Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members

Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired.

This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System.

This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository.

A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code.

Time-to-gender-affirming hormone initiation after diagnosis receipt.

A total of 2439 Service members were included (M age 24 y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female ( P <0.001), and Asian and Pacific Islander ( P =0.02) and Black ( P =0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis.

The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.