GIVEing transitioning veterans support

Jonathan Kaupanger
June 26, 2018 - 2:50 pm



Alice Sophie Ashton has been a woman for just about a month.  At least according to the U.S. Navy.

“As far as the military is concerned, I’m a woman now,” says Alice.  “I’ve considered myself that for a while, but they’ve finally accepted it!”

Alice started her military career with the Air Force in 1997.  She got out in 2003, but three years later decided to re-up, and changed to the Navy.  She came out to her chain of command in early 2016, “I had already made sure they couldn’t fire me for it at that point,” she recalls.  The ban on transgender Americans serving in the military was finally lifted in June 2016.  She told her command as a courtesy so they could work together on the best way to come out to her unit. 

“My peers embraced me entirely,” Alice says.  They invited her to a party that Friday night and she went – for the first time – as herself.  No one had a problem with her at the party; she felt accepted.  Since this was before her gender marker was officially changed, the following Monday she showed up to work and presented as male.  Even though she checked at least three times, she was accused of wearing mascara. 

“It was difficult for a very long time,” Alice recalls. “I felt almost like I had multiple personalities!”  Because of military regulations, she had to dress like a male during the day.  “I was presenting one way at work and having to deal with that and then coming home and being able to be myself.”

Alice had to figure out her way on her own.  She didn’t know about it at the time, but had she stayed a veteran, she could have used services provided by the VA’s Gender Identity Veteran Experience (GIVE) clinic at the Louis Stokes Cleveland VA Medical Center.

“I think there are a lot of transgender individuals in the military,” says Dr. Megan McNamara, physician-director of GIVE.   “I think it’s been very difficult for them to identify themselves.  But we know from our own clinical experience, that many of these patients have been feeling these feelings for years and years and years and have never been able to express themselves.”

GIVE Clinic has been around since 2015, and was very small when it started with just 22 patients.  It’s not the normal VA type clinic that’s set for everyday use.  While there is dedicated staff, they have other duties at the Cleveland VAMC, too.  At first, GIVE Clinic was just open a half day, once a month; in July 2017 there were enough patients to move to being open a full day each week.

The number of patients now is a bit of a moving target.  “Being a transgender individual can be challenging at times and many of our patients struggle with both housing and employment issues,” says McNamara.  “Many patients establish with us and then move away for a variety of reasons.”  In total, McNamara says she’s seen anywhere from 80 to 100 veterans in her clinic over the years.  Today her current population is about 70.

Veterans Affairs does not pay for or provide surgery for transgender veterans.  It will provide all pre- and post-operative care though, including hormone therapy, voice therapy, regular primary care and electrolysis.  McNamara explains that veterans receive all the specific screening that’s relevant to each person.  “If you’re a transgender female, you’re a natal male transitioning to female. I would talk to you about prostate cancer screening.”  The same goes if you’re a transgender male.  A natal female transitioning to male still has a cervix, so a discussion on cancer screening is provided. 

The VA will not pay for any type of cosmetic surgery.  Facial feminization and thyroid shaving will not happen at a VA clinic.  After surgery from an outside source, home health aides and services will be coordinated by the VA.  Most importantly, any person who’s exploring their gender identity has full access to all mental health services and all social work services that the VA provides. 

Mental health is key for transgender veterans.  Until May, Alice had to present in male clothes even as she was developing as a woman.  “I’d either get dysphoria during the day dealing with that or else I would get a mindset where I’m pushing those emotions aside,” she says.  “If I had a good day I’d be like, ‘am I really transgender?’ It’s difficult to have to be two people.  I know of at least one, probably two or three people who have died because of this.  This is a very real thing.  It’s causing significant mental health issues with people.”

“Many transgender individuals have mental health issues for a variety of reasons,” says McNamara.   “Depression and anxiety are common and then the stigma they face in today’s current environment make things even harder and of course suicide is a huge issue.” 

For Alice, everything changed the day the Navy changed her gender marker.  “It was night and day after my gender marker changed,” she says.  “I no longer had to be two separate people.  I’m not going to say that everything is perfect, because it’s not, but it’s so much better!”

The GIVE Clinic is actively taking new patients.  “I am so passionate about this that I’d love to do this all the time” says McNamara.  “We’re really limited by the number of patients.  If we had the patients we’d be in the clinic all the time!”

Alice’s advice to other transgender people is to know your resources!  “Those are difficult to find sometimes, so getting a mentor is critical,” she says.  “Then read the regulations!  I’ve had to educate the command and my medical team on what the regulations are.  Multiple times!”

Now that Alice’s outside gender matches what she feels on the inside, we had to ask, did she have a favorite thing about being a woman and her answer was surprisingly simple.  “The fact that I can complement a women on her shoes without it being seen as problematic.  And it’s not seen as me being creepy.”

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