The top medical officer for the Navy and Marine Corps said his organization is poised to help service members navigate gender transition.

Vice Adm. Forrest Faison, the Navy’s Surgeon General, said the service is prepared to provide transgender sailors and Marines the proper guidance and medical care, but that it might refer some of the care to the private sector for now. 

In addition, a robust training effort is underway in the service to train all medical personnel about the Navy and Marine Corps' rules and procedures, which Faison said is a critical first step.

"We’re in the process of developing training that will be delivered later this month or the early part of next month to train every deckplate provider — we want to make sure they’re well trained and they’re compassionate and empathetic as we seek to provide the best care our nation can offer," Faison said in a Dec. 3 interview with Navy Times.

But it’s more than just training, he said, he’s also trying to build Navy medicine’s expertise in transgender medicine as well to give those deckplate caregivers not only the knowledge, but the assets to help sailors navigate these issues from simple counseling all the way to surgery.

"What we’re in the process of doing is standing up teams of experts — there’s actually one here in Portsmouth and one in San Diego that are referrals," Faison said.

"[Deckplate medical providers] can call this team and get guidance on every aspect of taking care of a patient, whether it’s hormone therapy, consideration for surgery or whether it’s mental health counseling or other issues involved in the transition."

Faison said those teams are in place now to give advice to healthcare providers as well as to service members on referrals.

The Navy released its transgender guidance in early November, shortly after Secretary of the Navy Ray Mabus signed out the department’s overall policy on the issue. The Marine Corps pushed out its version of the guidance Dec. 5.

To date, an unspecified number of sailors and Marines have come forward to investigate gender transition, both services said.

Sources from both services said that they’re not publicly tracking exact numbers because of the potential of violating a service member’s privacy.

Sailors and Marines wishing to switch genders must first have a detailed plan outlining the steps developed by their military medical provider and then that plan must be blessed by their commanding officer.

It’s not until their transition is complete and their legal gender status is changed that the military will recognize their "preferred gender" and change their records.

But some could get an exception to that policy along the way, which also must be approved by the service member’s command after their medical caregivers say it’s in the person’s best interests as part of their plan.

Faison stressed that transgender care is multi-faceted and there are a lot of considerations that are required well in advance of any surgical procedures to help service members sort out what it is they want and need.

"Most individuals that are transgender choose not to go all the way to surgery," he said. "While some will go part of the way."

When it comes to the physical medical treatment portions of transition, he said, the Navy is already well situated to provide care in many areas, but is still in learning mode on others and need time to develop service knowledge as well as expertise.

"We already manage hormone therapy every day for other conditions so we’ve got people that are able to do that," he said.

When it comes to actual surgeries, it gets a bit more difficult.

"I define surgery with the top and bottom," he said. "Top surgeries we do — augmentation surgeries, mastectomies, we do those for other medical conditions."

But, he said, where the service doesn’t have expertise is in the final gender reassignment surgeries — bottom surgeries as he modestly described them.

"Because of the potential for high complications, we consult experts in the civilian sector to make sure it’s done safely and with the lowest risk of adverse outcomes. For now, this procedure will likely be referred to a civilian center of excellence," he said.

About Mark D. Faram

Mark D. Faram is a former reporter for Navy Times. He was a senior writer covering personnel, cultural and historical issues. A nine-year active duty Navy veteran, Faram served from 1978 to 1987 as a Navy Diver and photographer.

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