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A Qualitative Analysis of Transgender Veterans’ Lived Experiences
Jessica A. Chen and Hollie Granato
Veterans Affairs Puget Sound Health Care System, Seattle,
Washington and University of Washington
Jillian C. Shipherd
Veterans Affairs Boston Healthcare System, Boston,
Massachusetts and Veterans Health Administration,
Washington, DC
Tracy Simpson and Keren Lehavot
Veterans Affairs Puget Sound Health Care System, Seattle, Washington and University of Washington
Transgender veterans (trans-vets) experience high rates of discrimination, family rejection, home-
lessness, and suicidality, yet little is known about trans-vets’ potentially positive experiences. There
has been minimal qualitative research on the subjective experiences at the intersection of transgender
and veteran identity. No study to date has focused on describing resilience among trans-vets. The
aims of the current study were to identify major themes related to both challenges and strengths in
the lived experiences of trans-vets, as well as advice they would give to their fellow trans-vets. A
national convenience sample of 201 U.S. transgender veterans provided online responses to 3
open-ended questions asking about challenges, strengths, and advice related to trans-vet identity.
Qualitative data were analyzed using thematic analysis and a hybrid of inductive and deductive
approaches. Several recurring themes were identified, including health care access and providers,
Veterans Health Administration (VA) and military experiences, discrimination, rejection versus
acceptance, concealment versus authenticity, and the importance of community. Trans-vets also
discussed feelings of personal strength, growth from adversity, and advocacy as important positive
experiences. Findings demonstrated the centrality of military and VA experiences as unique aspects
of transgender veteran identity. The present study was limited by the restricted nature of data
collected from brief, open-ended online questions. Results point to the importance of provider
training for trans-affirmative health care, especially in VA and military settings. Additionally,
trans-vets reported that resilience can be fostered through advocacy and community building.
Public Significance Statement
This qualitative study seeks to advance the voice of a traditionally underserved and marginalized
community, transgender veterans. The study presents themes of challenges and strengths that were
reported by transgender veterans and suggests how providers and policy makers may work to
improve healthcare for this community.
Keywords: LGBT, minority stress, resilience, transgender, veterans
This article was published Online First January 12, 2017.
Jessica A. Chen and Hollie Granato, Veterans Affairs Puget Sound Health
Care System, Seattle, Washington, and Department of Psychology, University
of Washington; Jillian C. Shipherd, Women’s Health Sciences Division, Na-
tional Center for PTSD, VA Boston Healthcare System, Boston University
School of Medicine, and LGBT Health Program, Office of Patient Care
Services, Veterans Health Administration, Washington, DC; Tracy Simpson,
Center of Excellence in Substance Abuse and Treatment (CESATE) and
Mental Illness Research, Education, and Clinical Center (MIRECC), VA
Puget Sound Health Care System and Department of Psychiatry & Behavioral
Sciences, University of Washington; Keren Lehavot, Health Services Research
& Development (HSR&D) Center of Innovation (COIN) for Veteran-Centered
and Value-Driven Care and MIRECC, VA Puget Sound Health Care System,
and Department of Psychiatry & Behavioral Sciences and Department of
Health Services, University of Washington.
Jessica A. Chen is now at HSR&D COIN, VA Puget Sound Health
Care System and Department of Health Services, University of Wash-
ington. Hollie Granato is now at Division of Psychology, Harbor-UCLA
Medical Center.
Data collection was supported by a research grant from the Williams
Institute Small Grants Program to K. Lehavot, T. Simpson, and J.
Shipherd. Manuscript preparation is the result of work supported by
resources from Denver-Seattle VA HSR&D COIN for Veteran-
Centered and Value-Driven Care, VA Puget Sound Health Care System
(Lehavot) and VA Boston Health Care System (Shipherd). Dr. Lehavot
was supported by a VA Career Development Award from the CSR&D
Service of the VA Office of Research and Development (IK2
CX000867). The views expressed in this article are those of the authors
and do not necessarily reflect the position or policy of the Department
of Veterans Affairs, the University of Washington, Boston University,
or the Williams Institute.
Correspondence concerning this article should be addressed to Jessica A.
Chen, HSR&D, VA Puget Sound, 1660 South Columbian Way (S-152),
Seattle, WA 98108. E-mail: Jessica.Chen663@va.gov
Psychology of Sexual Orientation and Gender Diversity In the public domain
2017, Vol. 4, No. 1, 63–74 http://dx.doi.org/10.1037/sgd0000217
63
Transgender individuals, defined as those whose gender identity or
expression differs from their assigned sex at birth, serve in the United
States military at rates two to three times that of the general population
(Harrison-Quintana & Herman, 2013;Shipherd, Mizock, Maguen, &
Green, 2012). This is true despite a ban on open transgender military
service that has only recently been lifted (Department of Defense,
2016). The Veterans Health Administration (VA) may be the largest
provider of LGBT health care in the world (Kauth & Shipherd, 2016),
where transgender-related diagnoses are five times more prevalent
than in the general population (Blosnich et al., 2013).
Transgender veterans, also known as trans-vets
1
(Johnson,
Shipherd, & Walton, 2016), experience elevated rates of social
stressors and health disparities (e.g., Brown & Jones, 2015;
Harrison-Quintana & Herman, 2013). Very little is known, how-
ever, about resilience, strengths, or positive experiences within this
population. The purpose of this study was to gain a better under-
standing of the broad range of trans-vets’ lived experiences so that
such knowledge could inform public policy and clinical practice.
Health Disparities and Minority Stress
Evidence suggests that trans-vets experience significant social
stressors and health disparities. Harrison-Quintana and Herman
(2013) examined social stressors among transgender service mem-
bers and veterans using data from the National Transgender Dis-
crimination Survey, the largest survey sample to date of transgen-
der and gender nonconforming people in the U.S. The authors
found that transgender service members and veterans reported high
rates of discrimination, including biased hiring (53%) and firing
(36%), police harassment (22%), and eviction for being transgen-
der (14%). Transgender service members and veterans also had
higher rates of lifetime homelessness compared with their civilian
transgender peers (21% vs. 18%) and compared with the general
population (21% vs. 7%; Harrison-Quintana & Herman, 2013).
A case– control study compared the VA charts of veterans with
transgender-related diagnoses (e.g., ICD-9 gender identity disor-
der) with veterans without such diagnoses (Brown & Jones, 2015).
The study found that veterans with transgender-related diagnoses
reported two times the rate of military sexual trauma and one-and-
a-half times the rate of incarceration compared with veterans
without transgender-related diagnoses matched on race and age.
The study also identified disparities across more than 20 medical
and mental health conditions, including cardiovascular disease,
breast and prostate cancer, alcohol abuse, depression, suicidality,
serious mental illnesses, and posttraumatic stress disorder (Brown
& Jones, 2015). Another study found that the rate of suicide
behaviors was 20 times higher among veterans with transgender-
related diagnoses than for the general VA population (Blosnich et
al., 2013), which is already at elevated risk compared with the
general U.S. population (Blow et al., 2012).
Minority stress theory (Meyer, 2003) suggests that social con-
ditions such as stigma, prejudice, and discrimination have a neg-
ative impact on physical and mental health. The theory distin-
guishes between external or distal stressors, such as discrimination
and rejection, and internal or proximal stressors, such as conceal-
ment, internalized transphobia, and the anticipation of rejection.
Although minority stress theory was originally developed for
sexual minority populations, it is theoretically applicable to trans-
gender individuals (Hendricks & Testa, 2012;Meyer, 2015) and
has been empirically evaluated in transgender populations
(Breslow et al., 2015).
Existing research on trans-vets suggests that minority stress is a
prominent factor in health. One study (Blosnich et al., 2016) found
that trans-vets living in states with employment nondiscrimination
laws had significantly decreased odds of having mood disorders
and self-directed violence. Another study (Lehavot, Simpson, &
Shipherd, 2016) found that external minority stress (i.e., discrim-
ination during military service) was significantly correlated with
past-year suicidal ideation and lifetime suicide plan or attempt.
The authors also found that internal minority stress during military
service (e.g., shame and concealment) was significantly associated
with past-year suicidal ideation and lifetime suicide plan or at-
tempt. These studies seem to corroborate the applicability of the
minority stress model to understanding health outcomes for trans-
vets, particularly mental health.
Resilience
Another central component of the minority stress model is the
importance of personal coping, social support, and community
connectedness in protecting against the effects of stressors (Meyer,
2003). Meyer (2015) refers to these factors as individual and
community resilience. A few studies have examined resilience
among transgender individuals (e.g., Riggle, Rostosky, McCants,
& Pascale-Hague, 2011;Singh, Hays, & Watson, 2011), though
none have done so with trans-vets.
Previous qualitative research on resilience among transgender
individuals in the general population found a consistent set of
themes: importance of authenticity, self-congruency and self-de-
termination; personal growth; community connection; social ac-
tivism and education; and increased empathy and awareness of
oppression (Moody, Fuks, Peláez, & Smith, 2015;Riggle et al.,
2011;Singh et al., 2011). Specific to community connection,
research by Hines (2007) and Galupo and colleagues (2014) has
highlighted the unique benefits of friendships with fellow trans-
gender people as a source of support, resources, and information
that may not be readily available from more traditional institutions,
such as biological family and health care providers.
Recent research has evaluated whether the resilience component
of the minority stress model buffers against negative health out-
comes for transgender individuals. Both greater overall resilience
(Breslow et al., 2015) and social support (Pflum, Testa, Balsam,
Goldblum, & Bongar, 2015) have been found to be associated with
lower psychological distress. Another study found that peer sup-
port mitigated the relationships between external minority stress
and depression and anxiety (Bockting, Miner, Romine, Hamilton,
& Coleman, 2013). Although a growing literature has identified a
number of important resilience themes for transgender individuals
in the general population, none of the research to date has focused
on resilience among trans-vets.
1
Per Johnson et al. (2016), the National Center for Transgender Equality
and the Transgender American Veterans Association have recommended
“trans-vets” as an appropriate short-hand term for transgender veterans,
though it is recognized that not all individuals in a heterogeneous group
will prefer the same term.
64 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
Current Study
To address existing gaps in the literature, the aims of the current
study were to use qualitative data to characterize both the chal-
lenges and strengths related to being a trans-vet. Qualitative data
were extracted from a national, cross-sectional survey on social
determinants of health among trans-vets. Data were analyzed using
a hybrid of inductive (data-driven) and deductive (theory-driven)
approaches (Elo & Kyngäs, 2008) rooted in thematic analysis
(Braun & Clarke, 2006). Data consisted of written responses to
three questions that queried the hardest aspects of being a trans-
vet, the best aspects of being a trans-vet, and advice to give to
fellow trans-vets.
Method
Procedure
Between February and May, 2014, participants were recruited
online through LISTSERVs, groups, and organizations serving
trans-vets and Facebook ads with target words such as “veteran”
and “transgender.” Advertisements contained a link to the infor-
mation statement, which presented the study purpose (to “learn
more about the health and life experiences of transgender veter-
ans”), eligibility criteria (18 ⫹years old, prior service in U.S.
Armed Forces, identify as transgender [current gender identity is
not the same as assigned sex at birth], and living in the U.S.), and
risks and benefits of participation. Those who agreed to participate
were directed to an anonymous, Internet-based survey that took
approximately one hour to complete. Participants were not com-
pensated for completing the survey. The research study was ap-
proved by the Institutional Review Board at VA Puget Sound
Health Care System.
The survey consisted primarily of quantitative measures regard-
ing demographics, health care utilization, discrimination and men-
tal health symptoms. These questions were part of a larger study on
trans-vet health and will not be described in the current method-
ology (see Lehavot et al., 2016 for additional detail). At the end of
the survey, participants had the opportunity to respond to three
open-ended questions, which were the focus of the present quali-
tative study. The questions were (a) “What has been hardest for
you about being a transgender veteran?”, (b) “What do you like
best about being a transgender veteran?”, and (c) “What advice
would you give other transgender veterans based on your experi-
ences?” These questions were meant to be open-ended and broad,
rather than attempting to elicit specific content from the partici-
pants.
Data Analysis
Responses to the three open-ended questions were analyzed
using thematic analysis (Braun & Clarke, 2006), a flexible quali-
tative method for identifying, analyzing, and reporting important
patterns and meaning in the data. Importance was inferred from
multiple dimensions, including the prevalence of a theme within
the data (i.e., the number of responses that fit that theme) and the
theme’s relevance to the existing research literature. Consistent
with semantic level thematic analysis (Braun & Clarke, 2006), the
focus was on describing explicit or surface meanings, given that
the textual data were relatively brief and there was no opportunity
for follow-up or clarification with participants.
Each of the three open-ended questions was analyzed separately
and sequentially. Beginning with the first question, the lead author
read the responses multiple times to achieve immersion (Hsieh &
Shannon, 2005). Then, the first author utilized open coding (Elo &
Kyngäs, 2008) based on close reading and notes (Hsieh & Shan-
non, 2005) to freely generate initial codes that described and
grouped together common responses.
After the initial codes were developed for a single question,
these codes, along with sample responses, were reviewed with the
entire authorship team, who refined codes through consideration of
the research literature and theoretical models. The team also at-
tempted to acknowledge our own subjectivity, including personal
and professional backgrounds, when interpreting the content of
participants’ responses. On the one hand, we attempted to remain
empathic and open (Finlay, 2008); on the other hand, we consid-
ered our clinical experiences working with trans-vets and the
diversity of our collective histories across race/ethnicity, sexual
orientation, and class as strengths that could serve as a source of
insight (Finlay, 2008).
Once the codebook for a given question was developed, the first
and second authors independently coded 100% of the responses for
that question. Each participant’s response to a single question was
coded for the presence of that question’s themes, and each re-
sponse was given one or more codes, as appropriate. Coding
discrepancies were initially discussed among the first and second
authors, and discrepancies that could not be resolved were dis-
cussed with the senior author until a satisfactory consensus was
reached. Approximately 7% to 9% of the responses required fur-
ther discussion among all three authors to reach consensus, and
these discussions often led to further refinement and definition of
the codes.
Multiple Themes Analysis
Given that a participant’s response to a single question could
encompass more than one theme, a visual representation system
was developed to show how much thematic overlap occurred
within each question (Figures 1 and 2). The goal of the visual
system was to aid pattern recognition and interpretation of the data.
In this system, each diamond represented a theme and the number
Figure 1. Overlapping themes for Question 1, “What has been hardest for
you about being a transgender Veteran?” The numbers in the diamonds
indicate the number of responses that fit that theme and the thickness of the
connecting lines indicates the amount of overlap.
65
QUALITATIVE ANALYSIS, TRANSGENDER VETERANS
inside indicated the number of responses that were coded as that
theme. The thickness of the connecting lines represented the num-
ber of responses that contained both themes (i.e., thicker lines
represent more overlap); each response was counted as 0.25 line
weight as defined by the Microsoft PowerPoint presentation soft-
ware. This visual system was developed to represent the intercon-
nectedness between themes in a nonarbitrary way that was directly
related to the thematic overlap counts.
To our knowledge, this is a novel visual system for representing
this type of data, although there is precedence for using quantita-
tive count data and visual representation to describe thematic
patterns and meaning (Sandelowski, 2001). In this study, this
approach is informed by the assumption that overlapping themes
suggest a different meaning than considering each theme on its
own, and that more frequent overlap may convey information
about the frequency or typicality of certain life experiences. Fig-
ures are presented for the first two questions (challenges and
strengths) but not for the third question (advice for other trans-
vets). The third question was less relevant to theoretical or con-
ceptual frameworks and its themes were less likely to overlap with
one another in consistent or meaningful ways.
Results
Participant Characteristics
A total of 498 individuals read the information statement and
agreed to participate. Of these, 298 remained after excluding those
with missing eligibility data (n⫽164), who did not meet eligi-
bility criteria (n⫽22), or who provided disingenuous surveys with
implausible values (n⫽14). Of the 298 trans-vets eligible for the
study, 201 provided responses to the qualitative questions. These
participants were predominantly Non-Hispanic White (87%), as-
signed male at birth (89%), and ranged in age from 18 to 83 years
old (M⫽49.90, SD ⫽14.83; see Table 1). The majority identified
as male-to-female (MTF)/transwomen (68%), followed by part
time as one gender and part time as another (18%). The vast
majority (91%) of participants had some college education. Nearly
30% reported an income ⱕ$25,000 per year.
Challenges
In response to the question, “What has been hardest for you
about being a transgender Veteran?,” trans-vets identified the
following themes listed in order from most frequent to least:
external minority stress,internal minority stress,VA-specific prob-
lems,military-specific problems,health care barriers, and lack of
Table 1
Descriptive Information for Online Sample of Transgender
Veterans (N ⫽201)
Variable n(%) or M(SD)
Age, M(SD) [range] 49.90 (14.83) [18–83]
Assigned sex at birth, n(%)
Male 178 (88.6)
Female 23 (11.4)
Gender during service, n(%)
Male 177 (88.1)
Female 24 (11.9)
Current gender identity, n(%)
MTF/transwoman 136 (67.7)
FTM/transman 22 (10.9)
Part time as one gender, part time as
another 37 (18.4)
Other (e.g., genderqueer) 6 (3.0)
Living full time as gender of choice
ⴱ
,n(%)
Yes 122 (60.7)
No 78 (38.8)
Race/Ethnicity, n(%)
White, Non-Hispanic 174 (86.5)
Mixed-race, including Hispanic 10 (5.0)
White, Hispanic 5 (2.5)
African American/Black 4 (2.0)
American Indian/Alaskan Native 4 (2.0)
Asian or Native Hawaiian/Pacific Islander 4 (2.0)
Sexual orientation, n(%)
Bisexual 63 (31.3)
Heterosexual 48 (23.9)
Lesbian/Gay 47 (23.4)
Pansexual 13 (6.4)
Asexual 9 (4.5)
Queer 5 (2.5)
Other (e.g., heteroflexible, unsure) 16 (8.0)
Education, n(%)
Some high school or high school graduate/
GED 18 (9.0)
Some college 87 (43.3)
College graduate 49 (24.3)
Postgraduate studies 47 (23.4)
Income
ⴱ
,n(%)
ⱕ$25,000 60 (29.9)
$25,001–$50,000 61 (30.3)
ⱖ$50,001 79 (39.3)
Military branch
ⴱ
,n(%)
Army 80 (39.8)
Navy 43 (21.4)
Air Force 41 (20.4)
Marines 19 (9.5)
National Guard/Reserves 12 (6.0)
Coast Guard 5 (2.5)
Ever received care at VA
ⴱ
,n(%)
Yes, within last 12 months 102 (50.7)
No 61 (30.3)
Yes, over 12 months ago 22 (10.9)
Enrolled but never used 15 (7.5)
ⴱ
Numbers do not total 201 due to missing data.
Figure 2. Overlapping themes for Question 2, “What do you like best
about being a transgender Veteran?” The numbers in the diamonds indicate
the number of responses that fit that theme and the thickness of the
connecting lines indicates the amount of overlap.
66 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
community connectedness (see Table 2 for sample quotes). A small
proportion of responses (n⫽21, 10.9%) did not fit any of the
major themes and were coded as other.
External minority stress. Based on minority stress theory
(Meyer, 2003), responses that were coded as external minority
stress emphasized experiences of discrimination, rejection, and
marginalization by others. External minority stress was the most
prevalent type of challenge noted by participants across multiple
spheres, from private (e.g., rejection from family), to public (e.g.,
discrimination in public places), to institutional (e.g., discrimina-
tion in the military).
Several participants identified disrespectful and discriminatory
experiences in the military and in the VA as one the hardest things
about being a trans-vet. Figure 1 demonstrates that external mi-
nority stress,military, and VA were among the strongest thematic
overlaps. More specifically, some participants described experi-
ences of not having their privacy respected when attempting to
seek care at the VA. One participant wrote:
When I went to the VA to apply for care, the person I gave the paperwork
to said loud enough for about 9 people behind me to hear “YOU HAD
THE SEX CHANGE!” I’m still debating on if I should enroll.
Similarly, another participant noted the “lack of safety and
privacy [when] accessing Vet facilities if known as transgender.”
Both responses exemplify how discrimination functions as a bar-
rier to accessing and receiving health care.
Other participants expressed distress related to institutional mil-
itary barriers, such as not being able to seek help with gender
identity during active duty for fear of being forcibly discharged.
For example, one participant said the hardest part of their experi-
ence was, “Having to wait until it was ok to seek therapy without
reporting it to address my Gender Dysphoria.” Consistent across
many responses was the idea that discrimination and fears of
repercussions prevented trans-vets from seeking health care.
Trans-vets also identified lack of acceptance from significant oth-
ers, children, friends, and families as a common external minority
stressor. One participant described the hardest part of being a trans-vet
as,
The impact on my family. After a lifetime of being the strong, present
husband and father, to suddenly find that was not what I was inside was
incredibly unsettling for them.
Some have noted that military culture tends to emphasize hyper-
masculine gender roles (Turchik et al., 2013), which may seem
inconsistent with the coming out or transition process, particularly for
trans-vet women.
In addition to discriminatory or rejecting experiences in specific
settings such as the VA, military, or with family, other participants
Table 2
Major Themes and Subthemes for the Question, “What Has Been Hardest for You About Being a Transgender Veteran?” (n ⫽193)
Theme or Subtheme Frequency n(%) Example quotes
Minority stress – External 68 (35.2) “My captain coerced me into having sex, believing that he could get me out.”
a
“The damage to my marriage and my wife’s inability to accept it.”
Minority stress – Internal 49 (25.4)
Concealment 35 (18.1) “Keeping the secret, not being able to be genuine.”
Rejection vigilance 10 (5.2) “Not interacting with many people I served with because of my fear they will reject
me.”
b
Internalized transphobia 8 (4.1) “Coming to grips with being transgender - i.e., accepting my gender identity as valid, and
beginning to move beyond the shame and harm”
VA services 43 (22.3)
Access 23 (11.9) “With the VA’s refusal to provide GRS surgery, I will never feel whole as a woman.”
Providers or staff 10 (5.2) “Most in the VA system really have no clue as to the correct terminology that’s
appropriate for addressing such individuals in a non-threatening or respectful way.”
c
Military 41 (21.2)
Cannot openly serve 16 (8.3) “Not being able to express my true self while on Active Duty.”
d
Forcible discharge 7 (3.6) “Being put on trial after 18 years of honorable, dedicated service and being recommended
for discharge because of a ‘mental condition’...Ionly had 2 years left to retirement.”
c
Documentation 6 (3.1) “Getting my DD-214 corrected to reflect ME!”
General health care 38 (19.7)
Access or cost 32 (16.6) “Fighting to get good care. Having to be the first to knock down doors.”
Providers 7 (3.6) “Having doctors ask really invasive questions just because they are curious.”
c
Lack of community 23 (11.9)
General 13 (6.7) “Being accepted by anyone that I actually have anything in common with.”
c
Military/veteran 13 (6.7) “I feel like I am on the fringe of the trans community and not welcome in the veteran
community.”
e
Other 21 (10.9) “The combination of dysphoria and PTSD”
“That when I was young enough to explore my identity, I did not have the opportunity”
Note. Responses could be coded as more than one theme. The following are additional codes that applied to the selected quotes:
a
Military.
b
Lack of community – Military.
c
External minority stress.
d
Internal minority stress – Concealment.
e
Lack of community – General.
67
QUALITATIVE ANALYSIS, TRANSGENDER VETERANS
noted more generally the difficulty of living in a society with anti-
transgender attitudes and stigma. One participant summed up the
unique challenges that come from the intersection of transgender and
veteran identity: “The mental scars of being trapped in an anti-
transgender environment, on top of adjusting to civilian life.”
Internal minority stress. Responses coded as internal minor-
ity stress dealt with concealment of one’s transgender identity, fear
of rejection based on being transgender, and internalized feelings
of shame about one’s gender identity. The most frequent response
concerned the difficulties of coming out. One participant stated,
“having to hide my true self from a lot of people because of the
fear of rejection or retaliation is pretty hard.” Several participants
discussed similar fears that coming out would lead to rejection or
discrimination. Others discussed the difficulty of accepting their
own transgender identity. For example, “The hardest thing for me
(so far) has been the process of realization and acceptance that I’m
transgender.”
As seen in Figure 1, the overlap between internal minority stress
and military was one of the strongest thematic overlaps for this
question. Several participants discussed the need to hide one’s
authentic gender identity while serving in the military. One par-
ticipant said the hardest part of being a trans-vet was “having to
refrain from dressing during my service years and keeping my
secret.” Another participant highlighted the connection between
fear of rejection and the military when stating, “[The hardest part
is] not interacting with many people I served with because of my
fear they will reject me.” The loss of military community was
echoed by another participant, who said they struggled with “not
being able to continue to serve and feeling like an outcast from the
military community.”
VA and military. After minority stress, the primary chal-
lenges reported by trans-vets were related to the VA and the
military. Within the VA theme, trans-vets reported difficulties
accessing health care in the VA either as a result of discrimination,
as discussed above under external minority stress, or policies
excluding the coverage of gender confirming surgeries. The strong
overlap between VA and external minority stress themes (see
Figure 1) emphasizes that it was not uncommon for participants to
discuss examples of maltreatment and bias they experienced from
VA health care providers and/or staff.
When trans-vets discussed military-specific problems, some ad-
dressed the military’s ban on open transgender service (cannot
openly serve) and related experiences of having to conceal one’s
identity (as discussed under internal minority stress) and of being
forcibly discharged for being transgender (forcible discharge).
Seven trans-vets described being forced to leave their military
careers, sometimes after decades of service. These respondents
often discussed the devastating loss of career, identity, and tangi-
ble benefits, such as retirement pensions. One veteran described
the long-term consequences of forcible discharge as such: “Being
forced to resign my command and my commission left me with
some serious economic/ employment challenges that have fol-
lowed me for over 20 years.” As noted above, these prominent
experiences of discrimination and concealment in the military
were represented by significant overlap between military and ex-
ternal and internal minority stress (see Figure 1).
Finally, a few participants addressed the difficulty of correcting
one’s military discharge paperwork (DD-214) to reflect one’s
current name and gender identity. It is important to note that
incorrect paperwork poses problems for accessing VA care and
other service benefits, such as the GI Bill.
General health care. More than one third of the study sample
reported never using the VA for health care (see Table 1). How-
ever, participants identified very similar problems with general
(non-VA) health care as with VA care, namely barriers to access
and negative experiences with providers. Concerns with general
health care included lack of access to gender confirming surgeries
because of cost or noncoverage (“no way to afford surgery result-
ing in high depression”), lack of access to mental health care due
to cost or unavailability of competent providers, provider insensi-
tivity (“the lack of knowledge and experience of medical profes-
sionals towards/about trans patients”), and frustration with the
gatekeeping function of physician letters when seeking transition
services. One participant summarized their encounters with a mul-
titude of health care access problems:
Not having access to health care that included coverage for genital
surgery, and feeling a burden to my health care providers because of
. . . needing medical documentation, letters, and so forth to change
identity documents. Having doctors ask really invasive questions just
because they are curious.
Lack of community. Trans-vets discussed the loss of rela-
tionships and of community, both with civilians and with vet-
erans, as a cost to coming out. One participant stated, “many of
my friends from the Navy now reject me simply because of my
choice of gender expression.” Another wrote, “I do not feel like
I am part of the Veteran community. I feel like I lost that part
of my life when I transitioned, like it was something that I had
to sacrifice.”
A few participants expressed the sentiment that being transgen-
der made them unacceptable to the military/veteran community
and being a veteran made it difficult to fit in with their local
transgender community. One participant elaborated on this sense
of isolation at the intersection of transgender and veteran identity:
Fellow non transgender vets hating me and fellow nonmilitary trans-
gender [people] hating me. I gave up because it’s a trap I cannot get
out of. My only trans friend committed suicide and I’ve yet to make
another such friend. It hurts.
Participants also expressed difficulty finding similar-aged, ac-
cepting peers in their community. For example, one participant
stated the hardest part of being a trans-vet has been “finding an age
appropriate Trans group. Most local groups are heavily populated
with trans under 30, and I’m 53.” Other concerns included diffi-
culties finding romantic relationships (“lack of potential partners”)
and difficulty adjusting to the civilian world after a military career.
One participant described their sense of isolation related to phys-
ical location:
I feel I cannot talk to anyone in the area. I live in a conservative city.
I’ve been wanting to find proper full time work so I can move to a
larger city where resources are available and where in my somewhat
indeterminate state I can be me. As for right now the only outlet I have
is the Internet and my anonymity.
Strengths
For many of the life domains that trans-vets identified as chal-
lenges, they identified the same life domains as sources of
68 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
strength. In response to the question, “What do you like best about
being a transgender Veteran?,” trans-vets identified the following
themes listed in order of their frequency from most frequent to
least: pride, authenticity, and resilience; health care; military and
pride in service;community;activism and education; acceptance
by others; and nothing (see Table 3 for sample quotes). Twenty-
two responses (11.5%) did not fit any of the major themes, so they
were coded as other.
Pride, authenticity, and resilience. Trans-vets reported that
one of the “best” aspects of their lived experience include feelings
of personal pride, fulfillment that comes from being authentically
oneself, and personal strength that comes from overcoming adver-
sity. Responses about personal pride discussed being happy with
and loving oneself (“pride in myself,” “I like being ME”) and
highlighted specific positives characteristics or traits, such as “cre-
ativity” and “empathy,” that they saw as an outgrowth of their life
experiences. One participant stated, “I like being WHO I am and
have always been, only now I can feel I am living a congruent life
that matches who I am inside.” Other responses also described
authenticity in terms of “finally being me.” One participant wrote,
“I am my true self and I know it positively and surely.”
Participants discussed resilience in terms of “enduring” and
“overcoming” challenges and becoming a stronger, more confident
person. Some connected resilience to their identity as a veteran.
For instance, one participant wrote, “I am a warrior on multiple
levels.” Another said, “The strength I gained in the military has
allowed me to transition.” Another aspect of resilience that was
discussed was the idea that overcoming challenges taught partic-
ipants unique life lessons. One participant valued “the perspective.
Not many people go through what I’m going through.”
Health care. Trans-vets reported that another “best” aspect
associated with their identity was access to affirming health care.
Trans-vets discussed access to hormone therapies and mental
health services in the VA, and several reported that individual
providers or clinics had been instrumental to their wellbeing. One
participant wrote, “The [name withheld] VAMC is top notch now
in its treatment of Transgender Veterans both medically and thru
our Support group.” Positive responses about health care either
named the VA outright or discussed benefits specific to VA care
(“the VA provides HRT [hormone replacement therapy] at little to
no cost,” “HRT and they paid for my gender therapist out in
town”). Figure 2 demonstrates that the overlap between pride,
authenticity, and resilience and health care were among the stron-
gest thematic overlaps. Such overlap suggests that affirming health
care may be associated with a positive sense of self.
Military and pride in service. Another common theme was
trans-vets’ feelings of pride in their military service, much like
other veterans who value military (Bryan & Morrow, 2011). Sev-
eral participants stated they were proud of their military service but
did not associate it with their gender identity (“Just being a veteran
is good for me - It has no bearing on my gender identity however
it does prove to me that gender is not important to serve your
country.”). A few individuals wrote about serving honorably “de-
spite” their gender identity (“Proud of my service despite being
transgender”). As seen in Figure 2, responses discussed the overlap
between pride, authenticity, and resilience and military,asde-
scribed above with the participant who wrote about “the strength I
gained in the military” as a form of resilience.
Community. The presence of a supportive community was
cited as one of the “best” aspects of being a trans-vet, especially
Table 3
Major Themes for the Question, “What Do You Like Best About Being a Transgender Veteran?” (n ⫽192)
Theme Frequency n(%) Example quotes
Pride, authenticity, and resilience 49 (25.5) “My freedom to express my gender without fear.”
“I’m finally the real me.”
“As a Transgender woman, I’m on top of the world as a strong and confident woman
who lives her life every day like it’s the best day I’ve ever had.”
Health care 39 (20.3) “Without the VA’s help, I wouldn’t be alive.”
“I have the best health care in the world.”
Military and pride in service 32 (16.7) “Despite my gender identity I still served my country with honor and distinction.”
“Proving to people that I can still serve my country and be transgender. I agreed to
give my life if necessary for the freedoms they enjoy, and I should be able to
enjoy being free myself.”
Community 24 (12.5) “The few transgender Veterans that I have met are all incredible people. We have
endured so much, and those of us who come out of it successfully are very
resilient, and make good friends.”
a
Activism and education 13 (6.8) “Breaking ground in activism for DOD acceptance of trans in service.”
“That I can educate and advocate and speak from personal experiences.”
Acceptance by others 10 (5.2) “Being accepted for who I am.”
“Nothing” 36 (18.8) “Nothing, would rather be cisgender.”
“What’s to like?”
Other 22 (11.5) “I haven’t discovered a ‘best’ yet. Being a transgender veteran just ‘is’.”
Note. Responses could be coded as more than one theme. The following are additional codes that applied to the selected quotes:
a
Pride, authenticity, and resilience.
69
QUALITATIVE ANALYSIS, TRANSGENDER VETERANS
community with fellow trans-vets. One participant valued “being
part of an important group of transpeople.” Individuals found
fellow trans-vets through online groups, VA groups, advocacy
organizations, or during shared time in service. Participants men-
tioned how important these connections were for “learning I am
not alone” and “knowing there are others out there just like me.”
Consistent with these statements, Figure 2 shows that community
and pride, authenticity, and resilience were among the strongest
thematic overlaps, suggesting that knowing other trans-vets is
associated with positive self-image.
Activism and education. Trans-vets discussed the impor-
tance of creating meaning out of their struggle with adversity.
Meaning was sometimes found through activism and education.
Trans-vets discussed the importance of educating health care pro-
viders, of advocating for legislation that promotes equity, and
more broadly of “spreading awareness” to change societal stigma.
For example, one participant wrote:
I am open and approachable about my gender identity with my health
care providers at the VA, who are often still early in their careers. As
long as they are respectful and do not get weird about it (only once),
I am happy to answer anything they may want to know. This is
important for future generations of trans veterans.
Acceptance by others. When trans-vets found acceptance by
others, this was one of the “best” aspects of their lived experience.
Trans-vets discussed the positive feelings associated with being
accepted by other veterans. One participant wrote: “I have been
completely accepted by the [VA name withheld] Women’s Veter-
ans Group.” Another participant wrote that one of the best expe-
riences was being treated with “courtesy and respect” by a prom-
inent military authority figure. Both of these responses signal how
meaningful acceptance can be when it occurs in a context that also
affirms one’s identity as a service member or veteran. Other
participants noted the broad changes in society’s acceptance of
transgender people (“seeing the changes in acceptance since I
started in the early 80’s”). One veteran specifically appreciated the
respect accorded to them because of their veteran status (see Table
3).
Nothing. A striking finding was that almost one in five trans-
vets in this study reported there was “nothing” they liked best
about being a transgender veteran. Responses such as “can’t think
of anything positive” suggest that a substantial minority of trans-
vets struggle to identify positive aspects associated with their
identity. Nothing responses ranged in intensity from feelings of
indifference (“it is what it is”) to comparing trans-vet status to an
affliction (“That’s...kind of like ‘what do you like best about
being a cancer patient.’”) Nothing responses also touched on
experiences of trauma and discrimination (“Cis[gender
2
] girls are
welcomed into MST [military sexual trauma] groups and we
transgirls are told go away....Wearedenied care, benefits, and
disability ratings...because we are trans”).
Advice
In response to the question, “What advice would you give other
transgender Veterans based on your experiences?,” trans-vets iden-
tified the following themes, listed in order from most frequent to
least: be yourself,recommend using VA,recommend avoiding VA,
get help,advocate for yourself and/or others,find community,do
not give up,do not delay transition, and avoid or serve or hide in
the military (see Table 4 for sample quotes). Approximately 13.7%
(n⫽26) of responses did not fit any of the major themes and were
coded as other.
Be yourself. The most common piece of advice offered to
fellow trans-vets was to be honest and true to oneself (“Be who
you are, and be proud of it,” “Get out and live authentically”).
Some responses coded in this category also explicitly discouraged
concealment (“Don’t hide who you are,” “Suppression is damag-
ing to you”).
VA: Recommend or avoid. Trans-vets who provided advice
about VA services were equally split between those who recom-
mended using the VA for health care and those who recommended
avoiding the VA. For those who recommended using the VA,
participants mentioned access to hormone therapy through the VA.
Others recommended specific VA hospitals where they have found
excellent care (“Move to [x] if you want the best VA trans care”).
For those who recommended avoiding the VA, negative opinions
ranged in intensity from having low expectations (“Do not expect
that you can rely upon the VA to provide you with a transgender
friendly/inclusive environment”) to having strong negative opin-
ions about the institution (“The VA doesn’t want us to do anything
but go away or die”). Even when individuals recommended avoid-
ing the VA, there were responses that simultaneously acknowl-
edged that the cost of outside health care can be a barrier to
accessing non-VA care.
Get help. Participants recommended that others get help from
medical and mental health professionals right away. Responses
emphasized that fellow trans-vets should not let shame or fear
deter them from the health care they deserve and participants were
reassuring about the helpfulness of seeing a professional, stating
“it’s worth it.” Thirteen participants explicitly mentioned the value
of mental health care, whereas seven explicitly recommended
seeking medical care for gender transition.
Advocate for yourself and/or others. Participants encour-
aged their fellow trans-vets to advocate for themselves, particu-
larly with medical professionals, and to fight for the rights of
others. One participant described in detail the necessity of advo-
cacy in the health care context:
Talk to your doctors about your specific needs and personal prefer-
ences as a trans
ⴱ
individual. Make them aware that these are simply
your preferences and everyone is different. Try to educate them on the
respectful terminology that you have personally experienced or cor-
rect them when they misgender or make a mistake. This will help
them with dealing with more patients such as yourself in the future.
Participants also discussed the importance of becoming edu-
cated about VA policies and health care guidelines for gender
transition because trans-vets could not rely on health care profes-
sionals to be informed about these issues. The advice of one
participant illustrates how some trans-vets expect to be more
well-informed than their providers to ensure appropriate services:
Educate yourselves in transgender treatment plans and educate your
Primary Care Providers. The VA issued a [Pharmacy Benefits docu-
ment] that very few VA PCP’s are aware of that spells out medication
2
The term cisgender denotes individuals whose gender identity con-
forms with their sex assigned at birth.
70 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
initial dosages, maximum dosages as well as target hormone levels.
Insure [sic] your PCP is aware of this letter and treats you accordingly.
Another idea in the advocacy theme was that persistence and
assertiveness are essential (“Don’t take no for an answer,” “be
relentless in pursuing treatment”). Responses also discussed the
importance of advocating for systemic changes in DoD policy, VA
benefits, and transgender rights more broadly. One participant
recommended, “keep pushing for more Trans coverage within the
VA.” Another wrote, “get involved in making changes at VA to
get Transgender Veterans the health care we all desperately need.”
A few responses touched on the importance of taking care of
oneself and putting one’s needs first, such as “do what you need
for yourself.”
Find community. Participants emphasized the importance of
informal social support. Find community responses recommended
that fellow trans-vets find a person or people they can trust and talk
openly with, whether that be within the transgender community or
outside of it. The main idea conveyed in these responses was
“don’t do it alone.”
Do not give up. When providing advice, participants also
gave words of encouragement that touched on ideas of persever-
ance (“never give up,” “hang in there”) and hope (“it gets better”).
These responses about perserverance overlapped with themes of
authenticity (“Don’t give up and to embrace your true nature,
whatever that may be”) and advocacy (“Keep your heads up. Keep
seeking the care that we deserve in the VA”).
Do not delay transition. A small proportion of responses
recommended to fellow trans-vets that they not wait to come out
and transition. These responses described their own regrets: “Do
not wait to come out till one is old like me.” Others addressed the
idea that gender dysphoria will not go away on its own: “If you
feel this way it doesn’t stop and only gets worse until you transi-
tion.” Do not delay transition responses also related transition to
pride and authenticity (“I wish I hadn’t waited so long. Also, don’t
put off your transition - be who you are, and be proud of it”).
Military. Within advice about the military, there were a few
distinct subthemes, described below.
Do not join/leave. Four participants specifically recom-
mended either not joining the military or leaving as early as
possible. Two of these recommendations specifically discussed
leaving the military to transition sooner rather than later, whereas
the other two responses more broadly discouraged military service
itself.
Serve/be proud. Four participants provided the exact opposite
advice, which was to encourage people to enlist and to be proud of
their service. Three of the responses that recommended military
Table 4
Major Themes and Subthemes for the Question, “What Advice Would You Give Other Transgender Veterans Based on Your
Experiences?” (n ⫽190)
Theme or Subtheme Frequency n(%) Example quotes
Be yourself 44 (23.2) “Never be afraid to be yourself. The greatest test of your character is your courage to be true to
yourself in every way.”
VA 29 (15.3)
Recommend 17 (11.1) “Use the VA for transgender issues. They are supportive and you earned the privilege.”
Stay away/Avoid 15 (9.5) “Avoid the VA. Get a really good job, save your money and take care of yourself outside of the
VA system.”
a
Get help 29 (15.3) “Seek counseling from an experienced gender therapist if one is available and if not, from a
therapist you feel comfortable talking to.”
Advocate 28 (14.7)
For yourself 23 (11.1) “Do what you need to do to take care of your needs.”
For others 5 (2.5) “Try to educate [your doctors] on the respectful terminology that you have personally experienced
or correct them when they misgender or make a mistake. This will help them with dealing with
more patients such as yourself in the future.”
a
Find community 27 (14.2) “Build a strong support system for yourself. Participate in a peer support group.”
Don’t give up 24 (12.6) “Things get better. If you’re feeling low there is only one way to go and that’s up.”
Don’t delay transition 14 (7.4) “Transition as fully as you can as soon as you can and never look back.”
Military 16 (8.4)
Don’t join/Leave 4 (2.1) “Don’t join, you’ll regret it every day for the rest of your life.”
Serve/Be proud 4 (2.1) “For all transgender vets: finish out your contract. Serve honorably. Leave the military, enjoy the
benefits, and live your life as you truly are.”
Hide/Conceal 8 (4.2) “Be proud of your service, but don’t let anyone know about your gender identity issues, you will
be kicked out.”
Other 26 (13.7) “I have had no experiences that would benefit any other Transgender Veteran.”
“Be prepared for a lot of hassle.”
Note. Responses could be coded as more than one theme. The following are additional codes that applied to the selected quotes:
a
Advocate for yourself.
71
QUALITATIVE ANALYSIS, TRANSGENDER VETERANS
service simultaneously discussed the necessity of hiding one’s
gender identity while in service (discussed further below), whereas
two of the responses emphasized the benefits available after mil-
itary discharge.
Hide. Another subtheme of military-related advice was the
recommendation to hide one’s true gender identity, specifically
while in service or when interacting with military institutions or
the VA. Responses discussed the importance of hiding transgender
status to avoid a dishonorable discharge and loss of benefits.
Others recommended hiding for safety reasons and to avoid dis-
crimination (“Don’t ever let other military know, active nor inac-
tive, that you’re transgender. Extreme bigotry from radical con-
servatives still plague the military”).
Discussion
The overarching goal of the present study was to provide a voice
to the full range of life experiences reported by trans-vets in a
national online survey. In this examination of challenges,
strengths, and advice for fellow trans-vets, a wide range of re-
sponses was identified. The diversity of responses often reflected
both sides of a given issue, such as lack of community as a stressor
and the presence of community as a source of strength. At times,
the identified themes directly contradicted each other, such as
participants recommending or discouraging use of VA health care,
or participants recommending joining or leaving the military. Most
of the results of this study were viewed through the lens of
minority stress theory, specifically the concepts of external and
internal minority stress and resilience factors (Meyer, 2003).
When asked about the greatest challenges they face, trans-vets
reported negative experiences across a number of domains, includ-
ing stressors imposed from the environment because of their
minority identity (external minority stress), stress experienced
within because of their minority identity (internal minority stress),
problems with the VA, problems with the military, problems with
health care in general, and a lack of community with other veterans
and with people in general. The broad range of life domains
highlighted in these responses, as well as the noteworthy overlap
in themes (see Figure 1), suggests that trans-vets face pervasive
challenges in their social context. These results paralleled existing
quantitative research with trans-vets that reported pervasive expe-
riences of minority stress (e.g., Blosnich et al., 2016;Brown &
Jones, 2015;Harrison-Quintana & Herman, 2013).
When asked about what they like best about being a transgender
veteran, participants reported experiences in many of the same
domains that presented challenges, including health care, military,
and community. They reported experiences that stood in opposi-
tion to external and internal minority stress (Meyer, 2003), namely
acceptance by others, personal pride and authenticity, and social
activism or education. There was noteworthy overlap between
themes of health care,community, and pride, authenticity, and
resilience. The overlaps suggested that access to affirming health
care and a supportive community were associated with individu-
als’ ability to endure and possibly grow from challenging experi-
ences. A unique finding is that trans-vets also reported positive
benefits of trans-specific health care as offered by the VA system.
Advice for fellow trans-vets touched on the importance of
finding community, getting help, advocating for and being true to
oneself, and not giving up. These themes fit well with the themes
identified in the resilience question and with the recovery model of
mental health (Anthony, 2000;Jacobson & Greenley, 2001;
Leamy, Bird, Le Boutillier, Williams, & Slade, 2011), which
emphasizes community, advocacy, self-determination, eliminating
stigma, and peer support. Health care providers who work with
trans-vets may enhance patient-centered care by facilitating com-
munity connection and peer support.
Interestingly, a large proportion of the responses (23.7% to
43.5%, depending on the question) were about the military and the
VA, even though the question prompts were intentionally broad
and general. Although this could be partly attributable to the fact
that the informed consent listed VA affiliations for the researchers,
it is also likely that these institutions play an important role in the
lived experiences of trans-vets. The significant overlap observed
between minority stress themes, resilience themes, and VA or
military themes suggest that these institutions can have both pos-
itive and negative influences. These influences can be enduring,
lasting long past military service.
Minority stress (Meyer, 2003) and resilience (Meyer, 2015)
impacted trans-vets’ mental health, wellbeing, sense of self, and
life stability. For example, several trans-vets discussed how their
financial stability has been negatively impacted by forcible dis-
charge from a military career, employment discrimination, and/or
limited health care access. Others discussed the instability and
uncertainty surrounding marriage and family in the context of
gender transition and possible rejection. In terms of resilience,
many responses connected specific methods of coping (e.g., activ-
ism, education, social support) to positive feelings about oneself
and improved mental and physical health. Across all three ques-
tions, the responses illustrated the repercussions of minority stress
and individual and community resilience on overall wellbeing.
Implications
Given the potentially powerful impact of health care, especially
the VA, on trans-vets’ lived experiences, a relevant question is
what VA policies or procedures exist to support trans-vet health.
Kauth and Shipherd (2016) reported on upcoming changes in the
VA to improve clinical environments, such as the addition of a
self-identified gender identity field in the electronic medical record
(EMR) to aid staff in using appropriate salutations and pronouns.
Tracking gender identity in the EMR will also provide more
accurate and representative data about trans-vets than what is
currently available, as VA research data currently rely primarily on
DSM/ICD diagnoses to identify trans-vets (Johnson et al., 2016).
Additionally, one of the most frequently mentioned themes in this
study was difficulty accessing health care services, particularly
gender confirming surgeries. Kauth and Shipherd (2016) note that
the VA ban on gender confirming surgeries is currently under
review. The military also just lifted its ban on open transgender
service and will provide all medically necessary transition-related
care. This recent change will likely impact a major barrier to care
for active duty transgender service members, who often delay care
for gender identity issues due to fear of career repercussions
(Johnson et al., 2016). The findings from the present study under-
score the potentially profound effects of institutional policies that
affect health care access and the mental health of trans-vets (Blos-
nich et al., 2016).
72 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
Another prominent theme related to health care was the impor-
tance of providers’ ability to deliver competent care to trans-vets.
To this end, Kauth and Shipherd (2016) note the VA’s substantial
efforts put forth in the past five years to rapidly disseminate
educational and training resources to health care providers about
transgender individuals. For example, the VA offers an online
repository (SharePoint) that provides educational materials and a
list of VA support groups; online trainings, including specialty
endocrinology and mental health trainings; access to interdisciplin-
ary e-consultation for individual patient issues; and training and
consultation for interdisciplinary teams through videoconferenc-
ing. The responses in this survey indicate that the lack of provider
competency is a major stressor that can negatively impact health.
On the other hand, trans-vets reported that access to knowledge-
able and affirming providers is not taken for granted but is instead
identified as a significant positive experience.
Finally, many trans-vets discussed the power of advocacy, com-
munity, and seeking professional help. Clinically, providers have
an opportunity to provide encouragement to their patients, facili-
tate or support trans-vet groups in VA, and advocate on trans-vets’
behalf within the health care system. As the VA strives to embody
a recovery model for Veterans (SAMHSA, 2005), this study rein-
forces the need for instilling hope, respect, and empowerment.
Limitations and Future Directions
This study has several limitations that should be acknowledged
and that highlight a needed pathway for future research. Online
sampling and voluntary, written responses may be biased toward
more highly educated respondents. Previous research comparing
in-person and online respondents to the National Transgender
Discrimination Survey found that online respondents were more
likely to be older, White FTM individuals with higher socioeco-
nomic status and educational attainment than in-person respon-
dents (Reisner et al., 2014). As the present study was not a
population-based survey, it is impossible to ascertain if the sample
was representative of the larger trans-vet community.
The present sample was primarily White transwomen who iden-
tified as male during their military service (see Table 1). Given
findings that the combination of multiple minority identities is
known to be associated with worse outcomes, particularly for
African American transgender individuals (Grant et al., 2011) and
racial minority trans-vets (Brown & Jones, 2014), future research
efforts should focus on understanding how the lived experiences of
racial/ethnic minority trans-vets may or may not differ from the
majority.
Additionally, existing research suggests there may be important
differences in the experiences of transwomen and transmen veter-
ans, with transmen reporting higher rates of lifetime suicide plans
and attempts (Lehavot et al., 2016). Unfortunately, given the
relatively small proportion of transmen in this sample, we could
not systematically compare the responses of transwomen and
transmen. However, future studies should be designed to answer
this important question.
While the online survey methodology allowed for highly effi-
cient recruitment of a very large, national sample of trans-vets,
face-to-face or telephone interviews may improve diversity of
recruitment and allow for elaboration and clarification of partici-
pants’ responses. Interviews may provide greater depth of under-
standing than relatively short, online text responses.
Conclusion
At the very same temporal juncture that the military, VA, and
other societal institutions are examining the need for policy
changes around transgender rights, the scientific literature is be-
ginning to offer useful information about both stress and resiliency
factors for trans-vets. The results of the present study shed light on
specific factors that may act as either barriers or promoters of
wellness. Further efforts to understand the lived experiences of
trans-vets are likely to produce important information for clini-
cians who seek to provide competent and empowering care.
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Received July 27, 2016
Revision received November 28, 2016
Accepted November 29, 2016 䡲
74 CHEN, GRANATO, SHIPHERD, SIMPSON, AND LEHAVOT
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