On July 26, President Donald Trump released another polemic tweet informing the public that “the United States Government will not accept or allow Transgender individuals to serve in any capacity in the US military,” citing the “tremendous medical costs” that transgender individuals pose to the health system. He affirmed his position again two weeks later, stating that transgender health care has “been a very confusing issue for the military” and emphasizing that he is “doing [the military] a favor.” The President based this declaration on a recent Rand study which estimates the cost of transgender care to range between $2.4 and $8.4 million, less than one-tenth of one percent of the over half-trillion-dollar military budget.
However, the President’s conclusion is short-sighted and dangerous. What he has failed to recognize is that his transphobic rhetoric likely costs the health system and the government much more. Anti-LGBT policies have real health consequences on populations and, in this case, a population much larger than the estimated 1000 to 6000 transgender service members — the entire LGBT population — owing to augmented minority stress.
Minority stress theory posits that continuous micro- and macroaggressions, including overt and implicit acts of discrimination and stigmatization, lead to poorer health outcomes for minority populations over time. Members of the LGBT community are no exception. They suffer increased rates of depression, substance abuse, eating disorders, asthma, obesity, high cholesterol, diabetes, back pain and headaches compared to their non-LGBT peers. It is increasingly understood that living with increased baseline stress promotes systemic inflammation, compromises immunity, and impairs healing while simultaneously straining the cardiovascular, nervous and endocrine systems.
Whether or not the President’s tweets reflect official policy, his statements are undoubtedly direct macroaggressions against LGBT individuals who hear and internalize them to the detriment of their health. Ironically, these tweets likely counteract his professed motivation to save money for the military. Management of the chronic conditions mentioned above demands a tremendous amount of resources, and the President’s repeated attacks will only exacerbate that cost by intensifying the level of minority stress.
The president’s ire for minorities has not been limited to the LGBT community. We’ve been reminded of that as we watched the aftermath of the protests in Charlottesville. The President’s de facto complicity with white supremacists is just another virulent strain of his penchant for discrimination, and this additional minority stress will have real health consequences to people of color. And, it’s worth noting that this minority stress is doubly toxic for individuals with intersectional identities who are being increasingly marginalized by the rhetoric coming from the Oval Office. These people are our patients, and they’re under assault. As physicians, we must hold the line and hold the President accountable for his language and the health crises it will cause.