, 2016.
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Background

The handbook is designed to assist our transgender Service members in their 

gender transition, help commanders with their duties and responsibilities, and 

help all Service members understand new policies enabling the open service 

of transgender Service members. The handbook includes advice, questions and 

answers, and scenarios.

This handbook outlines some of the issues faced by commanders, transgender 

Service members, and the Military Services; it does not have all of the solutions 

– individual circumstances will vary. It is an administrative management 

tool, and is not a health management tool or policy document. Additional 

key parts of this handbook include: Annex A, which contains questions and 

answers to help with understanding specific terms and words; Annex B, which 

provides step-by-step details of the gender transition process; Annex C, which 

highlights situation-based scenarios that may be useful for training situations; 

and Annex D, which provides links to additional resources. For specific policies 

refer to Department of Defense Instruction (DoDI) 1300.28,2 Directivetype Memorandum (DTM) 16-005,3 Service policies, and/or Service Central 

Coordination Cells (SCCC).4

2 DoD Instruction (DoDI) 1300.28, “In-Service Transition for Service Members Identifying as 

Transgender,” June 30, 2016. 

3 Directive-type Memorandum (DTM), 16-005, “Military Service of Transgender Service 

Members,” June 30, 2016.

4 See Annex D for SCCC contact information.
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Introduction

Sex and gender are different. Sex is whether a person is male or female through 

their biology. Gender is the socially defined roles and characteristics of being 

male and female associated with that sex. There are a number of people for 

whom these associations do not match. This feeling may arise in childhood, 

adolescence or adulthood and may result in gender dysphoria. Sometimes 

people’s gender identity does not match their sex at birth. 

Gender dysphoria is a medical diagnosis that refers to distress that some 

transgender individuals experience due to a mismatch between their gender and 

their sex assigned at birth. The condition can manifest in a person as strong and 

persistent cross-gender identification and a discomfort with their biological 

sex, or a sense of inappropriateness in the gender role of that sex. Transgender 

Service members may face challenges centered on their own personal situation 

and/or others’ unfamiliarity with gender identity issues. 
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Policy

In July 2015, the Secretary of Defense directed the Department of Defense to 

identify the practical issues related to transgender Americans serving openly in 

the military and to develop an implementation plan that addresses those issues 

consistent with military readiness. On June 30, 2016, the Secretary announced a 

new policy5 allowing open service of transgender Service members and outlined 

three reasons6 for this policy change:

■ The Army, Navy, Air Force, Marine Corps, and Coast Guard need to avail 

themselves of all available talent in order to remain the finest fighting force 

the world has ever known. The mission to defend this country requires that 

the Services do not have barriers unrelated to a person’s qualification to 

serve or preventing the Department of Defense (DoD) from recruiting or 

retaining Service members. 

■ There are transgender Service members in uniform today. DoD has a 

responsibility to them and their commanders to provide clearer and more 

consistent guidance. 

■ Individuals who want to serve and can meet the Department’s standards 

should be afforded the opportunity to compete to do so.

This handbook will explain the framework by which transgender Service 

members may transition gender while serving.

5 DoDI 1300.28 and DTM 16-005. 

6 U.S. Secretary of Defense Ash Carter Remarks, June 30, 2016.
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Terms and Definitions

The following terms are associated with open service by transgender individuals. 

The list is not all-inclusive. The definitions are consistent with those in the 

new policy.

Cross-sex hormone therapy. The use of feminizing hormones in an individual 

assigned male at birth based on traditional biological indicators or the use of 

masculinizing hormones in an individual assigned female at birth. A common 

medical treatment associated with gender transition. 

Gender dysphoria. A medical diagnosis that refers to distress that some 

transgender individuals experience due to a mismatch between their gender and 

their sex assigned at birth.

Gender identity. One’s internal or personal sense of being male or female. 

Gender marker. Data element in the Defense Enrollment Eligibility Reporting 

System (DEERS) that identifies a Service member’s gender. A Service member 

must meet all military standards associated with the member’s gender marker in 

DEERS and use military berthing, bathroom, and shower facilities in accordance 

with the DEERS gender marker.7

Gender transition is complete. A Service member has completed the medical 

care identified or approved by a military medical provider in a documented 

medical treatment plan as necessary to achieve stability in the preferred gender. 

Gender transition process. Gender transition in the military begins when a 

Service member receives a diagnosis from a military medical provider indicating 

that the member’s gender transition is medically necessary, and concludes when 

the Service member’s gender marker in DEERS is changed and the member is 

recognized in the preferred gender. 

Human and functional support network. Support network for a Service member 

that may be informal (e.g., friends, family, co-workers, social media.) or formal 

(e.g., medical professionals, counselors, clergy). 

7 While the gender marker change is reflected in DEERS, the Services’ personnel data systems are 

the means to input gender; as such, the remainder of this handbook refers to ‘Services’ personnel 

data systems’.
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Medically necessary. Those health care services or supplies necessary to prevent, 

diagnose, or treat an illness, injury, condition, disease, or its symptoms and that 

meet accepted standards of medical care. 

Non-urgent medical care. The care required to diagnose and treat problems that 

are not life or limb threatening or that do not require immediate attention. 

Preferred gender. The gender of a transgender Service member when gender 

transition is complete and the gender marker in DEERS is changed. 

Real life experience (RLE). The phase in the gender transition process when 

the individual commences living socially in the gender role consistent with their 

preferred gender. RLE may or may not be preceded by the commencement 

of cross-sex hormone therapy, depending on the individual gender transition 

medical treatment plan. The RLE phase is also a necessary precursor to certain 

medical procedures, including gender transition surgery. RLE generally 

encompasses dressing in the new gender, as well as using preferred gender 

berthing, bathroom, and shower facilities.8 

Service Central Coordination Cell (SCCC). Service-level cell of experts 

created to provide multi-disciplinary (e.g., medical, legal) advice and assistance 

to commanders with regard to service by transgender Service members and 

gender transition in the military.9 

Stable in the preferred gender. Medical care identified or approved by a 

military medical provider in a documented medical treatment plan is complete, 

no functional limitations or complications persist, and the individual is not 

experiencing clinically significant distress or impairment in social, occupational, 

or other important areas of functioning. Continuing medical care, including but 

not limited to cross-sex hormone therapy, may be required to maintain a state 

of stability. 

Transgender Service member. A Service member who has received a medical 

diagnosis indicating that gender transition is medically necessary, including any 

Service member who intends to begin transition, is undergoing transition, or 

has completed transition and is stable in the preferred gender.

8 RLE intended to occur off duty; however, exceptions to policy may be granted. Consult Service 

policy for specifics.

9 A complete listing with SCCC contact information can be found at Annex D.
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The Basics

Sex and gender are different. Sex is the assignment made at birth as male 

or female, based on anatomy. Gender identity is an individual’s internal sense 

of being male or female. Gender role or expression is the socially defined roles 

and characteristics of being male and female associated with that sex. For most 

people, gender identity and expression are consistent with their sex assigned at 

birth. However, in transgender individuals, gender identity and/or expression 

differs from their sex assigned at birth. 

Gender dysphoria is a medical diagnosis that refers to distress that some 

transgender individuals experience due to a mismatch between their gender 

and their sex assigned at birth. 

Broadly, the term “transgender person” refers to individuals whose internal 

sense of being male or female (gender identity) is different from the sex they 

were assigned at birth. Some transgender individuals feel compelled to align 

their external appearance with their gender identity and undergo transition to 

the preferred gender. Gender transition care is individualized and can include 

psychotherapy, hormone therapy, RLE, and sex reassignment surgery. 

Traditionally, society has had little understanding of what it means to transition 

gender. Many transitioning people have been subjected to hostility, ridicule, 

and discrimination. Every person has the right to have their gender identity 

recognized and respected, and all Service members who receive a diagnosis 

that gender transition is medically necessary will be provided with support and 

management to transition, within the bounds of military readiness.

Gender transition is the process a person goes through to live fully in their 

preferred gender. Gender transition in the military may present challenges 

associated with addressing the needs of the Service member while preserving 

military readiness. The oversight and management of the gender transition 

process is a team effort with the commander, the Service member, and the 

military medical provider (MMP). DoD values the contributions of all Service 

members and tries to ensure all are as medically ready as possible throughout 

their service. Individual readiness is a key to Total Force readiness.
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Gender Transition Approval Process Overview

Gender transition is highly individualized. Figure 1 outlines the main 

components. Generally, the gender transition process includes: 

■ Diagnosis and medical treatment plan received from or validated by 

an MMP;

■ Gender transition (initiate medical treatment plan, complete medical 

treatment plan, Service member requesting gender marker change); and

■ Compliance with gender standards post-gender marker change.

The process depicted is only a framework and Service members may progress 

on varying timelines. The commander, informed by the recommendations of 

the MMP, the SCCC, and others, as appropriate, will respond to the request to 

transition gender while ensuring readiness by minimizing impacts to the mission 

(including deployment, operations, training, exercise schedules, and critical skills 

availability), as well as to the morale and welfare and good order and discipline 

of the command.

Within this framework, the commander plays a key role in making 

recommendations and taking action on:

■ The timing of medical treatment associated with gender transition; 

■ Timing of RLE (e.g., non-duty hours, duty hours with an exception to 

policy (ETP))

■ Requested ETPs associated with gender transition; and 

■ A change to the Service member’s gender marker in their Service’s 

personnel data system. 
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Figure 1: Gender Transition Process

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For the Transgender Service Member

“...the reality is that we have transgender Service members 

serving in uniform today, and I have a responsibility to them 

and their commanders to provide them both with clearer and 

more consistent guidance than is provided by current policies.”

—Statement by Secretary of Defense Ash Carter10

DoD’s revised transgender Service member policy ensures your medical care 

is brought into the military health system (MHS), protects your privacy when 

receiving medical care, and establishes a structured process whereby you may 

transition gender when medically necessary.

In-Service Transition

Gender transition in the military begins when you receive a diagnosis from an 

MMP indicating that gender transition is medically necessary and concludes 

when you change your gender marker in your Service’s personnel data system. 

Your commander is a critical part of your transition and much of this section 

will highlight his/her role. The table below outlines responsibilities for both 

Active and Reserve Component Service members requesting in-service 

transition. To make a request, you must: 

10 U.S. Secretary of Defense Ash Carter Remarks, June 30, 2016.
18

Active Component & Reserve Component 

Uniformed Full-Time Support Personnel

Reserve Component 

(All Others)

1. Secure a medical diagnosis and a medical 

treatment plan from your MMP. If the 

diagnosis and treatment plan are from a 

non-military medical provider (nonMMP), you are required to notify your 

MMP at the earliest practical opportunity 

to bring your care into the MHS. Your 

MMP will review, and if appropriate 

validate the non-MMP’s diagnosis and 

treatment plan.

1. Secure a medical diagnosis and a medical 

treatment plan from your non-MMP.

2. Notify your commander of the diagnosis 

and medical treatment plan indicating 

that gender transition is medically 

necessary. Work with your commander 

and your MMP to develop a transition 

plan that includes a timeline for treatment 

and an estimated date for a change of 

your gender marker in your Service’s 

personnel data system.

2. Notify your commander of the diagnosis 

and medical treatment plan, indicating 

that gender transition is medically 

necessary. Work with your commander to 

have an MMP validate the non-MMP’s 

diagnosis and treatment plan and develop 

a transition plan that includes a timeline 

for treatment and an estimated date for 

a change of your gender marker in your 

Service’s personnel data system.

3. Notify your commander of any changes 

to the medical treatment plan, the 

projected schedule for such treatment, 

any exceptions to policy (ETP) you may 

request, and the estimated date on which 

your gender marker would be changed in 

your Service’s personnel 

data system.

3. Same as AC.

4. Obtain one of the following to change 

your gender marker in your Service’s 

personnel data system:

■ A certified true copy of a state birth 

certificate reflecting your preferred 

gender; or

■ A certified true copy of a court order 

reflecting your preferred gender; or

■ A U.S. Passport reflecting 

your preferred gender.

4. Same as AC. 
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Active Component & Reserve Component 

Uniformed Full-Time Support Personnel

Reserve Component 

(All Others)

5. Obtain your MMP’s confirmation 

that gender transition is complete.11

5. Obtain a non-MMP confirmation 

that your gender transition is complete, 

then validate with an MMP (in concert 

with commander).

6. Obtain written approval from your 

commander to change your gender marker 

in your service’s personnel data system.

6. Same as AC.

7. Submit paperwork to your personnel 

administrative office once you have all 

the required documentation and your 

commander’s written approval to obtain 

your gender marker change.

7. Same as AC.

8. Meet all applicable military standards 

in your preferred gender (to include 

using military berthing, bathroom, and 

shower facilities), when your gender 

marker is changed in your Service’s 

personnel data system.

8. Same as AC.

9. Adhere to the ongoing medical 

treatment plan developed by your 

MMP to address continuing medical 

needs, including follow-up visits related 

to continuous hormone treatment and 

routine health screening.12

9. Adhere to the ongoing medical 

treatment plan developed by your 

non-MMP to address continuing 

medical needs, including follow-up 

visits related to continuous hormone 

treatment and routine health screening.

11 In DoDI 1300.28, gender transition is complete when a Service member has completed the 

medical care identified or approved by a military medical provider in a documented medical 

treatment plan as necessary to achieve stability in the preferred gender.

12 The MMP (or non-MMP, if you are not on active duty) may determine certain aspects of your 

medical care and treatment to be medically necessary, even after your gender marker is changed 

in your Service’s personnel data system (e.g., cross-sex hormone therapy). A gender marker 

change does not prohibit you from receiving further care and treatment.
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Communication 

It is vital that you are open and honest with your leadership when discussing 

the gender transition process. This will enable you to convey your needs as well 

as address any questions or concerns from your leadership.

Communication with colleagues is equally important as they may not be 

familiar or comfortable with gender transition. It is important to remember 

that while you have had many months, probably years, to understand your need 

to transition, this may be the first time your colleagues have encountered gender 

transition. They may have difficulty understanding the reasons and the process. 

There are many ways to respectfully disclose your gender identity to your 

colleagues. How and when you wish to tell your coworkers is something you will 

need to discuss with your commander and/or your MMP. It is important to state 

what information you are open to discussing and what information you wish to 

remain private. Communication strategies could include:

■ Ask your leadership to convene a unit meeting and make an announcement 

on your behalf. Have health professionals and/or chaplains available to 

answer questions;

■ Share a letter from you with your unit;

■ Distribute a letter or notification via email; and/or

■ Make the announcement in person at a unit meeting.

Finding a Mentor

Similar to seeking a mentor to assist and guide in career/professional 

development, it may be advisable to seek a mentor to assist you in your 

transition. A mentor should be someone familiar with the process you are 

undertaking. If possible, choose someone from your peer group or military 

pay grade. If you cannot find your own potential mentor(s), consider seeking 

recommendations from your commander, a chaplain, or medical professional. 

Below are some areas where a mentor may be beneficial:

■ Providing advice on military issues related to the correct wear of your 

preferred gender uniform and related grooming issues;

■ Being a supportive sounding board;
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■ Providing frank and honest advice; and

■ Being a unit point of contact, or conduit, for questions from the workplace 

related to gender transition.

Considerations

Below are some career considerations that you may wish to take into account.

Period of Adjustment

Early on in your transition you may need to consider that adjusting your 

appearance and grooming can take some time. During this period of transition, 

it may be appropriate to discuss periods of authorized absence with your 

commander and the MMP.

For most of your transition, you should not need to use convalescent leave; 

however, you may require some time to recover from certain medical or surgical 

treatments. Accordingly, when convalescent leave is recommended, ensure 

you have coordinated with your unit leadership, administrative personnel, and 

medical personnel.

Impact Transitioning May Have on Your Career

Transitioning gender may have an impact on several different aspects of your 

career including deployability, assignment considerations, medical classification, 

and aspects of individual readiness (e.g., physical fitness, body composition 

assessment, and professional military education attendance). Since the impact to 

your career could be significant, it is strongly recommended you discuss this with 

your commander and/or mentor.

Assignments

You may need to discuss with your MMP and commander whether you want 

to transition while in your current unit or upon arrival at a new unit. There are 

advantages and disadvantages to both. The latter has the advantage of leaving 

your old life at your last duty station and arriving at your next assignment ready 

to start your new life. However, the disadvantage is that you will have to reestablish your support network in the new location.

Completing transition within a normal Permanent Change of Station cycle 

of 3-4 years is possible, but may or may not be desirable depending on your 

circumstances. Below are some issues to consider:
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■ Specialized medical care may not be available at all duty locations. 

Assignments near installations with such care may need to be considered;

■ Moving locations means potentially moving away from a stable 

environment, including medical specialists and social support. However, 

making a fresh start may be easier for some transitioning members;

■ Your duty locations may impact decisions about when to commence RLE 

in your preferred gender; and

■ Not all duty assignments will be able to support a gender transition. 

Individual Medical Readiness (IMR)

Medical care for gender transition is managed in the same way as other medical 

conditions. You may be non-deployable for some periods during your gender 

transition process. It is your responsibility to inform your leadership regarding 

your medical condition when, as a result of any medical treatment, you will be 

or have become non-deployable.13 

Physical Readiness Testing (PRT)

PRT is a fundamental requirement of your military service. You are required 

to meet the PRT standards based upon your gender marker in your Service’s 

personnel data system and in accordance with Service regulations. Similar 

to other circumstances where Service members may not meet standards, it is 

important that you consult regularly with your MMP to ensure you can meet 

standards (i.e., fitness). If you are unable to meet the standards, it may be 

necessary to request an ETP.

Privacy

Maintaining dignity and respect for all is important. You will need to consider 

both your own privacy needs and the privacy needs of others. This includes, but 

is not limited to, maintaining personal privacy in locker rooms, showers, and 

living quarters. One strategy might include adjusting personal hygiene hours. 

If you have concerns, you are encouraged to discuss them with your chain 

of command.

Military Records 

Your records prior to transition (e.g., awards, performance evaluations) are 

historical and will not be changed after completion of your gender transition. 

13 DoDI 6025.19, “Individual Medical Readiness (IMR),” June 9, 2014.
23

Your Service has a board process that may consider changes to historical military 

records.14 All records generated after your Service’s personnel data system gender 

marker is changed will reflect your preferred gender.

Expectation Management

The military developed a process to allow you to transition gender while you 

serve. Keep the lines of communication open and be patient with the process. 

Your timeline may need to be flexible due to operational requirements. 

Tips for Transitioning Service Members

The following tips have been provided by Service members from an allied 

foreign military who have transitioned gender.15

■ Honesty. “If you wish to be respected you must also give that same respect 

to your coworkers up and down the chain. How you treat others and inform 

others will be directly related to the way you are treated. It is incredibly 

hard to open up and trust people with a personal secret you have probably 

carried for your entire adult life; however from my experiences if you keep 

an open-door philosophy and answer honest questions with polite and clear 

non-emotional detail, most will accept and understand.”

■ Be professional. “The hormones you may [take] to change will have a varied 

and perhaps profound effect on not only your physical body, but more 

importantly your emotional stability. Try not to allow this to cloud or affect 

your judgement, it will be hard for some to see this happening, trust in your 

friends when they point out little slips and errors in your emotional wellbeing, they have your interests at heart!”

■ Empower those around you. “Knowledge equals power which equals 

understanding; empowering those around you to understand will help 

them feel less threatened and confused, which can assist in being treated 

with respect and understanding rather than confusion and possibly even 

contempt and hostility.”

■ Be confident. “Know yourself, make as much effort as possible to be part of 

the team and not hide or be hidden away to avoid embarrassment. Stepping 

14 See Annex D for a list of Service links to boards for correction of military records. 

15 Australian Air Force, Air Force Diversity Handbook: Transitioning Gender in the Air Force, 

April 2013, 19.
24

out in to the work arena will be hard, but the sooner you face this challenge 

the sooner your well-being can return.”

■ Trust. “Trusting others when you’re vulnerable is hard for most serving 

people. We are proud, strong, and generally rather too stubborn to allow 

others to take charge of us when we feel we can manage ourselves. The 

problem is you may not understand all that is happening around you, 

particularly with your coworkers. So listen and trust in your commanders 

based on their good sound knowledge.”

■ Planning. “Map out your transition as best you can, try and forecast as 

much as possible and pass this on to the relevant commanders. Learn and 

understand not only what’s happening now in your world, but look and 

think about where you will be and what you may need.”
25

For the Commander

“We owe commanders better guidance on how to handle 

questions such as deployment, medical treatment and other 

matters. And this is particularly true for small unit leaders, 

like our senior enlisted and junior officers.”

—Statement by Secretary of Defense Ash Carter16

The Commander’s Impact

In the course of your duties, you may encounter a transgender Service member 

who wants to transition gender. It is important that you are aware of your 

obligations and responsibilities with regard to the support and management 

of Service members who are transitioning gender. You are responsible and 

accountable for the overall readiness of your command. You are also responsible 

for the collective morale and welfare and good order and discipline of the unit 

and for fostering a command climate where all members of your command are 

treated with dignity and respect. 

Commander’s Roles and Responsibilities

In-Service Transition

When you receive a request from a Service member for medical treatment or 

an ETP associated with gender transition, you must consider the individual 

needs associated with the request and the needs of your command. The table 

below outlines your responsibilities for Active and Reserve Component Service 

members requesting in-service transition. In making a decision on the request, 

your responsibilities include:

16 U.S. Secretary of Defense Ash Carter Remarks, June 30, 2016.
26

Active Component & Reserve Component 

Uniformed Full-Time Support Personnel

Reserve Component 

(All Others)

1. Complying with the provisions of DoDI 

1300.2817 and with Military Department and 

Service regulations, policies, guidance, and 

with your SCCC, as appropriate.

1. Same as AC.

2. Evaluating a Service member’s request to 

transition gender. Ensure, as appropriate, 

a transition process that: 

■ Considers the individual facts and 

circumstances presented by the 

Service member; 

■ Considers military readiness and impacts 

to the mission (including deployment, 

operations, training, and exercise schedules, 

and critical skills availability), as well as to 

the morale and welfare and good order and 

discipline of the unit;

■ Is consistent with the medical treatment plan 

generated or validated by the MMP; and 

incorporates consideration of other factors, as 

appropriate.

2. A Service member will likely provide a 

diagnosis and medical treatment plan from 

a non-MMP. In this instance, it still must be 

validated by the MMP. Consult your chain of 

command for guidance, if required. You must 

still evaluate Service member’s request in light 

of the 3 bullets in the active duty column.

3. Reviewing a Service member’s request for 

completeness.18 If you determine the request 

to be incomplete, you must return it to the 

Service member, with written notice of the 

deficiencies identified, as soon as practicable, 

but not later than 30 days after receipt. 

3. Same as AC.

17 DoDI 1300.28.

18 Refer to Figure 1 and Service policy for completeness determination; in all cases, it will include: 

completed medical treatment plan and commander approval of request.
27

Active Component & Reserve Component 

Uniformed Full-Time Support Personnel

Reserve Component 

(All Others)

4. Responding to any requests for medical 

treatment or an ETP19 associated with 

gender transition, as soon as practicable, but 

not later than 90 days after receiving a 

request determined to be complete. Your 

response shall:

■ Be in writing; including notice of any actions 

taken by you; and 

■ Be provided to both the Service member and 

their MMP. 

4. Same as AC.

5. At any time prior to the change of the Service 

member’s gender marker in Service’s personnel 

data system, you may modify a previously 

approved approach to, or an ETP associated 

with, gender transition.

5. Same as AC.

6. Approving in writing20 the request to change 

a Service member’s gender marker in your 

Service’s personnel data system upon receipt 

of the recommendation by the MMP and the 

requisite legal documentation from the Service 

member. The Service member is then able to 

take the approval and the legal documentation 

to the personnel administrative office to obtain 

the change to the gender marker.

6. Ensuring non-MMP’s statement of 

completion is validated by an MMP, prior to 

your approval. The remaining process in active 

duty column should be followed.

7. When the gender marker in the Service’s 

personnel data system is changed:

■ Apply uniform, grooming, body composition 

assessment (BCA), PRT, Military Personnel 

Drug Abuse Testing Program (MPDATP), 

and other standards reflecting the Service 

member’s gender marker in the Service’s 

personnel data system; and

■ Direct the use of berthing, bathroom, and 

shower facilities according to the Service 

member’s gender marker as reflected in the 

Service’s personnel data system in facilities 

that are subject to regulation by the military.

7. Same as AC.

19 Your Service will determine the approval level for ETPs. Refer to Service policy or your SCCC 

if there are concerns.

20 There is no prescribed format for approving a request to change gender marker. Refer to Service 

policy or your SCCC if there are concerns.
28

What You Should Expect From the Military Medical 

Provider (MMP) 

The MMP plays a key role in the gender transition process. The MMP will:

■ Provide the medical diagnosis applicable to the Service member; list the 

medically necessary treatments, including the timing of the proposed 

treatment and the likely impact of the treatment on the individual’s 

readiness, and deployability; and

■ Formally advise you when the Service member’s medical treatment plan 

for gender transition is complete and recommend a time at which the 

gender marker may be changed in your Service’s personnel data system.

■ Validate the non-MMP’s confirmation that Service member’s gender 

transition is complete. 

Policy Implications

You have broad responsibilities to maintain your unit’s readiness. Select 

policy areas that may impact the transition process are highlighted below. 

Non-Military Medical Care

If an active duty Service member’s diagnosis and/or treatment plan are from 

a non-MMP, direct the individual to notify the MMP at the earliest practical 

opportunity to bring the care into the MHS. The MMP must consider, and if 

appropriate, validate the Service member’s diagnosis before initiating any other 

steps in the transition process. If the request is from a non-active duty Service 

member, the non-MMP diagnosis and/or treatment plan must still be approved 

by an MMP.

Military Personnel Uniform and Grooming Standards

Exceptions for uniform and grooming standards may be considered per your 

Service’s policy. You may consider current and preferred gender uniforms, form, 

fit and/or function, the Service member’s professional military image, as well as 

impact on unit cohesion and good order and discipline. If you have questions, 

refer to your SCCC.
29

Deployment

Service members will deploy if they are medically and otherwise qualified 

to do so. As with any Service member, exceptions may be considered by your 

Service and must be coordinated with the deployed commander, if unique 

medical needs exist. Individuals requiring close monitoring or ongoing care 

may not be available for deployment.

Physical Fitness

There are no separate standards for transgender Service members. Any 

exceptions to PRT standards will be administered by your Service. Individuals 

undergoing cross-sex hormone therapy may experience changes to their body 

shape and physical strength, which may have a notable effect on their ability to 

maintain standards. If that is the case, consult with the individual and the MMP 

as you would for any other Service member with a medical condition affecting 

their ability to meet physical fitness standards. 

Privacy Accommodations

If concerns are raised by Service members about their privacy in showers, 

bathrooms, or other shared spaces, you may employ reasonable accommodations, 

such as installing shower curtains and placing towel and clothing hooks inside 

individual shower stalls, to respect the privacy interests of Service members. In 

cases where accommodations are not practicable, you may authorize alternative 

measures to respect personal privacy, such as adjustments to timing of the use 

of shower or changing facilities. This should be done with the intent of avoiding 

any stigmatizing impact to any Service member. You are encouraged to consult 

with your SCCC for guidance on such measures.

Military Personnel Drug Abuse Testing Program

The MPDATP23 requires urinalysis specimens to be collected under the direct 

supervision of a designated individual of the same sex as the Service member 

providing the specimen. You have discretion to take additional steps to promote 

privacy, provided those steps do not undermine the integrity of the program. 

However, all collections must be directly observed. You are encouraged to use 

discretion and/or contact your SCCC for additional guidance. 

23 DoDI 1010.16, “Technical Procedures for the Military Personnel Drug Abuse Testing Program 

(MPDATP),” October 10, 2012.
30

Tips for Commanders 

The below tips are provided by an allied foreign military and may prove useful:24

■ Protect the service member’s privacy. Information management is 

very important.

■ Listen to the Service member’s wishes with respect to disclosure to the 

workplace and the broader community.

■ Consider consultation with the chaplain, behavioral health personnel, and 

medical providers.

■ Seek guidance and advice from other commanders and supervisors who 

have experience with individuals who transitioned gender while serving. 

■ Encourage the Service member to articulate a plan to include a timeline 

and strategy for notifying coworkers and other command personnel.

■ Assist the Service member with identifying a mentor with whom they 

are comfortable.

■ Encourage open communication. Feel free to ask questions.

■ Ensure bullying, bias, harassment, hazing, or any other unacceptable 

behavior is not tolerated.

24 Australian Air Force Handbook.
31

For All Service Members

“I am 100 percent confident in the ability of our military 

leaders and all our men and women in uniform to implement 

these changes in a manner that both protects the readiness of the 

force and also upholds values cherished by the military—honor, 

trust, and judging every individual on their merits.”

—Statement by Secretary of Defense Ash Carter25

The cornerstone of DoD values is treating every Service member with dignity 

and respect. Anyone who wants to serve their country, upholds our values, 

and can meet our standards, should be given the opportunity to compete to 

do so. Being a transgender individual, in and of itself, does not affect a Service 

member’s ability to perform their job. Previous policy, however, required 

transgender Service members to hide their gender identity and forced them 

to receive their gender-related medical care outside the MHS.

The June 30, 2016, policy allows transgender Service members to openly 

acknowledge their gender identity, brings all of their medical care into the MHS, 

allows transgender Service members to transition their gender when medically 

necessary, and allows the commander to work with the Service member and an 

MMP to implement a gender transition plan that meets the individual’s medical 

requirements and unit readiness requirements.

Understanding Gender Transition

The gender transition process is individualized. Gender transition can 

include social, medical, and legal components. Social transition, in the military 

context, will generally encompass living in the preferred gender after duty hours. 

(You may encounter a situation where you know a Service member by one 

name during duty hours and another after duty hours; this all depends on 

the individual’s transition.) Medical treatment may include behavioral health 

care, use of hormones (which may change physical appearance), and/or surgery. 

25 U.S. Secretary of Defense Ash Carter Remarks, June 30, 2016.
32

Other aspects of transition includes formally changing one’s gender with federal, 

state, and military documentation.

Some individuals prefer that very few people know they are transgender Service 

members and hope that after transition they can quietly blend in with their new 

gender. Others are committed to educating the public about gender identity, are 

eager to answer questions, and continue to talk openly about being a transgender 

Service member long after transition.

Revealing gender identity at work may be one of the last steps transgender Service 

members take to live and work in their preferred gender. By the time they inform 

their chain of command they plan to change gender, they have often been dealing 

with this issue for many years. It is also important not to “out” a transgender 

Service member (i.e., do not talk about someone else’s gender identity or status 

unless they are okay with it.) The bottom line is to treat others with the dignity, 

respect, and consideration you would like to be treated with by others.

Harassment and Bullying

Everyone plays a role in stopping bullying and harassment. You must be 

proactive and question behavior that is inappropriate at the time it occurs. 

You must report inappropriate behavior to your chain of command immediately. 

Remember, everyone is responsible for fostering the best possible command 

climate within your unit. 

The impact harassment can have on Service members should not be underestimated; 

it has the potential to affect the member both personally and professionally. 

Inappropriate jokes, attitudes, or comments that marginalize transgender Service 

members are damaging to command climate. In an environment that permits 

inappropriate jokes and behavior, transgender Service members who have not 

disclosed their status may be unlikely to seek the care they need.

Respect for Personal Information

You are responsible for upholding and maintaining the high standards of the 

U.S. military at all times and at all places. Out of respect for all Service members, 

as mentioned earlier, you should not disclose someone’s gender identity without 

their permission, unless the disclosure is made for official use.26 

26 Services retain the authority provided by law and Department and Service regulations to 

counsel, discipline, and involuntarily separate, as appropriate under the circumstances, those 

Service members who fail to obey established standards.
33

Tips for Service Members

Your social interactions and developing friendships with peers contribute to 

a positive work environment. Do not make assumptions about an individual’s 

gender or sexual orientation. Let others volunteer personal information.

Try to ensure planned social activities are inclusive of Service members and their 

families who may not fit into your perception of what is typical.

If you notice colleagues or peers are expressing opinions that may alienate others, 

speak up regarding how their statements may impact others. Often people may 

be unaware of how their statements, questions, and activities may alienate and 

offend their coworkers, team members, or staff.

You should be sensitive to the use of pronouns when addressing others. This will 

vary by individual and unit. If there is ever any question about pronoun usage, do 

not hesitate to ask the Service member how they wish to be addressed.

If you have questions or concerns, you are encouraged to talk with your chain 

of command.

Privacy

Maintaining dignity and respect for all is important. You will need to consider 

both your own privacy needs and the privacy needs of others. This includes, but 

is not limited to, maintaining personal privacy in locker rooms, showers, and 

living quarters. One strategy might include adjusting personal hygiene hours. 

If you have concerns, you are encouraged to discuss them with your chain 

of command.
34

Acronyms

AOR Area of Responsibility

BCA Body Composition Assessment

DEERS Defense Enrollment Eligibility Reporting System

DES Disability Evaluation System

DoD Department of Defense 

DoDI Department of Defense Instruction

DTM Directive-type Memorandum

ETP Exception to Policy

HT/WT Height/Weight

IMR Individual Medical Readiness

ING Inactive National Guard

IR Individual Readiness

IRR Individual Ready Reserve

MHS Military Health System

MLOA Medical Leave of Absence

MMP Military Medical Provider

MPDATP Military Personnel Drug Abuse Testing Program

MSA Military Service Academy

MTF Military Treatment Facility

PRT Physical Readiness Test

RLE Real Life Experience

ROTC Reserve Officers’ Training Corps

SCCC Service Central Coordination Cell

SELRES Selected Reserve
35

Bibliography

Australian Air Force. Air Force Diversity Handbook: Transitioning Gender in the Air Force.

Australian Air Force, 2013.

DTM 16-005, “Military Service of Transgender Service Members,” June 30, 2016.

DoDI 1010.16, “Technical Procedures for the Military Personnel Drug Abuse Testing

Program (MPDATP),” October 10, 2012.

DoDI 1215.08, “Senior Reserve Officers’ Training Corps (ROTC) Programs,” June 26, 2006.

DoDI 1215.13, “Ready Reserve Member Participation Policy,” May 5, 2015.

DoDI 1300.28, “In-Service Transition for Service Members Identifying as Transgender,” June 30, 2016.

DoDI 1332.14, “Enlisted Administrative Separations,” January 27, 2014, as amended.

DoDI 1332.18, “Disability Evaluation System (DES),” August 5, 2014.

DoDI 1322.22, “Service Academies,” September 24, 2015.

DoDI 6025.19, “Individual Medical Readiness (IMR),” June 9, 2014.

DoDI 6130.03, “Medical Standards for Appointment, Enlistment, or Induction in the Military Services,” 

September 13, 2011. 

DoDI 6490.04, “Mental Health Evaluations of Members of the Military Services,” March 4, 2013.

U.S. Secretary of Defense Ash Carter, “Secretary of Defense Ash Carter Remarks Announcing

Transgender Policy Changes,” Washington, D.C., June 30, 2016. 
36

Annex A: 

Questions and Answers

Listed below are responses to frequently asked questions organized by topic and 

applicable to multiple audiences.

The Basics 

1. What does transgender mean?

A. Transgender is a term used to describe people whose sex at birth is different 

from their sense of being male or female. A transgender male is someone 

who was born female but identifies as male, and a transgender female is 

someone who was born male but identifies as female.

2. What is gender identity?

A. Gender identity is one’s internal sense of being male or female.

3. What is gender dysphoria?

A. Gender dysphoria is a medical diagnosis that refers to distress that some 

transgender individuals experience due to a mismatch between their gender 

and their sex assigned at birth. 

4. Is being a transgender person the same as being a transvestite or 

a cross-dresser? 

A. No. “Transvestite” is an outdated term that is considered derogatory. 

A “cross-dresser” is a person who wears clothing of the opposite sex for 

reasons other than gender identity (see question #2). A transgender person 

who dresses according to their gender identity is not “cross-dressing.” 

5. What is the relationship between sexual orientation and gender identity? 

A. There is no relationship between sexual orientation and gender identity.

6. What pronouns should I use with transgender Service members?

A. This will vary by individual and unit. Transgender Service members should 

work with their unit leadership to establish correct pronoun usage. If there 

is ever any question about pronoun usage, do not hesitate to ask the Service 

member how they wish to be addressed. 
37

7. What happens when federal and state laws appear to conflict?

A. When not on federal property, Service members must abide by local laws. 

If there are any questions or concerns about how state laws may affect 

Service members and/or their dependents off federal property or in areas 

of concurrent federal and state jurisdiction, the installation legal assistance 

office should be consulted.

It is also the commander’s responsibility to ensure the safety of unit 

personnel. This includes reminding Service members of risks through use 

of safety bulletins, alerts, or briefings regarding off-installation activities. 

Additionally, judge advocate and SCCC resources are available to enhance 

risk management strategies.

Health Care Issues 

8. What hormones do transgender people need? 

A. Not all transgender Service members need cross-sex hormone therapy. 

Male or female hormones may be prescribed by medical providers in order 

for transgender Service members to develop the physical characteristics of 

their preferred gender if that is part of their transition plan.

9. What if a deployed transgender Service member loses his or 

her medications? 

A. In the event that a Service member lost his or her supply of hormones, 

and for some unlikely reason was not able to obtain replacements, any 

side effects, like irritability, decreased energy, or hot flashes, would take 

a few weeks to become evident. None of these side effects would be 

life threatening. 

In-Service Transition Policy Issues

10. Have other countries allowed transgender individuals to serve openly 

in their militaries? 

A. Yes. At least 18 countries: Australia, Austria, Belgium, Bolivia, Canada, 

Czech Republic, Denmark, Estonia, Finland, France, Germany, Israel, 

the Netherlands, New Zealand, Norway, Spain, Sweden, and the United 

Kingdom, allow transgender personnel to serve openly. 
38

11. What about Service members whose beliefs just cannot allow them to 

accept this as normal?

A. In today’s military, people of different moral and religious values work, 

live, and fight together. This is possible because they treat each other with 

dignity and respect. This will not change. There will be no changes regarding 

Service members’ ability to freely exercise their religious beliefs, nor are 

there any changes to policies concerning the Chaplain Corps of the Military 

Departments and their duties. Service members will continue to treat with 

respect and serve with others who may hold different views and beliefs.

12. What is the Service Central Coordination Cell (SCCC)?

A. Each Service has an SCCC of medical, legal, and policy experts, primarily to 

advise field commanders and medical service providers. Contact information 

for the SCCCs can be found in Annex D of this handbook. 

13. Will Reserve Component members receive any kind of medical care or 

financial assistance to pay for transition-related treatment? Can they be 

treated in a military treatment facility (MTF) throughout their transition?

A. Reserve Component members typically receive health care through private 

civilian health insurance. Those enrolled in TRICARE Reserve Select may 

be able to access mental health and hormone treatment through TRICARE 

and are eligible for care in MTFs on a space-available basis. Service 

members are encouraged to contact their civilian provider/TRICARE for 

eligibility benefits. A civilian diagnosis and medical treatment plan must be 

submitted to your chain of command and validated by an MMP. This may 

be accomplished by telemedicine if available or submission of civilian health 

documentation to an MMP for review per Service policy. 

14. How will the military protect the rights of Service members who are 

not comfortable sharing berthing, bathroom, and shower facilities with a 

transitioning Service member? Are they forced to just accept a transgender 

person living and showering with them?

A. To the extent feasible, a commander may employ reasonable 

accommodations to protect the privacy interests of Service members, 

while avoiding a stigmatizing impact to any Service member. 

Commanders are encouraged to consult with their SCCC for guidance.
39

15. How long will a Service member’s deployment eligibility be affected? Is this 

a way to get out of deployment? Can a Service member in the process of 

transitioning, which can be a lengthy process, still deploy if called upon?

A. A Service member’s period of non-deployability will vary by individual 

based on the care needed. Availability for deployment and any anticipated 

duty limitations would be part of the conversation Service members 

have with their commanders and medical providers as part of a medical 

treatment plan. Medical recommendations concerning unanticipated calls 

for deployment would be made in the same way as other medical conditions 

and as part of the pre-deployment process.

New Accession Policy Issues

Recruiting

16. Does the new policy mean the Military Services will start recruiting 

transgender applicants immediately?

A. No, policy is being revised to allow the Military Services to recruit new 

personnel no later than July 1, 2017.27 

When training of the Force is complete and the new DoDI 6130.03 is 

effective, the Military Services will begin accessing transgender applicants 

who meet all standards, holding them to the same physical and mental 

fitness standards as everyone else who wants to join the military.

Detailed accession policy can be found in in DoD DTM 16-005, “Military 

Service of Transgender Service Members.”28

17. What should a recruiter do if a transgender applicant wants to enlist, but 

the new policy is not in place?

A. A recruiter should ensure the applicant meets all standards (e.g., physical 

fitness, medical fitness) prior to being accessed. This is also a good time to 

assist the applicant in understanding the accession requirements so they 

can prepare themselves for entry once the new policy is in place.

27 DTM 16-005.

28 Ibid.
40

Military Service Academy (MSA)/

Reserve Officers’ Training Corps (ROTC)

18. Does the new accession policy mentioned above apply to the Service 

Academies and the Reserve Officers’ Training Corps (ROTC)?

A. Yes, effective July 1, 2017, the gender identity of an otherwise qualified 

individual will not bar them from joining the military, from admission 

to the MSAs, or from participating in ROTC or any other accession 

program. However, they must adhere to accession standards prior to 

being commissioned.

19. If ROTC or MSA students seek to transition during college, would they 

need to be stable for 18 months prior to commissioning?

A. Yes. An individual participant who is transgender is subject to separation 

from ROTC in accordance with DoDI 1215.0829 or from an MSA in 

accordance with DoDI 1322.22,30 based on a medical condition that 

impairs the individual’s ability to complete such training or to access into 

the Armed Forces, under the same terms and conditions applicable to 

participants in comparable circumstances not related to transgender 

persons or gender transition. ROTC and MSA cadets and midshipmen 

are required to meet medical accessions standards when they are 

appointed as commissioned officers.

20. What are the medical requirements that must be met by an MSA cadet or 

midshipman to be eligible for a commission? 

A. Cadets and midshipmen are subject to medical accession standards 

enumerated in DoDI 6130.0331 prior to being commissioned.

29 DoDI 1215.08, “Senior Reserve Officers’ Training Corps (ROTC) Programs,” June 26, 2006.

30 DoDI 1322.22, “Service Academies,” September 24, 2015.

31 DoDI 6130.03, “Medical Standards for Appointment, Enlistment, or Induction in the Military 

Services,” September 13, 2011. (Currently under revision to reflect DTM 16-005 changes.)
41

21. What are the medical requirements that must be met by a ROTC cadet or 

midshipman to be eligible for a commission? 

A. In accordance with DoDI 1215.08,32 E3.2 (Senior ROTC Programs), 

complete medical examinations must be conducted before enrollment in 

the scholarship program or at the time of or immediately before enrollment 

in Senior ROTC programs of the Army, Navy, and Air Force. Such 

examinations must, in all respects, be equal to the examination conducted 

to determine medical qualifications for appointment as a commissioned 

officer. Provided the cadet or midshipman meets the requirements in DoDI 

6130.03,33 they would be qualified to receive a commission.

22. Would a cadet or midshipman be able to undergo hormone therapy while at 

one of the MSAs or enrolled in ROTC? 

A. It depends. Cadets and midshipmen must continue to meet medical 

accession standards while at the MSA or enrolled in ROTC. If the 

standards for appointment into the U.S. Military Services are not 

maintained, an ROTC cadet or midshipman may be placed on an 

involuntary Medical Leave of Absence (MLOA) by the Service Secretary 

or designee. When an MLOA is recommended, a medical record review 

will determine whether the health-related incapacity or condition presents 

clear evidence that, following medical treatment, the cadet or midshipman 

will be unable to meet the physical standards for appointment into the U.S. 

Armed Forces within a reasonable period of time. Military Service Academy 

cadets and midshipmen who cannot meet medical accession standards and 

become medically disqualified may be disenrolled.34

32 DoDI 1215.08.

33 DoDI 6130.03.

34 DoDI 1322.22.
42

Annex B: 

Gender Transition Roadmap for U.S. Military Personnel

Below is a summary of the gender transition process for a Service member 

in accordance with the recently implemented DoD Instruction, “In-Service 

Transition for Transgender Service Members.” The roles, responsibilities, 

and courses of action available to transgender Service members and their 

commanders are described below.

Service Member Responsibilities

Before Initiating Gender Transition

Request an assessment by an MMP in order to confirm a diagnosis stating 

gender transition is medically necessary.

■ Collaborate with and assist the MMP with developing a medical 

treatment plan for submission to the commander. This plan should 

include a projected timeline for completion of gender transition, and 

estimated periods of non-deployability and absence. 

■ Notify the commander of the recommended treatment and request 

approval of the timing of the treatment plan. The written request 

should include the following: 

● Medical treatment plan outlining all medically necessary care and 

a projected schedule for such treatment; and an estimated date for 

the completion of gender transition and a gender marker change 

in the appropriate Service personnel data system. 

Reserve Considerations

■ All transgender Reserve Component Service members (except Selected 

Reserve (SELRES) Full-Time Support personnel who fall under Active 

Component rules/requirements) will submit to, and coordinate with, 

their chain of command evidence of a civilian medical evaluation that 

includes a medical treatment plan.

■ To the greatest extent possible, commanders and Service members shall 

address periods of non-availability for any period of military duty, paid 

or unpaid, during the Service member’s gender transition with a view 
43

to mitigate unsatisfactory participation through the use of rescheduled 

training or authorized absences.

During Gender Transition

■ Initiate gender transition after obtaining the commander’s approval.

■ Inform the commander of any medical issues that come up in the 

course of gender transition.

■ Notify the commander of any changes to the approved timeline of the 

medical treatment plan. 

■ Request the commander process an ETP, if necessary.

When Gender Transition is Complete

■ Through your MMP, inform the commander that gender transition is 

complete, along with a recommended time to change gender marker in 

the Service personnel data system.

■ Request the commander’s written approval to change the gender 

marker in the Service personnel data system. The request must comply 

with Service policies and must, at a minimum, be accompanied by one 

of the following legal documents to support gender change: 

● A certified true copy of a State birth certificate reflecting your 

preferred gender;

● A certified true copy of a court order reflecting your preferred 

gender; or

● A U.S. passport reflecting your preferred gender.

■ Upon receipt of the commander’s approval, submit supporting 

documentation to personnel servicing activity to change the 

gender marker in the Service personnel data system.

After Gender Marker Change in the Service Personnel Data System

■ Meet applicable Service standards of the preferred gender, including 

medical fitness, physical fitness, uniform and grooming, deployability, 

and retention standards.
44

■ Use military berthing, bathroom, and shower facilities associated with 

the preferred gender.

■ Request ETPs, as needed, from the commander.

Commander Responsibilities

Before Initiating Gender Transition

No later than 30 calendar days after receiving a Service member’s request to 

transition gender:

■ Review Service member’s request to ensure that it contains the required 

documentation in accordance with DoD and Service policies, to include 

a medical treatment plan with a projected timeline for completion 

of gender transition, estimated periods of non-deployability/absence, 

and estimated date of gender marker change; 

■ Coordinate with an MMP. If request to transition gender is from an 

RC Service member they will likely provide a diagnosis and medical 

treatment plan from a non-MMP. In this instance, it still must be 

validated by an MMP;

■ Consult with the SCCC; and

■ If the Service member’s request is incomplete, return it with a written 

notice of additional required documentation. 

No later than 90 calendar days after receiving a Service member’s 

request to transition gender:

■ Provide a written response to Service member’s request for gender 

transition or an ETP, with a copy to the MMP; and 

■ In reviewing the Service member’s gender transition request, ensure 

the decision: 

● Complies with DoD, Service policies, and guidance;

● Considers the individual facts and circumstances presented by the 

Service member;
45

● Considers the needs of the command (including deployment, 

operations, training, exercise schedules, critical skills availability, 

morale and welfare, and good order and discipline of the unit);

● Minimizes impacts to the mission and readiness by balancing the 

needs of the individual with the needs of the command;

● Is consistent with the medical treatment plan; and

● Incorporates input provided by the MMP. 

During Gender Transition

In cases where a transitioning Service member is unable to meet standards or 

requests an ETP during the gender transition, review Service policies outlining 

the actions a commander may take to balance the needs of the individual 

Service member and unit readiness. As permitted by Service policies, the 

commander may: 

■ Adjust the date on which the Service member’s gender transition, or 

any component of the transition process, will commence;

■ Advise the Service member regarding options for extended leave 

status or participation in other voluntary absence programs during 

the transition process;

■ Arrange for the transfer of the Service member to another organization, 

command, location, or duty status (e.g., Individual Ready Reserve 

(IRR)), as appropriate, during the transition process;

■ Review and forward ETP requests for application of standards for 

uniforms and grooming, PRT, and MPDATP participation;

■ Establish, or adjust, command policies on the use of berthing, 

bathroom, and shower facilities;

■ Refer for a determination of fitness in the disability evaluation system 

in accordance with DoDI 1332.18;35

35 DoDI 1332.18, “Disability Evaluation System (DES),” August 5, 2014.
46

■ Initiate administrative proceedings, comparable to actions that could 

be initiated with regard to others whose ability to serve is limited by 

medical conditions unrelated to gender transition; and

■ Consult the SCCC, with regard to: 

● Service by transgender Service members and gender transition in 

the military;

● Implementing DoD, Military Department, and Service policies and 

procedures; and

● Assessing the means and timing of any proposed medical care 

or treatment.

■ Coordinate with the MMP regarding any medical issues that arise in 

the course of a Service member’s gender transition;

■ Ensure that requests for ETPs are processed within 90 days and provide 

a written response to both the Service member and their MMP; and

■ Modify a previously approved timeline for gender transition or an ETP 

at any time prior to the change in a Service member’s gender marker in 

the Service personnel data system.

● A determination that modification is necessary and appropriate will 

be made in accordance with DoD/Service policies and procedures. 

● Notify Service member of such modification under established 

DoD procedures as described in the ‘before intitiating gender 

transition’ section at beginning of ‘commander’s responsibilities’.

When Gender Transition is Complete

■ Review a Service member’s request to change gender marker in the 

Service personnel data system to ensure that it complies with Service 

requirements, to include at a minimum: 

● A recommendation from the MMP stating that gender transition 

according to the medical treatment plan is complete and that the 

Service member is stable in the identified gender; and
47

● One of the following legal documents to effect gender change: 

● A certified true copy of a State birth certificate reflecting the 

Service member’s preferred gender;

● A certified true copy of a court order reflecting the Service 

member’s preferred gender; or

● A U.S. passport reflecting the member’s preferred gender. 

■ If the Service member’s request is complete, provide written approval 

to Service member authorizing gender marker change in the Service 

personnel data system.

After Gender Marker Change in the Service Personnel Data System

■ Apply uniform standards, grooming standards, BCA standards, PRT 

standards, MPDATP standards, and other standards according to the 

Service member’s identified gender listed in the Service personnel 

data system.

■ Direct the use of military berthing, bathroom, and shower facilities 

according to the Service member’s gender listed in the Service 

personnel data system.

■ Review ETP requests as appropriate.
48

Annex C: 

Scenarios

The following fictional cases illustrate scenarios that may be encountered when 

addressing individual issues.36 The delineation of responsibilities in each scenario 

is intended only to provide a general discussion of issues that may arise. The 

scenarios are not all inclusive, nor are they directive in nature. All personnel are 

reminded to consult with their Chain of Command, SCCC, Service, and DoD 

guidelines before determining the best course(s) of action. Commanders are 

reminded of their responsibility to ensure good order and discipline throughout 

their entire unit.

Readiness

Scenario 1: Inability to Meet Standards during Transition

A senior officer, Tony, is transitioning to become Tanya. The officer is about 

halfway through the gender transition timeline agreed upon with his military 

medical provider (MMP) and commander and is taking feminizing hormone 

therapy. The officer is aware that male standards (berthing, uniform, BCA, PRT, 

etc.) will still apply until his transition is complete. However, midway through 

hormone treatment, it becomes increasingly difficult for Tony to meet the 

male body composition and physical readiness standards. Tony’s commander 

is supportive, but several key unit training events have been scheduled over the 

next several months, making immediate accommodation difficult.

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to individual medical readiness (IMR) that may impact the ability to 

meet standards. It is essential that communication among Service member, 

commander, and the MMP is ongoing.

Service member responsibilities

■ If necessary, work with the MMP to obtain proper waiver for male 

physical readiness standards during the period of gender transition 

and ensure the commander is informed; and

36 The scenarios presented are fictitious and not intended to represent any actual person or event.
49

■ Discuss alternatives with the commander, such as rescheduled 

training events or extended leave/absence until gender transition 

process is complete.

Commander responsibilities

The commander can exercise multiple options listed below, as permitted by DoD 

and Service policies:

■ Advise Tony on the option of taking extended leave/absence during the 

gender transition process;

■ Explore the possibility of transferring Tony to another organization 

with less rigorous operational requirements;

■ Refer Tony for a determination of fitness in the disability evaluation 

system;37 or 

■ Review approved ETPs consistent with Service policies for male 

physical readiness and male body composition standards and ensure 

they are followed until the change of gender marker in the Service 

personnel data system to a female is complete.

Scenario 2: Physical Standards

A Service member has completed their medical treatment plan and is requesting 

commander approval to change their gender marker in the Service personnel 

data system. The commander has concerns about the Service member’s ability to 

meet height/weight (HT/WT) and physical readiness training (PRT) standards 

for the preferred gender.

Key takeaway(s)

This scenario illustrates the importance of ongoing communication among 

Service member, commander, and the MMP, and the requirement for the 

commander to approve in writing all gender marker change requests. This 

communication will assist the commander in determining the timing of the 

gender marker change in the Service’s personnel data system.

37 DoDI 1332.18. (USCG reference is Physical Disability Evaluation System, COMDTINST 

M1850.2 (series))
50

Service member responsibilities

■ Part of your transition process should include a provision to meet new 

HT/WT and PRT standards and consider whether an ETP will be 

required as you progress through the medical treatment plan.

■ Continue communicating with your commander and your MMP 

on your ability to meet HT/WT and PRT standards.

Commander responsibilities

■ Part of the Service member’s transition process should include a 

provision to meet new HT/WT and PRT standards as they progress 

through their medical treatment plan.

■ Counsel Service member on HT/WT requirements and personal 

fitness and the potential negative outcomes should they fail to meet 

those requirements.

■ Consult with the MMP on Service member’s ability to meet standards.

■ Consider two possible courses of action for gender maker change in 

Service personnel data system: (1) grant gender marker change with 

ETPs or (2) delay gender marker change until all standards of the 

preferred gender are met.

■ Consult DoD and Service policy as well as the SCCC. 

Scenario 3: Pregnancy

Lieutenant Marty changed his gender marker in the Service personnel data 

system from female to male after completing an approved transition plan. 

Lieutenant Marty has not had sex reassignment surgery as part of the transition 

plan and is working with his MMP on a plan to start a family. Lieutenant 

Marty approached his commanding officer a few weeks ago and mentioned 

he was pregnant. 

Key takeaway(s)

This scenario illustrates the importance of ongoing communication among 

Service member, commander, and the MMP with regard to Individual Medical 

Readiness (IMR). It also emphasizes the importance of understanding 
51

special medical care that may be required and administrative benefits resulting 

from pregnancy.

Service member responsibilities

■ It is your responsibility to notify the chain of command of any change 

to IMR.38

■ Though you have changed your gender marker in the Service personnel 

data system, there are IMR requirements that may be contrary to what 

is listed in the personnel data system (i.e., gender reflects male, however 

you have female anatomical characteristics). Health matters specific 

to anatomical characteristics still require appropriate medical review 

as they may affect your overall health and readiness, thus you will still 

require annual female examinations.

■ You will receive any/all treatment/check-ups/physicals as it relates 

to female genitalia, including, in this case, prenatal care. Upon giving 

birth, you will be entitled to all relevant medical care, administrative 

entitlements, and leave prescribed under Service policies. 

■ Be aware that colleagues may find this situation confusing. Consider 

how and when you would like to discuss the pregnancy with your 

chain of command and colleagues. 

Commander responsibilities

■ Comply with Service pregnancy policies. 

■ Understand and be prepared to address administrative entitlements 

with Lieutenant Marty (i.e., maternity leave).

■ Even though Lieutenant Marty has maintained female anatomy, he 

must be screened for pregnancy prior to deployment. If Lieutenant 

Marty became pregnant on deployment he will be transferred in 

accordance with Service policy.

■ Consider workplace communications at the appropriate time with 

consideration of Lieutenant Marty’s wishes.

■ Consult with the SCCC.

38 DoDI 6025.19.
52

Career

Scenario 4: Specialized Career Limitations

A male aviation officer with 12 years of service approaches his commanding 

officer and requests guidance on how to complete a transition from “Eric” to 

“Erica.” He has been living as a female when not on duty, and has already 

started hormone therapy, prescribed by a civilian provider, sought consultation 

for surgical transition, and is about to have a legal name change. 

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, and the importance of bringing all medical care into the 

MHS, whether a member of the Active or Reserve Component. Even though 

the Service member has received gender transition-related treatment with 

a civilian medical provider, they must have their subsequent care within the 

military health system. Finally, the scenario highlights how performance of 

duty may be limited depending on specialty/career field. 

Service member responsibilities

■ Immediately notify the flight surgeon of care received by a civilian 

medical provider.

■ You are required by policy to inform your commander of medical 

treatment that may impact your medical readiness status.

■ You have a responsibility to maintain your health and fitness, meet 

IMR requirements,39 and report medical (including mental health) 

and health issues that may affect your readiness to deploy or fitness 

to continue serving in an active/reserve status;

■ Receive a diagnosis and a treatment plan from an MMP. 

■ Provide all medical documentation from your civilian provider to 

the MMP.

■ Develop a transition timeline with the MMP and the commander. 

39 Ibid.
53

Commander responsibilities

■ Consider Service policies applicable to Service members regarding 

unauthorized medical care.

■ Direct Service member to an MMP for diagnosis and review of 

procedures already performed.

■ Consult the MMP and/or the SCCC regarding the impact of gender 

transition on the Service member’s readiness status and ability to 

perform military duties, highlighting the immediate impact to the 

officer’s ability to maintain aviation credentials.

■ Consider the timing of medical requirements in the treatment plan and 

any impacts to the mission (including deployments, operations, training 

and exercises) as well as the morale and welfare, and good order and 

discipline of the unit.

Scenario 5: Entry-Level Training

After four months, Private Lee completes recruit and combat training. She 

then reports to Ft. Sill for Military Occupational Specialty training. Upon 

arrival, Private Lee tells her Platoon Sergeant she is currently feeling distress 

as she believes she should be a man. Although she pushed herself through to 

completion, recruit training increased her distress. Private Lee has expressed 

reluctance about seeing a mental health specialist and/or medical care provider.

Key takeaway(s)

This scenario illustrates the importance of receiving a proper diagnosis from the 

MMP prior to other actions being taken. The commander has tools available to 

facilitate medical care for a Service member’s well-being and to ensure Service 

members complete initial entry training.

Service member responsibilities

■ Discuss situation with the commander.

■ Obtain an evaluation by an MMP.
54

Next, Private Lee received a diagnosis of gender dysphoria, and the commander 

is told her training will be interrupted as treatment is medically necessary. After 

one month, it is clear Private Lee’s medical condition impairs her ability to train.

Commander responsibilities

■ Consult with an MMP and determine need for a command-directed 

mental health evaluation.40

■ Consult with the SCCC.

■ Inform Private Lee potential courses of action may include: withdrawal 

from training due to her medical condition, a training delay, or an initial 

entry separation if within 180 days of accession.41

Reserve Component

Scenario 6: Individual Ready Reserve

Corporal Kennedy is a member of the IRR and does not have access to an 

MMP. He has recently completed the transition from female to male. Corporal 

Kennedy wants to be considered male by his Service. He has a new birth 

certificate showing his preferred gender.

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, whether a member of the Active or Reserve Component. Even 

though the Service member did all of their gender transition-related treatment 

with a civilian medical provider, they must still adhere to established military 

medical and personnel processes.

40 DoDI 6490.04, “Mental Health Evaluations of Members of the Military Services,” 

March 4, 2013.

41 DoDI 1332.14, “Enlisted Administrative Separations,” January 27, 2014, as amended.
55

Service member responsibilities

■ All IRR Service members have a responsibility to maintain their 

health and fitness, meet IMR requirements,42 and report to their 

chain of command any medical (including mental health) and 

health issues that may affect their readiness to deploy or fitness 

to continue serving.

■ Provide medical documentation indicating that transition is complete 

to their IRR command and ensure it is available to an MMP to confirm 

the diagnosis.

■ Provide legal documentation of gender change (i.e., certified birth 

certificate, U.S. passport, certified court order) to IRR command. 

Commander responsibilities

■ Review documentation with an MMP to ensure completeness and 

compliance with Service instructions and DoD policy.

■ If complete, provide letter authorizing gender marker change in the 

Service personnel database.

■ Consult with SCCC.

Scenario 7: Standards and Exceptions to Policy

Sergeant Rich, a Selected Reservist, informs his commanding officer that he 

has been living as a female when he is not in a drilling status. He requests to 

be called Meena; to use the female bathroom; to be held to female physical, 

uniform, and grooming standards; and to have his gender changed in his official 

military personnel file.

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, whether a member of the Active or Reserve Component. 

Even though the Service member has initiated their gender transition-related 

treatment with a civilian medical provider, they must still adhere to established 

military medical and personnel processes.

42 DoDI 1215.13, “Ready Reserve Member Participation Policy,” May 5, 2015.
56

Service member responsibilities

■ All Selected Reserve Service members have a responsibility to maintain 

their health and fitness, meet IMR requirements,43 and report to 

their chain of command any medical (including mental health) and 

health issues that may affect their readiness to deploy or fitness to 

continue serving.

■ Provide medical documentation to the MMP showing diagnosis and 

medical treatment received from civilian medical provider.

■ Upon confirmed diagnosis by the MMP, work with the MMP and 

commander to develop a transition plan.

■ Provide legal documentation of gender change (i.e., certified birth 

certificate, U.S. passport, certified court order). 

Commander responsibilities

■ Facilitate Sergeant Rich’s consultation with the MMP and discuss need 

for any ETPs that may be required.

■ Upon confirmed diagnosis by the MMP, work with Sergeant Rich and 

the MMP to develop a gender transition plan consistent with your 

unit’s operational responsibilities.

■ When transition is complete, as certified by the MMP, provide a letter 

authorizing gender marker change in the Service personnel database.

■ Ensure your unit is properly trained to accept and understand Sergeant 

Rich’s preferred gender.

Scenario 8: Satisfactory Reserve Participation

Sergeant Williams is a Selected Reserve member with an Army Reserve 

unit. He has been in consultation with his commander regarding his gender 

transition. The medical treatment portion of his gender transition will require 

him to miss up to 2 months of duty. Both the commander and Sergeant 

Williams are working through potential mitigation strategies to ensure 

he does not become an unsatisfactory participant. 

43 DoDI 6025.19.
57

Key policy takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, whether a member of the Active or Reserve Component. 

The commander also has tools available to address the Service member’s absence.

Service member responsibilities 

■ As part of the previously agreed to transition, continued communication 

with the commander is key to success.

■ Be aware of participation requirements to ensure a satisfactory year 

is achieved.

■ Consult with the commander regarding alternative training opportunities. 

Commander responsibilities 

■ You have the necessary tools to develop an initial mitigation strategy; 

options available to you include: (1) rescheduled training; (2) authorized 

absences; or (3) alternate training. 

■ Individual Service policies will detail processes and procedures required 

to use the above mitigation tools. 

■ Consult with your SCCC.

■ Ensure your unit is properly trained to accept and understand Sergeant 

Williams’ preferred gender.

Scenario 9: Medical Compliance

Airman Bristol, a Selected Reserve member with an Air Force Reserve unit, 

has an approved transition plan. She has been contemplating an unscheduled 

medical procedure between unit training assemblies. It is highly unlikely that the 

surgical procedure will require her to miss training. Airman Bristol is uncertain 

if she needs to report the procedure to her chain of command.
58

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, whether a member of the Active or Reserve Component. 

Even though the Service member has initiated their gender transition-related 

treatment with a civilian medical provider, they must still adhere to established 

military medical and personnel processes. The commander also has tools 

available to facilitate the Service member’s well-being.

Service member responsibilities 

■ You have a responsibility to maintain your health and fitness, meet 

IMR requirements,44 and report to your chain of command any medical 

(including mental health) and health issues that may affect your 

readiness to deploy or fitness to continue serving in an active status.

■ Discuss with your commander to address potential adjustments to your 

transition plan and any readiness implications.

Commander responsibilities 

■ You should prepare Airman Bristol for any potential periods of nonavailability and work with her to mitigate absences. Options available 

to you include: (1) rescheduled training; (2) authorized absences; or (3) 

alternate training.

■ Consider potential adjustments to Airman Bristol’s transition plan 

based on individual needs as well as readiness. 

■ Individual Service policies will detail processes and procedures required 

to use any of these mitigation tools.

■ You must also balance the needs of the individual and the unit in terms 

of readiness. While Airman Bristol may have great flexibility in her Air 

Force Reserve unit as to the timing of the medical procedure, this may 

not always be the case. Continued dialogue between you and Airman 

Bristol is important to individual and unit readiness. For further 

information, you should consult your chain of command and/or SCCC.

44 Ibid.
59

Scenario 10: Unauthorized Medical Care

An Active Guard/Reserve (AGR) National Guardsman has completed nearly all 

aspects of gender transition with the assistance of a civilian medical provider. His 

gender transition and medical treatment have not been disclosed to the chain of 

command. He would like to be recognized in his preferred gender.

Key takeaway(s)

This scenario illustrates the importance of notifying the commander of any 

changes to IMR, whether a member of the Active or Reserve Component. Even 

though the Service member did all of their gender transition-related treatment 

with a civilian medical provider, they must still adhere to established military 

medical procedures.

Service member responsibilities

Even though you have completed nearly all aspects of gender transition by a 

civilian medical provider, you must: 

■ By policy, inform your commander of medical treatment that may 

impact your medical readiness status. 

■ Maintain your health and fitness, meet IMR requirements, and report 

medical (including mental health) and health issues that may affect 

your readiness to deploy or fitness to continue serving in an active/

reserve status.

■ Request and receive a diagnosis and a treatment plan from an MMP.

■ Provide all medical documentation from your civilian provider to 

the MMP.

■ Develop a transition timeline with the MMP and the commander. 

Commander responsibilities

■ Consider Service policies applicable to Service members regarding 

unauthorized medical care.

■ Direct the Service member to military medical for diagnosis and review 

of procedures already performed.
60

■ Consult the MMP and/or the SCCC regarding the impact of gender 

transition on the Service member’s readiness status and ability to 

perform military duties.

■ Consider the timing of medical requirements in the treatment plan and 

any impacts to the mission (including deployments, operations, training 

and exercises) as well as the morale and welfare, and good order and 

discipline of the unit.

Privacy and Cohabitation

Scenario 11: Use of Shower Facilities

A transgender Service member has expressed privacy concerns regarding the 

open bay shower configuration. Similarly, several other non-transgender Service 

members have expressed discomfort when showering in these facilities with 

individuals who have different genitalia. 

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander. It also depicts steps a commander may 

take to permit privacy, based on Service policy.

Service member responsibilities

■ If you have any concerns about privacy in an open bay shower setting, 

you should discuss this with your chain of command.

■ Consider altering your shower hours.

Commander responsibilities 

■ You may employ reasonable accommodations when/if you have a 

Service member who voices concerns about privacy. This should be 

done with the intent of avoiding any stigmatizing impact to any 

Service member. If permitted by Service policies, some of these 

steps may include:

● Facility modifications, such as installing shower curtains and 

placing towel and clothing hooks inside individual shower stalls. 
61

● In cases where accommodations are not practicable, you may 

authorize alternative measures to respect personal privacy, such as 

adjustments to timing of the use of shower or changing facilities.

● Take proactive steps through the chain of command to ensure that 

expressions of discomfort don’t escalate into harassment or hazing. 

● Consult the SCCC for guidance on how to institute such measures. 

Scenario 12: Urinalysis

A transgender Service member is randomly selected to undergo a urinalysis test 

at their new command.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander. The commander must adhere to 

procedures outlined in the Military Personnel Drug Abuse Testing Program 

(MPDATP)45 and Service policy.

Service member responsibilities

■ Discuss your circumstances with command leadership during sign-in 

period to determine your options and allow the commander the ability 

to adjust as required/desired for your comfort and the comfort level of 

the observer, particularly if you have not undergone full surgical change.

Commander responsibilities

■ Depending on Service regulations, you may consider alternate 

observation options if a request from a transgender Service member or 

an observer is made. Options could include observation by a different 

observer or medical personnel.

■ You have discretion to take additional steps to promote privacy, 

provided those steps do not undermine the integrity of the program. 

However, all collections must be directly observed.

45 DoDI 1010.16.
62

■ Consult with the SCCC; if unable to make special accommodation, 

spend time discussing with both the observer and the Service member.

■ Ensure your observers are properly trained.

Good Order and Discipline

Scenario 13: Living Quarters

You are the leading Chief Petty Officer aboard ship. A high performing Petty 

Officer, who is transgender and completely transitioned, approaches you and 

states she can no longer tolerate her roommate. Through positive reinforcement, 

counseling, and mentorship, you attempt to resolve the issue at the lowest level 

in the chain of command. However, you notice her performance starting to 

diminish, and she and her roommate are making derogatory comments to coworkers about each other. The behavior has become disruptive to the entire unit 

and others are starting to complain. She puts in a request to be re-assigned to 

another berthing area onboard ship.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander, as well as standards of conduct. It also 

highlights existing tools available to resolve the situation.

Service member responsibilities

■ Respecting each other’s rights within a closed space is critical to 

maintaining good order and discipline.

■ Standards of conduct apply equally to all Service members. 

Commander responsibilities

■ Take an active and positive leadership approach with a focus on conflict 

resolution and professional obligations to maintain high standards 

of conduct. 

■ Counsel the individuals and encourage them to resolve their personal 

differences. Make clear to both that respecting each other’s rights within 

a closed space is critical to maintaining good order and discipline. 
63

■ If the issue cannot be resolved and alternative berthing arrangements 

can be made within command policy and without degrading good order 

and discipline of the unit, you may consider alternative arrangements.

Scenario 14: Proper Attire during a Swim Test

It is the semi-annual swim test and a female to male transgender Service 

member who has fully transitioned, but did not undergo surgical change, would 

like to wear a male swimsuit for the test with no shirt or other top coverage. 

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander. It also depicts steps a commander may 

take to permit privacy, based on Service policy.

Service member responsibilities

■ You may be comfortable with your outward appearance; however, there 

may be a period of adjustment for others. It is courteous and respectful 

to consider social norms and mandatory to adhere to military standards 

of conduct.

■ Discuss with your chain of command.

Commander responsibilities

■ It is within your discretion to take measures ensuring good order 

and discipline.

■ When administering the swim test, counsel the individual and address 

the unit, if additional options (e.g., requiring all personnel to wear 

shirts) are being considered.

■ Consult with your SCCC.

Scenario 15: Living Quarters

Following her transition (which did not include any sex reassignment surgery) 

and gender marker change in the Service personnel data system from male 

to female, Petty Officer Kelleher was assigned to a Coast Guard cutter and 
64

provided quarters in female berthing. Shortly after her arrival aboard the 

cutter, several females in Petty Officer Kelleher’s berthing area complained to 

the Command Senior Chief about being uncomfortable around Petty Officer 

Kelleher as she still has male genitalia. The Command Senior Chief approached 

the commanding officer with these complaints hoping to achieve some sort 

of resolution.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander, as well as standards of conduct. It also 

highlights existing tools available to resolve the situation.

Service member responsibilities 

■ You are not required to modify or adjust your behavior based on the fact 

you do not “match” the physical appearance of those in your berthing 

area. You must, however, follow all relevant shipboard and/or Service 

regulations commensurate with your gender.

■ If you suspect others feel uncomfortable, or begin to feel uncomfortable, 

you should immediately reach out to an appropriate member of your 

command and note your concern. Should you feel uncomfortable 

approaching your command, every effort should be made to use 

resources available through the command senior enlisted leader 

network (e.g., Command Master Chief, Command Sergeant Major).

■ The preservation of personal privacy, dignity, and respect is a 

responsibility shared by all crew members.

Commander’s responsibilities 

■ Prior to Petty Officer Kelleher’s arrival, ensure crew has received 

baseline training on policy regarding service by transgender personnel.

■ Immediately upon the gender marker change in the Service personnel 

data system, Petty Officer Kelleher will be responsible for meeting 

all applicable military standards in her preferred gender, and subject 

to regulation by the military, will use those berthing, bathroom, and 

shower facilities associated with the preferred gender.
65

■ You are responsible for the collective morale and welfare and good order 

and discipline of the unit and for fostering a command climate where 

all members of your command are treated with dignity and respect.

■ An initial approach to the complaints may entail meeting with the 

Command Senior Chief as well as the complaining members of the 

berthing area to determine the exact nature of their complaints. You 

should inform them that Petty Officer Kelleher’s assignment to female 

berthing is required regardless of her physical appearance and that their 

lack of comfort is not reason to prevent Petty Officer Kelleher from 

residing in female berthing or make her subject to treatment different 

from others.

■ Similarly, as with any other issue taking place in a berthing area that 

affects the morale and welfare and good order and discipline, you (or 

Command Senior Chief ) may also want to speak with Petty Officer 

Kelleher to inform her of the perceived problem regarding her physical 

appearance and its effect on the other members in the berthing area. 

Such a conversation should be handled very carefully; coordination with 

the SCCC is advisable to gain assistance on strategies to successfully 

engage in such communication.

■ In every case, you may employ reasonable accommodations to respect 

the privacy interests of Service members. Avoid stigmatizing actions 

that may single out any Service members in an attempt to resolve 

the complaints. 

Real Life Experience (RLE)

Scenario 16: Attending a Unit Social Event

A Service member has been undergoing transition for the last three months, 

from male to female, and his gender marker has not been changed in the Service’s 

personnel data system. Only the immediate chain of command is aware of this 

transition. The Service member desires to attend an off-post unit event dressed 

as a female.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander, as well as standards of conduct. It also 
66

highlights existing tools available to resolve the situation, as well as emphasizing 

the RLE agreement that was discussed when developing the transition plan.

Service member responsibilities

■ Your RLE should be conducted in accordance with your approved 

transition plan. If this specific situation is not addressed, discuss 

this with your commander and the MMP to potentially modify 

the transition plan. 

■ Devise a communication plan with the commander to inform unit 

members of the transition to your preferred gender prior to attending 

unit events.

Commander responsibilities

■ Maintain good order and discipline. 

■ During transition planning, discuss and document expected conduct 

to include RLE and whether ETPs may be necessary.

■ If approving the ETP, ensure the unit members are properly trained 

prior to the event. If granting an ETP is not practicable, discuss with 

the Service member and advise him not to attend such activities as a 

female until unit members are properly trained. 

Scenario 17: Off Duty

A Service member has been undergoing transition for the last three months, 

from male to female, and has not yet changed his gender marker in the Service’s 

personnel database system. The unit is aware of his transition. He is preparing 

to begin his RLE after duty hours (i.e., wearing make-up, wigs, and female 

clothing) and would like to do so in his barracks room, unit day room, and 

on the military installation. He is still using the male facilities.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander, as well as standards of conduct. It also 

highlights existing tools available to resolve the situation, as well as emphasizing 

the RLE agreement that was discussed when developing transition plan.
67

Service member responsibilities

■ Your RLE should be conducted in accordance with your approved 

transition plan. If this specific situation is not addressed, discuss 

this with your commander and the MMP to potentially modify the 

transition plan (i.e., request an ETP if necessary).

Commander responsibilities

■ During transition plan development, discuss and document expected 

conduct to include RLE.

■ Consider ETPs if requested by Service member; ensure your unit is 

aware and properly trained prior to granting an ETP.

■ Only at the Service member’s request, consider authorizing extended 

leave, transfer to IRR, ING, or Career Intermission Program/

Temporary Separation in accordance with Service policy to allow the 

Service member to live in their preferred gender and conduct RLE. 

Care should be taken to not apply any undue pressure on the Service 

member to avail himself of these voluntary options.

■ Consider notifying the installation commander that you have a 

transitioning Service member to mitigate any potential confusion 

at base access control points.

Overseas

Scenario 18: Liberty Call and Personal Safety

The USS SHIP is about to pull into port for 3 days of liberty. The diverse crew, 

which includes a transgender Service member, has been working hard in the 

Arabian Gulf and is excited about a few days off. There is concern for Service 

member safety ashore due to wide spread anti-LGBT sentiment. Additionally, 

there are criminal penalties for violations of social norms.

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander. Additionally, emphasis is placed on 

using available tools to evaluate assignments that may be potentially risky for the 

Service member. 
68

Service member responsibilities 

■ You must always remember that the laws and what is considered 

socially normal in the host country may be vastly different than 

in the U.S.

■ Pay attention to any travel warnings given at your command as a 

pre-arrival brief. You should also consult the Foreign Clearance 

Guide,46 Travel Precautions, and Information section for LGBT 

travel information for that country. 

■ You should ensure that when you visit the country that you are always 

accompanied by some of your shipmates and avoid areas that are listed 

as dangerous. Be cautious of potential risky situations and don’t do 

anything you would not do at home. 

■ You should avoid all physical displays of affection in public. 

Commander responsibilities 

■ While having a transgender Service member might be unique to your 

crew, the specific issues and concerns are analyzed similarly to any other 

safety issues that may be encountered by any member of your crew.

■ Conduct a thorough analysis of the country you are visiting prior to 

arrival. At a minimum, you should review the U.S. State Department’s 

country specific website and DoD Foreign Clearance Guide. 

■ Tailor your pre-briefs to the crew on the accepted country norms and 

places to avoid. Ensure a robust buddy system for liberty is prescribed. 

Educate your non-commissioned officers about any concerns regarding 

the port. 

Scenario 19: Assignment Considerations

A newly reported transgender female Service member arrives in the 

CENTCOM Area of Responsibility (AOR) to serve as an advise-and-assist 

mentor to women police officers. The country of assignment specifically 

requires female trainers for their female police officers. 

46 See Annex D.
69

Key takeaway(s)

This scenario illustrates the importance of open lines of communication between 

the Service member and the commander, as well as the personnel assignment 

officer. Additionally, emphasis is placed on using available tools to evaluate 

assignments that may be potentially risky for the Service member. 

Service member responsibilities 

■ You must be mindful of challenges presented by beliefs and norms 

in the AOR and how they are different than the accepted norms in 

the U.S. 

■ You may need to adjust your expectations in the event that you are 

asked to shift to a different billet in support of the mission. It is 

important to maintain a flexible mentality when working with 

foreign nations to better meet the needs of the overall mission.

Commander responsibilities 

■ This situation is unique in that close proximity with women and men in 

foreign countries may be more complicated than in the U.S. 

■ Some nations view transgender people as culturally unacceptable and 

will not recognize the individual’s preferred gender. 

■ Conduct a thorough analysis of the country prior to arrival. At a 

minimum, you should review the U.S. State Department’s country 

specific website and DoD Foreign Clearance Guide. 

■ You are encouraged to discuss this situation with your chain of 

command and the SCCC.

Proceed with caution for the safety of the Service member and the possible 

attention local media interest would generate in assigning this individual to 

the billet. The individual may need to be reassigned. 
70

Annex D: 

Additional Resources and Links

DoD Public and CAC-Enabled Websites

Public DoD website, “Department of Defense Transgender Policy”:

http://www.defense.gov/transgender

DoD CAC-enabled website:

https://ra.sp.pentagon.mil/DoDCCC/SitePages/HomePage.aspx

Foreign Clearance Guide: 

https://www.fcg.pentagon.mil/

Passport

The Department of State has established procedures allowing a person to change 

the gender on their U.S. Passport. Significantly, an amended birth certificate is not 

required. Details on this process are contained in the attached information page, found 

at this link:

http://travel.state.gov/content/passports/english/passports/information/gender.html

Service Boards for Correction of Military Records

Air Force:

http://www.afpc.af.mil/board-for-correction-of-military-records

Army:

http://arba.army.pentagon.mil/abcmr-overview.cfm

Coast Guard:

http://www.uscg.mil/legal/BCMR.asp

Navy and Marine Corps:

http://www.secnav.navy.mil/mra/bcnr/Pages/home.aspx
71

Service Central Coordination Cells (SCCCs)

Air Force:

usaf.pentagon.saf-mr.mbx.af-central-coordination-cell@mail.mil

Army:

usarmy.pentagon.hqda-dcs-g-1.mbx.sccc@mail.mil

Coast Guard:

SCCC@uscg.mil

Marine Corps:

USMC.SCCC@usmc.mil

Navy:

usn_navy_sccc@navy.mil