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VA plans to offer gender-confirmation surgery to transgender veterans, reversing ban

The Department of Veterans Affairs is moving to provide gender-confirmation surgery through its health-care coverage, reversing a 2013 ban, VA Secretary Denis McDonough announced Saturday.

McDonough pledged to overcome a “dark history” of discrimination and take steps to expand access to care for transgender veterans at a Pride Month event in Orlando, which this month marked the fifth anniversary of a mass shooting at Pulse, a gay nightclub, that left 49 people dead . The VA plans to begin the two-year process this summer, a VA spokesman confirmed.

“This time will allow VA to develop capacity to meet the surgical needs that transgender veterans have called for and deserved for a long time,” McDonough said to a crowd gathered at the Orlando event, “and I am proud to begin the process of delivering it.”

The change marks a significant departure from VA under President Donald Trump, who limited transgender people from serving in the military, a prohibition reversed by President Biden soon after he took office . In 2013, while Biden was vice president, a department directive said VA “does not provide sex reassignment surgery,” effectively preventing transgender veterans from a surgery considered medically necessary by the World Professional Association for Transgender Health .

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The federal rulemaking process, expected to begin this summer, will include a period for public comment, spokesman Terrence Hayes told The Washington Post on Saturday.

Although the cost to VA is unknown, it’s estimated that fewer than 4,000 veterans would be interested in this surgery, Hayes wrote in an email. The National Center for Transgender Equality estimates that there are about 134,000 transgender veterans.

Some people treat gender dysphoria, a feeling that the body a person is born into does not conform to one’s gender identity, with medical treatments or transition-related surgeries.

Suicidal thoughts and mental illness are experienced at a far higher rate for LGBTQ veterans than those outside the community, McDonough noted. In addition to psychological distress, they also may experience prejudice and stigma. About 80 percent of LGBTQ veterans have encountered a hurtful or rejecting experience in the military because of their gender identity, McDonough said.

Transgender veterans have reported suicidal thoughts disproportionately compared with other veterans or the general population, recent studies have found.

“We’re making these changes not only because they are the right thing to do but because they can save lives,” McDonough said in prepared remarks.

He said VA would also change the name of the Veterans Health Administration’s LGBT health program to the LGBTQ+ Health Program to reflect inclusiveness.

McDonough praised the facility he spoke at, Orlando Vet Center, sharing a story about a transgender woman who struggled with depression and suicidal thoughts until she was able to seek care.

Transgender rights emerge as a growing political flash point

Since taking office, Biden has reoriented the federal government’s posture on transgender issues, expanding protections for transgender students and reviving anti-bias safeguards in health care for transgender people.

In Florida, where McDonough spoke, Gov. Ron DeSantis (R) signed a bill this month preventing transgender athletes from participating in school sports , a move critics described as an “attack” on the community.

Noting the law signed by DeSantis, Gina Duncan, director of transgender equality for the statewide LGBTQ civil rights organization Equality Florida, told the Orlando Sentinel that her agency was “thrilled to have allies at the highest level of government.”

“In a moment of fierce state and local backlash against the transgender community, this move by the Biden administration is a reminder that elections matter,” Duncan said. “Support for transgender veterans and the lifesaving health care they need to live authentically is a critical component to fulfilling our nation’s promise of caring for those who’ve served.”

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VA Secretary Denis McDonough made the announcement about the VA planning to offer gender confirmation surgery to transgender veterans at a Pride event in Orlando, FL, last month. McDonough is shown here raising the Pride flag over VA headquarter. Photo from the Office of the Secretary of Veterans Affairs Twitter feed

WASHINGTON — With VA’s announcement that it will begin initiating the process to offer gender confirmation surgery to transgender veterans, the move highlights not only the shift between one administration and the next in how transgender individuals are treated, but also how the larger cultural conversation has changed in regard to their rights.

VA Secretary Denis McDonough made the announcement last month at a Pride event in Orlando, FL, saying it was “the right thing to do.”

“We are taking the first necessary steps to expand VA’s care to include gender confirmation surgery—thereby allowing transgender vets to go through the full gender confirmation process with VA at their side,” he declared.

Transgender veterans currently can receive all gender-confirming care at VA, with the exception of gender confirmation surgery. Servicemembers and veterans have testified before Congress about how difficult it is to receive gender-confirming care when it needs to be fragmented between military, VA and private providers, depending on what services are covered.

In 2019, seeking this type of care became more difficult for active duty servicemembers when President Donald Trump instituted a ban on all transgender individuals serving in the military. He cited the “tremendous medical costs” of gender confirmation treatment as justification for the ban. It was a position that some defense and healthcare officials said they could not support, explaining that the estimated $8 million cost was a miniscule fraction of DoD’s budget.

This image is on the VHA’s LGBTQ+ Health Program’s website: https://www.patientcare.va.gov/lgbt/

President Joe Biden reversed the ban when he entered office. He also directed the Department of Health and Human Services to prohibit discrimination on the basis of sexual orientation and gender identity by healthcare organizations receiving federal funding. This reversed a Trump-era policy that allowed these organizations to discriminate against transgender individuals. 

The new policy at VA will take time to finalize. It requires a change in the Code of Federal Regulations, which VA has warned could take as long as two years. VA plans to use that time to hire providers and develop the framework to provide a full continuum of care for those seeking gender-confirmation surgery. 

As for how many veterans that will include, VA is estimating that fewer than 4,000 veterans would be interested in this type of procedure. The department said it will work to estimate the annual cost of the rule change as they move forward with implementing it; VA officials noted, however, that the cost will vary depending on whether the veteran seeks the care in VA or through a community partner. 

This is not the first time VA has tried to change the rules banning the department from providing gender confirmation surgery. VA proposed the same rule change in 2016. However, it approached the move much more hesitantly, announcing it would be taking public comments prior to initiating the rule change. 

Before the public comment period even began, VA hit a wall of criticism from legislators and conservative critics. Many questioned whether VA had the resources and whether gender confirmation surgery—then referred to as sex reassignment surgery—was medically necessary. 

Shortly afterward, Trump began his four-year term, and the proposal to lift the ban quickly died.

VA’s recent announcement was met with much the same criticism as five years ago, with opponents focusing on tight funds and intimating that gender-confirmation surgery is not medically necessary. 

“President Biden and Secretary McDonough should be less focused on winning the culture wars and more focused on helping the veterans who are suffering from the actual wars,” declared Rep. Mike Bost (R-IL), the ranking Republican on the House Committee on Veterans’ Affairs. “Congress has been waiting for months for them to come to the table and help us deliver care and benefits to toxic-exposed veterans who are sick and dying. We have gotten no response. Yet, somehow, they found time to decide that taxpayers should pay for gender transition surgeries at VA medical facilities. This announcement clearly has more to do with advancing a radical liberal agenda than serving veterans.”

The medical literature around gender confirmation surgery has grown in the last five years, however, and studies have found the long-term mental health benefits to be significant. A 10-year longitudinal study released in August 2020 found that, for every year that passed since the surgery, the likelihood of the individual seeking mental health treatment appeared to fall by as much as 8%. 1

According to VA officials, the impetus for the rule change is rooted in serving veterans. 

“Gender-affirming procedures have been proven effective at mitigating serious health conditions, including suicidality, substance abuse and dysphoria,” a VA spokesperson explained. “Updating this policy would allow VA to provide transgender and gender diverse veterans with coordinated, medically necessary, transition-related surgical procedures. In addition, revising the medical benefits package would enable a safe, coordinated continuum of care that is veteran-centric and consistent with VA values of equity and respect for all veterans.”

• Bränström R, Pachankis JE. Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. Am J Psychiatry. 2020 Aug 1;177(8):727-734. doi: 10.1176/appi.ajp.2019.19010080. Epub 2019 Oct 4. Erratum in: Am J Psychiatry. 2020 Aug 1;177(8):734. PMID: 31581798.

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VA again delays decision on transgender surgery options

Veterans Affairs leaders will delay plans to offer expanded surgery options to transgender veterans for at least several more months as they conduct new studies into the issue, a decision a senior House Democrat called “unacceptable.”

The move comes in response to a lawsuit filed last month by the Transgender American Veterans Association, which argues department officials are endangering the health of transgender veterans by refusing to provide gender confirmation surgery .

VA Secretary Denis McDonough in June 2021 announced plans to offer the procedures, also known as gender reassignment surgeries, at some department medical centers as part of larger efforts to make VA “more welcoming” to all veterans.

But in the nearly three years since that announcement, no surgeries have been performed , and the issue remains stalled in the rulemaking process.

Transgender vets sue VA to force move on gender confirmation surgeries

The move comes on the three-year anniversary of president joe biden's repeal of the ban on transgender individuals serving in the military..

In response to the TAVA lawsuit, McDonough on Feb. 22 issued a memo saying the department has not yet decided “how and when it might ultimately provide gender affirming surgery” and that officials need to better understand how other recent rules changes — including an expansion of health care options under the PACT Act — might impact the number of veterans eligible for those procedures.

During a press conference on Monday, McDonough said he expects that review to take several months.

“I’ve said before that transgender veterans deserve world-class health care and benefits, and that gender-affirming care should be available to all vets who need it,” he said. “But we’re not ready to begin rulemaking at this point to address [gender confirmation surgeries.]”

Advocates have decried those delays. In their lawsuit, TAVA officials called the surgeries “medically necessary care” and said the failure to move ahead with the procedures “puts transgender veterans at increased risk of physical harm, psychological distress, and suicide.”

In a statement Monday, officials from the Yale Law School’s Veterans Legal Services Clinic (which filed the lawsuit along with TAVA) said that McDonough “has broken his promise to transgender veterans to provide life-saving, doctor-prescribed, transition-related surgical care” with the latest move.

On Monday, House Veterans’ Affairs Committee ranking member Mark Takano, D-Calif., echoed those concerns.

“VA has been studying the impact of gender-affirming care on the veteran community for years,” he said in a statement. “All of the studies I have read point to this type of care being important and necessary for transgender veterans. I am extremely frustrated that it has taken three years for VA to make this disappointing decision.”

Takano noted that the department’s inaction on the issue comes as transgender health care has become a target of conservative lawmakers across the country. He criticized the department for failing to lead on the issue.

“I will continue to push the secretary to make the right decision,” he said. “This unacceptable outcome cannot be the final word from this administration.”

McDonough did not give a specific end date for the latest review, but said he would “be prepared to dig into that as soon as it’s finished.”

In the past, VA officials have estimated that as many as 4,000 veterans nationwide would be interested in the procedures, also known as gender reassignment surgeries. The department does offer other support for transgender veterans, but those services have come under criticism from conservative lawmakers in recent months.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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Transgender vets sue VA to force move on gender confirmation surgeries

Advocates for transgender veterans are asking a federal court to force the Department of Veterans Affairs to move ahead with plans to provide gender confirmation surgery and other support services after years of inaction, according to a lawsuit filed Thursday.

The action from the Transgender American Veterans Association and Yale Law School’s Veterans Legal Services Clinic comes two months after the groups threatened legal action against the department and three years since President Joe Biden repealed the ban on transgender individuals serving in the military.

Advocates say despite promises from VA leadership, the department has not made any meaningful steps towards providing the critical surgeries to interested veterans.

In July 2021, VA Secretary Denis McDonough announced that the department would begin offering the procedures, also known as gender reassignment surgeries, at some department medical centers, part of a larger effort to make VA “more welcoming” to all veterans. But in the 30 months since, no surgeries have been performed, and the issue remains stalled in the rulemaking process.

After two years, still no timeline for transgender surgeries at VA

TAVA submitted a petition on the issue to department officials in May 2016, arguing the services are needed for the health and well-being of transgender veterans. Thursday’s legal filing argues that VA needs to respond to that petition within 30 days.

“Transgender veterans deserve the gender-confirmation surgery that VA has promised. At the very least, VA has a legal duty to TAVA and its members to grant or deny their rulemaking petition,” the advocates wrote in their message to the court. “Transgender veterans should not have to wait any longer.”

In the past, VA officials have estimated that as many as 4,000 veterans nationwide would be interested in the procedures, also known as gender reassignment surgeries. The department does offer other support for transgender veterans, but those services have come under criticism from conservative lawmakers in recent months.

Transgender veterans can pay for the surgeries on their own through private hospitals, but the procedures can be expensive. And advocates argue that move puts critical medical care for veterans outside their normal health coverage, causing complications with future health coordination among physicians.

Rebekka Eshler, president of TAVA, said her group did receive a response from VA leaders to their November threat of legal action, but it contained no new timelines or promises of action.

“It was basically the same language they’ve been using for the past three years,” she said. “Yes, the VA supports transgender surgeries and the things that are necessary to support transgender veterans. But at this time, they’re still reviewing the rule.”

In an interview with Military Times in November, McDonough acknowledged the delay but said he was not yet ready to move ahead with the surgeries.

“As the person who called for this and as the person who will be defending the policy when we do it, when I’m ready to move ahead, I’ll do it,” he said. “This is an important suite of care for vets.”

Eshler said the long delay has caused distrust not only among her group’s membership but also within the veteran community.

“These guys made a promise,” she said. “Did they keep their word? This is a way for VA to show all veterans that, yes, they are giving all veterans the care they deserve.”

The National Center for Transgender Equality has estimated that there are more than 134,000 transgender veterans in America today, and another 15,000 transgender individuals serving in the armed forces.

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Transgender veterans file 2nd lawsuit against VA for gender-affirming surgery coverage

An advocacy group for transgender veterans filed a second lawsuit against the federal government over its exclusion of gender-affirming surgery from health benefits for veterans. 

The lawsuit is the latest update in a yearslong effort by the Transgender American Veterans Association, or TAVA, to push the Department of Veterans Affairs to cover gender-affirming surgery — coverage that the association says the VA has been promising to provide for years. 

In 2016, TAVA filed a petition asking the VA to start the rulemaking process to amend its health benefits for transgender veterans to include gender-affirming surgery.

The VA covers nearly all transition-related care for veterans, including hormone therapy, fertility preservation, hair removal, voice training and psychosocial support. Surgery, however, is the exception. If trans veterans want to receive genital or breast surgery, among other surgical procedures, they have to pay out of pocket or use private insurance. Such surgeries are covered for active duty service members. 

TAVA filed a lawsuit in January and asked the court to compel the VA to respond to its 2016 petition within a reasonable time. The VA responded Feb. 22 and denied TAVA’s petition. 

In his letter denying TAVA’s petition, Veterans Affairs Secretary Denis McDonough said the recently enacted PACT Act — a 2022 law that expands health care benefits for veterans exposed to burn pits, Agent Orange and other toxic substances — will necessitate that the VA produce and collect new information that might require the department to submit new data on a proposed rule to cover gender-affirming surgeries. 

“Because VA is not ready at this time to initiate a rulemaking addressing the specific regulatory changes proposed in the petition, VA hereby denies the petition for rulemaking,” McDonough wrote in his letter to the Transgender Law Center attorneys representing TAVA, which was shared with NBC News. 

TAVA filed a second lawsuit Monday in the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., to challenge the VA’s denial, arguing that the denial violates the Administrative Procedure Act and the equal protection component of the Fifth Amendment, “as it amounts to unconstitutional discrimination on the basis of sex and transgender status.” 

“VA’s rejection of TAVA’s petition for rulemaking after nearly eight years of letting the petition languish — and nearly three years of promises to provide the coverage it requested — demonstrates the agency’s failure to take seriously the needs of transgender veterans, the inadequacy of the care it currently provides, and the urgent need for reform,” TAVA’s lawsuit states.

Terrence Hayes, the press secretary for the VA, said Monday the VA is unable to comment on any potential or pending litigation.

Josie Caballero, the acting president of TAVA, said her initial reaction to the VA’s rejection of TAVA’s petition for rulemaking was shock and then disappointment, because the VA has promised for years to cover gender-affirming care for trans veterans.

For example, in June 2021, McDonough announced that the department was “taking the first necessary steps to expand VA’s care to include gender confirmation surgery,” which he said would take time, CNN reported then . 

“But we are moving ahead, methodically, because we want this important change in policy to be implemented in a manner that has been thoroughly considered to ensure that the services made available to veterans meet VA’s rigorous standards of quality health care,” McDonough said at the time.

Caballero said gender-affirming surgery is medically necessary for many trans people, and, as a result, “denying access puts our lives at risk.” She said many of TAVA’s members are tired of the VA giving them the runaround. 

“We just want the VA to keep its promises — the promise of health care, the promise of being able to live with dignity and have our health care provided because we fought, we put our bodies on the line,” she said. “This is the least that this country can provide for us. And the VA should not be a barrier to providing lifesaving health care.”

For more from NBC Out, sign up for our weekly newsletter.

Jo Yurcaba is a reporter for NBC Out.

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Transgender veterans sue VA to cover gender-affirming surgeries

Natalie Kastner, an Army veteran, was hospitalized with a severed artery in 2022 after she removed her right testicle at home without formal medical training or anesthesia. Kastner served from 2006-2008 as a combat engineer at Fort Drum, N.Y. (Natalie Kastner)

WASHINGTON — A group of transgender veterans filed a lawsuit Thursday demanding the Department of Veterans Affairs provide gender-affirming surgeries.

The Transgender American Veterans Association is asking a federal appeals court judge to compel the VA to render a decision on the nonprofit’s 2016 request to reverse a regulation that excludes gender-affirming surgeries from the care that the VA provides. Gender-affirming surgery involves changing a person’s physical appearance and sexual characteristics.

The court on Thursday ordered VA Secretary Denis McDonough to submit a brief in response to the association’s lawsuit within 14 days.

Veterans seeking the surgery must now pay out of pocket and obtain care at a non-VA facility, according to the suit.

The VA already provides veterans with hormone therapy and other medical treatment related to gender dysphoria, a mental-health condition diagnosed in people whose gender identity does not match their sex at birth, the lawsuit states.

“The rule has been sitting on the VA secretary’s desk, and nothing has changed. What is the holdup?” said Rebekka Eshler, president of TAVA, which held a news conference Thursday to announce the lawsuit.

Without VA coverage, many transgender veterans cannot afford the surgery, said Eshler, who served as an Army fire-support specialist from 2012 to 2015 at Joint Base Elmendorf-Richardson in Alaska.

There are more than 160,000 veterans who are transgender, and many of them use the VA for health care, according to the association.

“Transgender veterans should not have to wait any longer,” the lawsuit states. “At the very least, VA has a legal duty to TAVA and its members to grant or deny their rulemaking petition.”

Gender-affirming surgery can cost between $50,000 and $130,000, according to the Yale Law School Veterans Legal Service Clinic, which represents TAVA.

McDonough announced in 2021 that the VA was taking steps to expand VA care to include gender-reassignment surgery, “thus allowing transgender vets to go through the full gender-[affirmation] process with VA by their side.”

“This proposed rule is continuing through VA’s rulemaking process and is being considered carefully and thoroughly, with full understanding of its importance and urgency,” said Terrance Hayes, the VA press secretary.

He said a policy change for the surgery needs to be implemented “in a manner that has been thoroughly considered to ensure services to veterans meet the VA’s rigorous standards for health care.”

The VA initiated a cost-benefit analysis of the procedure and received public comment about providing gender-affirming surgery, according to the lawsuit. Yet the VA failed to issue a decision or make the procedure available at VA hospitals.

Ann Murdoch, former TAVA president, is a retired Army lieutenant colonel and Bronze Star recipient who served for 24 years, including in Afghanistan. Prior to her retirement in 2013, Murdoch worked at the Pentagon.

Murdoch discussed at Thursday’s news conference the toll that gender dysphoria had on her mental health, and she suffered from depression and considered suicide.

“I knew from an early age that the girl on the inside did not match the body on the outside,” Murdoch said. “Fortunately, I did have private resources and support of family able to access life-saving surgical intervention.”

The lawsuit also described the experiences of Natalie Kastner, an Army veteran with gender dysphoria.

Kastner was hospitalized with severe blood loss from a severed artery in March 2022 after she removed her right testicle at home “without formal medical training,” the lawsuit states.

“I wanted to fix myself. I had no option. I had no hope,” said Kastner, a 39-year-old disabled Army veteran who lives on a fixed income. Kastner, a former combat engineer, was honorably discharged in 2008 after serving for two years at Fort Drum, N.Y.

Kastner said she acted out of desperation because she could not afford to pay out of pocket for the surgery.

“I tried to perform my own gender-affirming surgery at home, without any medical training. Were it not for emergency room care, I would have lost my life,” she said.

Support for gender-affirming surgery from the American Medical Association and American Psychiatric Association, according to the lawsuit.

“Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people,” according to the AMA.

The American Psychiatric Association has stated “medical research demonstrates the effectiveness and necessity of mental-health care, hormone therapy and sex reassignment surgery for many individuals diagnosed” with gender dysphoria.

previous coverage

• Veterans can now identify as transgender, nonbinary on their VA medical records
• Trans veterans seek VA coverage for surgery, but agency still drafting proposed rules

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Yale veterans clinic sues VA over gender confirmation surgery

Students at the Yale University School of Law sued the U.S. Department of Veterans Affairs in federal court to force the agency to cover gender confirmation surgery for transgender veterans.

It’s the second time the veterans clinic is taking the VA to court over the rights of transgender veterans. In February, the VA denied a request to start the formal rulemaking process that would provide gender confirmation surgeries.

In court documents filed Monday, the Transgender American Veterans Association (TAVA) said the VA's denial of the rulemaking process was unconstitutional and discriminatory based on sex and transgender status.

“[The VA has] promised time and again that providing gender confirmation surgery is a top priority for them, and have not acted on that promise,” said Sophie Park, a member of the team that represents TAVA.

Park said gender confirmation surgery can be "life-saving" for patients who experience gender dysphoria.

“This will be such an important step towards inclusive care and making sure trans veterans feel cared for and safe.”

When the VA denied the rulemaking petition, Sec. Denis McDonough said the VA was still collecting necessary information in light of the passage of the PACT Act, the massive expansion of veteran benefits with health problems related to toxic exposure.

Clinic Lawsuit Challenges VA Denial of Gender-Affirming Surgery

Today, the Transgender American Veterans Association (TAVA) filed a second federal lawsuit against the U.S. Department of Veterans Affairs (VA), challenging VA’s denial of TAVA’s 2016 rulemaking petition requesting gender-affirming surgery. VA’s denial comes after nearly eight years of delay — and after nearly three years of Secretary of Veterans Affairs Denis McDonough publicly promising to provide the care it requested. TAVA’s lawsuit contends that VA’s refusal to provide necessary medical care reneges on its public promise and violates the Administrative Procedure Act, the Constitution, and Section 1557 of the Affordable Care Act. 

TAVA is represented in the lawsuit by the Yale Law School  Veterans Legal Services Clinic .

TAVA’s lawsuit challenges VA’s denial of its rulemaking petition, which maintains its refusal to provide gender-affirming surgery at VA. The lawsuit follows an earlier one filed by TAVA in January 2024, which sought a court order that VA act on TAVA’s 2016 rulemaking petition requesting gender-affirming surgery. In response, VA breached its commitment to make gender-affirming surgery available by denying TAVA’s petition.

“TAVA will not stand idly by as VA continues to discriminate against and breaks its promises to transgender veterans,” said Josie Caballero, Acting President of TAVA. “VA’s refusal to provide gender-affirming surgery is an affront to the dignity and well-being of transgender veterans. Gender-affirming surgery is not a choice for many transgender individuals — it’s often a critical part of our care that healthcare professionals consider medically necessary. Denying us access to these puts our lives at risk.”

“It is an insult to transgender veterans who have served our country honorably, only to be denied the same healthcare services other veterans receive,” said Bekky Eshler, President of TAVA. “Transgender veterans are entitled to equal treatment. We deserve to be treated with respect and compassion. It is well past time for the VA to ensure that all veterans have access to the complete slate of healthcare services they need and deserve. TAVA is not giving up this fight, and VA is not off the hook.”

VA’s denial endangers the health and well-being of many of the nation’s 163,000 transgender veterans, according to the filing. In its lawsuit, TAVA explains that gender-confirmation surgery dramatically reduces the risks of suicidal ideation, depression, and psychological distress for transgender people who live with gender dysphoria. For years, medical professionals, scientific researchers, veterans service organizations, civil rights groups, former military officials, and political figures in both local and federal governments have urged VA to provide adequate gender-affirming care, which includes gender-confirmation surgery.

“Why has Secretary McDonough turned his back on the thousands of veterans who have been denied life-saving health care their VA doctors recommend?” said Jack Baisley ’25, a law student intern with the Yale Law School Veterans Legal Services Clinic. “VA has a legal responsibility to provide comprehensive and inclusive healthcare to all veterans, regardless of gender identity. There is no good excuse for VA’s refusal to provide transgender veterans access to equal care. By denying transgender veterans access to gender-affirming surgery, VA is failing to fulfill its duty to those who have served our country.” 

The lawsuits ask the courts to review VA’s denial of TAVA’s 2016 rulemaking petition and direct VA to provide gender-affirming surgery.

Transgender American Veterans Association (TAVA) is a nationwide, nonpartisan, nonprofit organization that works to ensure its members receive full services and dignified treatment from the VA and to provide a supportive community for all veterans who identify under the “Transgender Umbrella.” 

The Veterans Legal Services Clinic , which represents the petitioner, is part of the Jerome N. Frank Legal Services Organization at Yale Law School.

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Transgender Cosmetic Surgery

Gender reassignment surgery is becoming more popular as many patients with gender dysphoria are seeking to achieve the outward appearance of the sexual persona that they feel they possess inside. The procedures performed in order to achieve the secondary characteristics of the desired sex are called transgender cosmetic surgery, and they can be done either before or after sexual reassignment surgery (SRS). Gender reassignment is a complex process that involves psychological, physiological, and physical changes. While there is considerable debate about the types and classifications of this condition, the general consensus is that medical and surgical gender transition remains one of the best treatment options for patients with gender dysphoria.

The SRS procedures performed in a male-to-female transgender patient includes vaginoplasty, clitorolabioplasty, penectomy and orchidectomy. In the female-to-male patients, the procedures include oophorectomy, hysterectomy, and penile and scrotal reconstruction. These are the core or primary procedures in gender reassignment surgery. Although sexual reassignment surgery (SRS) is appropriate for some, for many others, this may not be possible or desirable. Some gender dysphoric patients may simply wish to have the outward appearance of the opposite sex. These procedures are considered secondary operations in the process of gender reassignment.

A wide range of secondary operations help achieve this goal for the gender dysphoric patient. Many of these operations involve the face. Of paramount importance in identity development, the face forms the basis for creating personality and emotional foundation of an individual. Other secondary operations deal with the body and are especially important in completing the transition for these patients.

In male-to-female patients, a number of procedures are performed to change the sexual appearance of the patient. These procedures are often performed after the patient has had hormonal therapy and has undergone electrolysis and laser hair removal of the face and body.

A partial list of these procedures is provided below:

• Rhytidectomy
• Platysmaplasty
• Tracheal shave
• Facial fat grafting
• Rhinoplasty (nasal reshaping)
• Brow lift with or without forehead contouring
• Blepharoplasty
• Cheek, chin, and jaw surgery
• Scalp advancement and micro-hair grafting
• Lip surgery (lifting or augmentation)

Body contour operations help achieve a more feminine shape. Breast augmentation may be performed during the primary SRS operation or separately. If performed before the SRS operation, a complete psychological assessment has to be done, and the patient is expected to have been on hormone replacement drugs for some time prior to this operation.

A partial list of secondary body contour operations in male-to-female transgender operations is provided below:

• Breast augmentation
• Liposuction (removal of love handles)
• Fat grafting of buttock, thighs, and lower waist to create a more feminine shape
• Removal of 11th and 12th rib cartilages to create a more hourglass female shape

Female-to-male patients, likewise, undergo psychological evaluation and receive hormonal therapy prior to undergoing surgery. Primary operations for gender reassignment in this group include removal of the uterus and ovaries, closure of the vagina, phalloplasty, creation of a scrotal sack and placement of testicular implants, and mastectomy.

Apart from altering the hairline with electrolysis and laser hair removal, a partial list of procedures designed to create secondary sexual characteristics in female-to-male patients are listed below:

• Brow contouring for creation of frontal bossing
• Rhinoplasty
• Micro-hair grafting
• Lip surgery
• Contouring of cheek, chin, and jaw to create a more masculine facial structure

Body contouring procedures designed to alter the female shape to a more masculine shape are as follows:

• Mastectomy with repositioning of the nipple areolar complex as needed
• Nipple and areolar reduction
• Liposuction
• Body fat grafting for creating a more masculine shape
• Muscular implants
• Mirco-hair restoration as needed

The choice of which operation to do first will depend on the complexity of the procedure. These procedures are often combined, but, ultimately, a multi-staged operation may be necessary given the complexity of the operations that need to be performed. Dr. Marefat will discuss with you the best course of action specifically suited to your particular condition.

How do I get started with transgender cosmetic surgery in Virginia?

Dr. Marefat and the staff at Metropolitan Plastic Surgery would be happy to help you set up a private consultation to discuss transgender cosmetic surgery in Virginia.  Schedule an appointment  online or call one of our locations at 703-516-7600 (Arlington area) or at 703-560-9583 (Woodbridge).

Are there financing options for transgender cosmetic surgery treatments in Virginia?

Dr. Marefat offers a number of financial assistance programs and payment programs to cover the cost of transgender cosmetic surgery treatments in Virginia. Please visit the  patient financing section  of our website for more details or ask the staff at Metropolitan Plastic Surgery about these options so that you can get started with transgender cosmetic surgery treatments in Virginia today.

Gender-Confirmation Surgery

Everyone wants to feel authentic and comfortable in their own skin. For some people, that means having the physical look and feel of their gender identity. Transgender surgery includes several types of gender-affirmation procedures that can help you feel at ease in your body.

Transgender Surgery at UVA

At UVA, you’ll get care from one of the leading providers of gender-confirming procedures in the region. You’ll find compassionate surgeons with expert skill. In our supportive, inclusive environment, we’ll work with you to identify your goals and address your fears and concerns.

Your journey through the gender affirmation can be deeply personal and life-changing. We’re here to help make the process as comfortable as possible. Our methods aim to minimize scars, pain, and recovery time. We work for results that will please and empower you.

Gender-Confirmation Surgery at UVA

At UVA, our transgender surgeons understand the importance of aligning your physical appearance with your gender identity. Plastic and reconstructive surgeon JT Stranix, MD, and urologist Sean Corbett, MD, discuss the commitment and care offered by UVA's transgender surgery specialists. View transgender surgery transcript.

Gender-Confirmation Procedures

Transgender surgery includes:

• Top surgery
• Bottom surgery
• Facial surgery

In these procedures, we add or remove sex characteristics and features so that your physical appearance matches your gender identity. Top surgery removes or adds breasts. Bottom surgeries remove and construct genitalia. Facial plastic surgery adjusts and shapes the structure of your face to look more masculine or feminine.

Our expertise covers several options for both:

• Transgender women wanting male-to-female MTF surgery
• Transgender men wanting female-to-male FTM surgery

People who identify as nonbinary, intersex, and gender fluid may also benefit from some of these procedures.

Read our transgender surgery FAQs .

Gender-Affirming Surgery Prep

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University of Virginia Plastic Surgery 1300 Jefferson Park Avenue 4th Floor Charlottesville, VA 22908 Phone: (434) 924-1234 Location Hours: Monday–Friday | 8 a.m.–5 p.m.

Considering Transgender Surgery? Here’s What You Need To Know

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• Transgender Surgery

Choosing to undergo  transgender surgery  is a very personal, life-altering decision. Patients often report long-term mental health benefits and reduced gender dysphoria distress after the procedure. However, like any surgery, you should head into treatment with clear knowledge and expectations. If you’re considering transgender surgery here in Virginia or beyond, here are a few important facts you should know.

What Is Transgender Surgery?

Transgender surgery (also known as gender affirming surgery) is a procedure that  alters a person’s appearance  to better resemble their identified gender. There are a variety of procedures that can sculpt and shape the body to create a more feminine or masculine look.

Different procedures can be combined in various ways to provide flattering, natural-looking results. The team at UVA Plastic Surgery is proud to be one of the pioneers in the field of transgender surgery and offers the latest in gender-confirming care.

Top Surgery

Top surgery addresses the upper half of the body with a focus on contouring the chest. It typically involves either  breast augmentation  or  breast reduction  procedures.

• Chest feminization:  Silicone implants are placed to create larger, more feminine breasts.  Fat grafting  is routinely used to enhance the look and feel of the results.
• Chest masculinization:  Breast tissue is permanently removed to create a firmer, flatter chest. Most often this is removed directly with a double incision approach, but sometimes may be done with liposuction alone. The areolas are often resized and repositioned for a more masculine appearance.

Bottom Surgery

Bottom surgery transforms the genitals to match an individual’s gender identity using advanced reconstructive techniques. Every genital procedure is specifically tailored to each person’s goals and identity.

• Feminizing Genital Surgery:  Used to create the most aesthetically pleasing vulva and functional vagina possible. Scrotal and penile tissue is converted into vulva and may also be used to construct a vaginal canal if receptive intercourse is desired. Full depth vaginoplasties are routinely performed with peritoneal flaps and robot-assisted dissection.

Masculinizing Genital Surgery:  Phalloplasty uses tissue from either the forearm or the thigh to create a new phallus and urethra in two to three stages. Metoidioplasty converts an enlarged clitoris into a phallus in a single procedure. Vaginectomy, urethral lengthening, glansplasty, and scrotoplasty are performed during the second stage of phalloplasty, but are often performed in a single stage with metoidioplasty. Hysterectomy is typically performed prior to these procedures.

Facial Surgery

Facial surgery can sculpt your face into a more feminine or masculine appearance. The procedure is highly customizable depending on your unique aesthetic goals.

• Facial Feminization:  Creates a softer, more rounded appearance via hairline modification,  rhinoplasty , jawline reshaping, and other treatment options.
• Facial Masculinization:  Forms a well-defined chin and angular features with carefully placed implants and Adam’s apple enhancement.

How Do I Prepare for Gender Confirmation Surgery?

Many providers will require that you gather the proper paperwork before scheduling your gender affirmation procedures. We follow WPATH surgical guidelines and those requirements must be fulfilled prior to scheduling your appointment. If you need assistance with this process, we are more than happy to provide personalized help and resources to guide you through the process.

You should continue taking any hormone replacement therapy as prescribed throughout the process. Surgery will not be offered to individuals who are actively smoking, vaping, or using or tobacco of any kind as it significantly increases your risk of surgical complications. If you need help quitting, please let us know and we can assist you. Refrain from taking aspirin products for at least two weeks before your surgery, and be sure to eat a healthy, balanced diet with good sources of protein.

How Long Is Recovery After Transgender Surgery?

Your recovery time depends on the surgery (or combination of surgeries) you had performed. Cheek and nose treatments may present swelling for 2 to 4 weeks, while chin and jaw procedures may have soreness for a few months.

Top surgery patients will experience swelling and soreness for at least 1 to 2 weeks and should avoid high-impact activities during this time. Bottom surgery patients may need 4 to 6 weeks before resuming their usual activities.

How Much Does Transgender Surgery Cost?

The price of transgender surgery in Virginia depends on the procedure you’re having performed. Bottom surgeries, for example, can cost around $25,000 to $75,000, whereas top surgeries may range from $7,000 to $15,000. During your initial consultation, your doctor will be able to give you a customized price estimate for your surgery.

Does Insurance Cover Transgender Surgery?

In May 2021, the Biden administration prohibited discrimination against transgender people in healthcare. Since then, more employer insurance policies, including those sold under the Affordable Care Act, now often cover at least some gender-affirming procedures. A medical diagnosis of gender dysphoria is typically required for insurance coverage. Talk with your doctor and insurance provider to learn more about your transgender surgery funding options.

Our experienced team is proud to offer transgender surgery options to patients from Virginia, Tennessee, North Carolina, and beyond. We understand that this process is deeply personal, and we’re dedicated to staying by your side every step of the way.

To meet with our UVA doctors and discuss your cosmetic surgery options in the greater Richmond, VA, area, please request a consultation online. You can also contact our practice by phone at (434) 924-1234 to learn more.

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Ohio judge blocks ban on gender-affirming care for transgender minors—for now

An Ohio judge on Tuesday temporarily blocked an impending law that would restrict medical care for transgender minors in the Buckeye State.

The decision came weeks after the American Civil Liberties Union filed a lawsuit challenging the state on behalf of two transgender girls and their families. The measure prevents doctors from prescribing hormones, puberty blockers, or gender reassignment surgery before patients turn 18.

Attorneys contend the law violates the state Constitution , which gives Ohioans the right to choose their health care.

“Today’s ruling is a victory for transgender Ohioans and their families,” said Harper Seldin, staff attorney for the ACLU. “Ohio’s ban is an openly discriminatory breach of the rights of transgender youth and their parents alike and presents a real danger to the same young people it claims to protect.”

The legislation was set to take effect on April 24 after House and Senate Republicans  voted to override  Gov. Mike DeWine’s veto. Proponents of the bill contend it will protect children, but critics say decisions about transition care should be left to families and their medical providers.

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The suit in Ohio mirrors efforts in other states to challenge laws that restrict gender-affirming care for minors. A federal judge struck down a  similar policy in Arkansas , arguing it violates the constitutional rights of transgender youth and their families. The state is appealing that decision.

“We protect children with various restrictions that do not apply to adults − from signing legal contracts to buying alcohol and tobacco and more,” Attorney General Dave Yost posted on X , formerly known as Twitter, after the lawsuit was filed. “As I promised during the veto override, my office will defend this constitutional statute.”

What does the Ohio bill do?

The bill allows Ohioans younger than 18 who are already receiving hormones or puberty blockers to continue as long as doctors determine stopping the prescription would cause harm. Critics say that’s not enough to protect current patients because health care providers could be wary of legal consequences.

The legislation does not ban talk therapy, but it requires mental health providers to get permission from at least one parent or guardian to diagnose and treat gender dysphoria.

More: 6 jurors selected to serve in Donald Trump's hush money trial: Latest Trump trial news

The bill also bans transgender girls and women from playing on female sports teams in high school and college. It doesn’t specify how schools would verify an athlete’s gender if it’s called into question. Players and their families can sue if they believe they lost an opportunity because of a transgender athlete.

The lawsuit doesn’t specifically challenge the athlete ban. But it argues the legislation flouts the constitution’s single-subject rule, which requires legislation to address only one topic. House Republicans introduced separate bills on gender-affirming care and transgender athletes before  combining them into one .

In Tuesday’s decision, Franklin County Judge Michael Holbrook indicated that the law could be tossed out because of a single-subject violation.

“It is not lost upon this Court that the General Assembly was unable to pass the (Saving Ohio Adolescents from Experimentation) portion of the Act separately, and it was only upon logrolling in the Saving Women’s Sports provisions that it was able to pass,” Holbrook wrote.

Panel clears ban on gender reassignment surgery for minors

Tuesday’s decision came one day after a legislative panel cleared the way for an administrative rule that will ban gender reassignment surgery for minors. Ohio health care providers say they do not perform that procedure on patients under 18.

The rule will take effect May 3.

More: Supreme Court, in an emergency order, lets Idaho enforce ban on transgender care

The measure was among several that DeWine proposed to regulate gender-affirming care after he vetoed the legislation. In testimony for Monday’s meeting, opponents argued that the rules overstep the administration’s authority and conflict with federal law.

“The proposed administrative rule changes are based on biased definitions, ignore well-established best practices, and restrict countless patients’ access to gender-affirming care,” said Mallory Golski, civic engagement and advocacy manager for Kaleidoscope Youth Center.

DeWine’s other proposals are still working their way through the rulemaking process. That includes a requirement for transgender minors to undergo at least six months of counseling before further treatment occurs. Another rule would require providers to report non-identifying data on gender dysphoria diagnoses and treatment.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.

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Supreme Court Clears Way, for Now, for Idaho to Ban Transgender Treatment for Minors

The Idaho attorney general had asked the justices to move swiftly to let the state law, which would ban gender-affirming medical care for minors, go into effect.

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By Abbie VanSickle

Reporting from Washington

The Supreme Court temporarily allowed Idaho on Monday to enforce a ban on gender-affirming treatment for minors, effectively suggesting that some justices appear comfortable with wading into another front in the culture wars.

In siding with state officials who had asked the court to lift a block on the law as an appeal moves forward, the justices were sharply split, with a majority of the conservatives voting to allow the ban to take effect over the objections of the three liberals.

The court said the ban would apply to everyone except for the plaintiffs who brought the challenge.

Notably, the opinions focused not on transgender care, a hot-button political issue that has prompted several Republican-led legislatures to approve bills to restrict puberty-blocking drugs and hormone treatments, but on a broader legal question: universal injunctions.

Universal injunctions are when a single judge issues a sweeping decision that applies beyond those directly involved in the dispute. Some justices have signaled an interest in looking at the tactic.

Although orders in response to emergency applications often include no reasoning, the justices in this case divided into several factions.

The decision included concurrences by Justice Neil M. Gorsuch, who was joined by Justices Samuel A. Alito Jr. and Clarence Thomas, and Justice Brett M. Kavanaugh, who was joined by Justice Amy Coney Barrett. Chief Justice John G. Roberts Jr. did not note a position.

Justice Ketanji Brown Jackson dissented and was joined by Justice Sonia Sotomayor. Justice Elena Kagan noted a dissent.

The Idaho law, passed by the state’s Republican-controlled Legislature, makes it a felony for doctors to provide transgender medical care for minors, including hormone treatment.

States around the country have pushed to curtail transgender rights. At least 20 Republican-led states, including Idaho, have enacted legislation that limits access for gender transition care for minors.

In his concurrence, Justice Gorsuch said the use of a universal injunction “meant Idaho could not enforce its prohibition against surgeries to remove or alter children’s genitals, even though no party before the court had sought access to those surgeries or demonstrated that Idaho’s prohibition of them offended federal law.”

He wrote that the case broached the use of such injunctions, “a question of great significance that has been in need of the court’s attention for some time.” In recent years, he added, lower courts had overstepped their bounds by seeking “to govern an entire state or even the whole nation from their courtrooms.”

In her dissent, Justice Jackson also honed in on similar questions. But she wrote that the case, particularly given that it was brought on the emergency docket, was “not be the place to address the open and challenging questions that that issue raises.”

If there was any point of agreement in the case, it seemed to be a growing frustration with the number and scope of cases brought on the court’s emergency docket.

Justice Jackson noted that she saw “some common ground” with her conservative colleagues by agreeing that “our emergency docket seems to have become increasingly unworkable.”

The American Civil Liberties Union, which represents the plaintiffs in the case, denounced the outcome, saying it was “an awful result for transgender youth and their families across the state.”

“Today’s ruling allows the state to shut down the care that thousands of families rely on while sowing further confusion and disruption,” it said in a statement.

The Idaho attorney general, Raúl Labrador, a Republican and former member of Congress who helped found the conservative House Freedom Caucus, celebrated the decision.

“Denying the basic truth that boys and girls are biologically different hurts our kids,” Mr. Labrador said. “No one has the right to harm children, and I’m grateful that we, as the state, have the power — and duty — to protect them.”

Idaho officials had appealed to the Supreme Court after the U.S. Court of Appeals for the Ninth Circuit, in San Francisco, upheld a temporary block on the law as litigation continues in lower courts.

The law, the Vulnerable Child Protection Act, makes it a crime for medical providers to offer medical care to transgender teenagers.

Mr. Labrador, in his emergency application, said that the case raised a recurring question that a majority of the justices had expressed interest in: whether a court can enact a universal injunction.

Mr. Labrador contended that a federal court erred in applying the freeze so expansively. “The plaintiffs are two minors and their parents, and the injunction covers two million,” he wrote.

Temporarily barring the law meant “leaving vulnerable children subject to procedures that even plaintiffs’ experts agree are inappropriate for some of them,” he added.

Mr. Labrador continued, “These procedures have lifelong, irreversible consequences, with more and more minors voicing their regret for taking this path.”

The plaintiffs had asserted that the case was not the right vehicle for addressing concerns about universal injunctions.

That is because the four plaintiffs are anonymous, referred to only by pseudonyms. If the court narrowed the temporary pause on the Idaho law to apply only to those directly involved in the lawsuit, the plaintiffs, including minors, would be forced to “disclose their identities as the transgender plaintiffs in this litigation to staff at doctors’ offices and pharmacies every time they visited a doctor or sought to fill their prescriptions.”

Abbie VanSickle covers the United States Supreme Court for The Times. She is a lawyer and has an extensive background in investigative reporting. More about Abbie VanSickle