Lt. Cmdr. Blake Dremann has received millions of dollars in training from the Navy Department.

The military paid for Dremann to attend the Supply Corps Basic Qualification Course, Anti-Terrorism Officer School, Helicopter Control Officer School, Basic and Intermediate Leadership schools, Submarine Officer Basic Course and Joint Professional Military Education phase one.

He also spent a year serving in Afghanistan from 2010 to 2011, five three-month strategic patrols aboard a submarine and worked for the Joint Staff Logistics Directorate.

Having won the Navy’s highest junior officer logistics award in 2015, Dremann is just the type of sailor the Navy, or any other military service, would want to hold on to.

But all that training and money may go to waste because Dremann is a transgender sailor.

President Donald Trump’s July 26 announcement over Twitter banning transgender individuals from the military may force Dremann, along with as many as 15,000 other transgender service members trained on the taxpayers’ dime, to leave the military.

In his tweets, Trump said his decision was based on the “tremendous medical costs and disruption that transgender [people] in the military would entail.”

A month later, Trump issued the guidance to the Defense Department. The Aug. 25 policy bans future transgender recruits and lets Defense Secretary James Mattis decide if current transgender service members can stay in the military on a case-by-case basis.

DoD Assistant to the Secretary of Defense for Public Affairs Dana White followed the release of the guidance with a simple statement: “The Department of Defense has received formal guidance from the White House in reference to transgender personnel serving in the military. More information will be forthcoming.”

An in-depth look by Federal News Radio, however,  found removing transgender service members from the military and training new recruits to take their place will have significant impacts on cost and readiness. The military will also lose its investment in those transgender troops it kicks out.

This comes at a time when lawmakers and DoD officials say the military is in a readiness crisis and is losing the battle with industry when recruiting and retaining top talent.

Proponents of the ban say transgender service members negatively affect military readiness because some medical treatments may make them non-deployable for long periods of time.

“The last thing we should be doing is diverting billions of dollars from mission-critical training to something as controversial as gender reassignment surgery.  However, the cost to readiness, recruitment, retention, morale and cohesion would have been even greater under the Obama policy.  As our nation faces serious national security threats, our troops shouldn’t be forced to endure hours of transgender ‘sensitivity’ classes and politically-correct distractions like this one,” said Tony Perkins, president of the Family Research Council, in a statement released after Trump’s tweets.

Lawmakers from both sides of the aisle reacted strongly to the president’s policy announcement.

“It would be a step in the wrong direction to force currently serving transgender individuals to leave the military solely on the basis of their gender identity rather than medical and readiness standards that should always be at the heart of Department of Defense personnel policy,” said Sen. John McCain (R-Ariz.), chairman of the Armed Services Committee, in a statement. “The Pentagon’s ongoing study on this issue should be completed before any decisions are made with regard to accession. The Senate Armed Services Committee will continue to conduct oversight on this important issue.”

Rep. Adam Smith (D-Wash.), ranking member of the Armed Services Committee, said in a statement he would fight for the reversal of the ban.

“President Trump has no credible information suggesting that transgender service undermines military readiness. Yet he is willing to ruin lives and deface our government’s commitment to equality in an apparent attempt to secure funding for his border wall,” he said.

Until Trump’s policy is finalized, transgender service members serving as doctors, signals officers, pilots and in other capacities are waiting to find out what their future in the military will be.

Readiness cost

Training service members is an expensive task.

Most recent estimates peg the cost of basic training at about $20,000 per service member. That’s the base amount of money the military will spend per person.

A RAND Corporation study estimated there are between 4,000 and 15,000 transgender service members currently in the military.

It is extremely difficult to estimate the total cost of removing transgender troops from the military when taking into account those who may be retiring, the high turnover rate in the military, and service members who may be leaving the military after an enlistment.

The costs for removing these service members are more than just training. Long-term investments also would be lost. As service members progress, they are required to complete more training to achieve higher ranks.

In the Army, for instance, enlisted soldiers must take professional development courses before advancing to the ranks of corporal, sergeant, staff sergeant or sergeant major.

The costs include supplies, equipment, contracts, student pay, allowances, travel costs and both base and medical support provided over the duration of the training.

Those training costs are only for the most basic training every person in the Army must complete at their ranks.

On top of that baseline training is specialty training for the occupation each service member is assigned. Those occupations can be anything from intelligence to engineering.

In one extreme example, the Air Force estimates it takes $12.5 million to train one F-22 fighter pilot.

The Palm Center, an organization that studies transgender issues in the armed forces, helped DoD formulate its transgender policy under President Barack Obama, letting transgender service members serve openly and have their medically necessary costs paid for by the government starting July 1, 2017. Defense Secretary Mattis postponed the implementation of that policy prior to Trump’s tweets calling for an outright ban.

Aaron Belkin, executive director of the Palm Center, told Federal News Radio transgender service members currently serve in every capacity imaginable, from cyber warriors, to pilots, to logistics officers like Dremann.

Sue Fulton is the president of SPARTA, an LGBTQ service member and veterans organization. She said the impact is much greater than most realize.

“Just within SPARTA, we have academy graduates who have gone through Annapolis or West Point. That is hundreds of thousands of dollars in leadership training, and they are leading units today or they are flying aircraft,” Fulton said in an interview with Federal News Radio. “Quantifying the training they got just through the academies is several hundred thousand dollars, and then follow on training to train an officer in their specialty varies depending on what their specialty is. If you’re talking about someone who goes to Ranger School or has pilot training or is an intel officer, again you are running into hundreds of thousands of dollars. We have folks who are military physicians who went to medical school who are currently serving the Army playing critical roles.”

On top of all the training costs are the expenses of keeping a service member in the military.

The Congressional Budget Office estimates it costs $170,000 a year to keep someone in the service when accounting for salary, basic housing allowance and health care.

Between mandatory training, occupational training and the expense of keeping a service member in the military, the incurred costs of losing transgender service members and retraining replacements far outweigh the estimated medical costs of paying for transition services, said Belkin and Fulton.

Some lawmakers, however,  feel that keeping transgender service members in uniform carries hidden costs.

“I’ve looked at this issue very, very closely and this policy is going to cost $1.35 billion over the next 10 years alone just for the sex reassignment surgeries of the transgender members of our service. And that equals 13 F-35 airplanes that we could buy with that or 14 F-18s,” said Rep. Vicky Hartzler (R-Mo.) during a July 26 interview on CNN.

She added the cost was based on calculations performed by her staff. “We need to invest every defense dollar to meet the threat that we’re facing right now as a nation.”

Rep. Duncan Hunter (R-Calif.) supported Hartzler’s views.

“You’re joining the U.S. military. Choose what gender you are before you join,” he said during a debate. “We’re not stopping transgender people from joining. We’re saying taxpayers in this country right now are not going to foot the bill for it.”

Hartzler also is worried about the time nontransgender service members spend on sensitivity training and the possibility of a transgender service member becoming nondeployable after surgery.

Transition costs

The cost of keeping transgender individuals and new recruits in the military is estimated to cost between $2.4 million and $8.4 million annually, according to a 2016 RAND Corporation study.

“The cost represents a 0.04-to-0.13-percent increase in active-component health care expenditures,” the study stated. The RAND study assumes active-duty military health care costs are about $6 billion.

Those numbers are corroborated in another study by Belkin, published in the New England Journal of Medicine in 2015.

“The provision of transition-related care will cost the military $5.6 million annually, or 22 cents per [military] member per month,” Belkin’s study stated.

The cost equals 0.00038-to-0.0013 percent of the approximately $640 billion base budget authorized by the House and Senate Armed Services Committees for 2018.

The RAND study stated between 29 and 129 service members on active duty would undergo transition-related care per year.

Many transitions are accomplished with injections that cost about $30 a month.

Some transitions do require surgery and can leave a service member nondeployable. For instance, the RAND study stated the recovery time after a hysterectomy is 111 days.

The conservative Family Research Council estimated the total cost of new transgender recruits and keeping current transgender service members at $1 billion a year.

That paper factors in hypothetical situations, like a year of leave for experience in the new gender, but there is no evidence DoD planned to offer that benefit.

Still, the worries over nondeployment are concerning for those supporting the ban.

“We must have soldiers who can deploy if called upon,” Hartzler said last month during a debate over an amendment she offered to the 2018 Defense authorization bill that would have reversed the Obama-era policy of paying for service members’ medical transition costs. The amendment failed by a close margin.

“Military members undergoing transition surgery are nondeployable for up to 267 days,” she said. “Similarly, regular hormone treatments render individuals nondeployable into the future. It makes no sense to create soldiers who are unable to fight and win our nation’s wars and unfair to nontransitioning individuals who must leave their families and deploy in their place.”

Multiple emails to Hartzler’s office seeking further comments were not returned.

Lt. Cmdr. Blake Dremann transitioned mostly on hormones at $30 a month while on five strategic deployments on a Navy submarine.

The Navy repealed its ban on women in submarines in 2010. Dremann, who still identified as a woman then, was picked to be one the supply officers to help with the integration of women on submarines.

“Here I was coming home from Afghanistan, about to go be famous for being a female to do something, and working on transitioning to a male,” Dremann told Federal News Radio.

Dremann’s transition started while he was serving in Afghanistan. While overseas, Dremann said he bought every book he could find on Amazon on transitioning.

“When I came home in 2011, I really started to socially go that direction, picking a name,” Dremann said.

Dremann started therapy to deal with issues after being overseas and found the counseling helped him come to terms with his gender dysphoria.

“I didn’t want to embarrass my family, I didn’t want to embarrass the Navy, especially after they just put me at the forefront of a big [submarine] program. I had to be very cautious about what steps I took toward my transition,” Dremann said. “In November of 2013, right before my fourth strategic deployment aboard a submarine, I decided I need to take the next step in starting hormones.”

Dremann started hormones that month, but had been transitioning socially for years. In March of 2014, the Navy paid for him to have a mastectomy due to back problems.

Two of Dremann’s submarine patrols were during his transition.

His doctor gave him smaller doses of the hormone for the deployment to decrease the severity of the effects. Those doses were increased slowly over the next year.

Dremann said there were no life-threatening effects. He was fully capable on his deployment in the submarine while taking the injections.

After serving on the submarine, he went to work at the Pentagon for the Joint Staff. During that time, when transgender people were still not able to serve openly, Dremann’s superior asked him if he went by a different name outside of work.

“What do I do at this point? Do I tell her no and risk there being some kind of consequences, or do I tell her yes and basically risk the same kind of consequences? So I was like, ‘Yes, I do. I go by Blake. I plan on getting it changed here legally in Virginia in the next couple weeks. But until that happens, I’m going to go by my birth name.’ I did that and I left. I had been at the Pentagon three days. I didn’t even have computer access at that point,” Dremann said.

Dremann’s boss called him an hour later.

“She told me the division had discussed it and if I’m OK with it, they’d like to call me Blake. … There was no big announcement. There was no nothing,” Dremann said.

Misconceptions

Gender dysphoria is diagnosed from the same medical criteria as depression or anxiety.

People with gender dysphoria must have “functional limitations” to be diagnosed.

“If you don’t have that functional limitation, then you don’t actually meet criteria for having that diagnosis,” and can’t get medical coverage from insurance or the government, said a Navy doctor who spoke to Federal News Radio on the condition of anonymity.

A functional limitation could be difficulty getting out of bed and going through life, difficulty with social interactions or being too afraid to go to work — things that make it hard to go through life every day.

Much like something like a major depressive disorder, people must show symptoms of gender dysphoria nearly every day.

“There is emerging data that when we treat people with gender dysphoria with medical therapy or surgical therapy to confirm their gender identity, that they get better. Those studies are really hard to do and they are just starting to do better and larger studies to demonstrate those outcomes,” the doctor said.

Treating gender dysphoria helped Army Staff Sgt. Catherine Schmid, a transgender soldier who transitioned from male to female and works in signals intelligence.

Schmid was so wrought with turmoil over her identity that she stood on the edge of the Tampa Bay Bridge considering suicide after coming back from Iraq and telling her wife that she was transgender. She said she stopped her attempted suicide only after calling a crisis hotline and realizing her two daughters would be better off with a transgender mother than a dead father.

Schmid started her transition in September 2014.

Before her transition, she was diagnosed with major depressive disorder and attention deficit disorder, but found the medicine was not helping her situation.

“I was feeling basically the symptoms of an anxiety disorder or mood disorder without actually having an anxiety or mood disorder because what I was experiencing was gender dysphoria,” Schmid told Federal News Radio.

When Schmid told her wife that she was transgender, her wife wanted a divorce.

“That was a significant emotional blow because I thought my only options were to try and shove it down again, or my life as I knew it would change forever,” she said.

Schmid went ahead with the transition.

“It was almost an immediate [mental change],” Schmid said. “It feels like the world is in color. It was like using the wrong fuel in your vehicle for a long time. You switch to the right fuel and you can instantly feel the change. Mentally that was it. Even my [evaluation reports] said ‘endured significant hardships during this period of time. Marked improvement following the start of medical treatment,’” Schmid said.

A common misconception about transgender individuals is that they all need surgery to fully transition into their identified gender, and that is not the case, according to the Navy doctor. The patient’s doctor decides what is medically necessary to make that person stable to be deployed.

For some transgender individuals, that consists purely of the $30-a-month hormone treatments. For others, it may include reassignment surgery, which can cost $10,000 to $20,000, depending on the circumstances.

Those steps are determined by the doctor.

Other conditions are treated the same way in the military.

“The military is not composed of totally healthy 18-year-olds. You have lots of diversity in the ranks and with that diversity comes illness,” the Navy doctor said.

The military lets people deploy as long as they are stable for a period of time and their conditions are manageable in theater, the doctor said.

“When I was deployed, I was surprised to find people there who had significant medical problems that one would think would prevent them from deploying, and yet they were there. God knows who signed what waiver to get them there. [The conditions] were much more limiting than someone happening to be transgender,” the Navy doctor said.

The doctor said he has taken care of sailors with “every chronic condition you can imagine,” from chronic back pain, to type-two diabetes, to asthma.

“You name it, there’s someone in the military who has it,” the doctor said, and the military pays for the treatments.

The purpose of the military

The purpose of the military is to be a lethal force capable of protecting the nation and fighting wars.

When former Defense Secretary Ash Carter allowed transgender individuals to serve openly, he said he was attempting to broaden the talent pool from which the military could recruit.

The leaders of the military services have told Congress for years they are facing stiff competition with private industry in the battle for talent.

Carter wanted to open the military to transgender people to recruit more high achievers like Blake Dremann and people who fill in-demand jobs like Catherine Schmid.

But others see Carter’s moves as social policy rather than bettering the military.

William Boykin, a former deputy undersecretary of defense for intelligence who is now executive vice president of the Family Research Council, told Federal News Radio the military should ban the future recruiting of transgender troops. His group praised Trump’s decision to ban transgender people from the military.

“Show me how the transgenders serving in the military enhances readiness. The answer is it doesn’t. What it does do is it detracts from readiness. It detracts from readiness because we spend an inordinate amount of time in the military training for things that don’t contribute to winning wars,” Boykin said.

You have to take every service member, “sit them down in a classroom for hours at a time to talk to them about how you integrate women into the infantry, how you integrate homosexuals into the military, how you integrate transgenders in, to talk to them about white privilege,” he said.

Boykin said taking up service member time on things other than war when they will be deployed is a disservice to them.

Boykin said despite his feelings on transgender individuals, he thinks those who are in the service should be given early retirement packages, because they will feel like the government has not been straight up with them.

“They came out in good faith believing that their government was allowing them to serve openly. You cannot break faith with them,” Boykin said. “We are not advocating they all be put out of the military.”

Still, Boykin has a problem with recruiting transgender people into the military and especially paying for their medical expenses.

“Why should we spend any taxpayer money to transition someone from one gender to the other when we don’t do cosmetic surgery for breast jobs, for facelifts for those wonderful wives that have kept that family together through eight, nine, 10 deployments? But if they want a facelift or they want a boob job, they have to go down to a surgeon and pay for it themselves,” Boykin said.

The next step

The Defense Department is expected to release more information on its implementation of the transgender guidance in the near future.

Schmid, Dremann and others say despite the uncertainty, they have jobs to do. Until they are told otherwise, they will report for duty and continue serving.

“I get up every morning and put my boots on and go to work and until I’m told otherwise. That’s what I’m going to do. While the initial shock lasted about 10 minutes while I collected myself, I really did have to buck up because I knew I had at least 500 or 600 service members that were going to be looking to me as that calm voice to lead them through whatever was coming next. In all honesty, my feelings don’t really matter because it’s a readiness issue at this point. You can’t kick out anywhere from 6,000-to-10,000 people and not have a readiness issue. The big thing is we are already here, we are already serving,” Dremann said.

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