Natalie Kastner has wanted gender affirming surgery since she was 16 years old.
鈥淚 fell into the trap where I thought like a lot of people do, that this is a phase,鈥� the former Army engineer said about the gender dysphoria that鈥檚 plagued her for years. 鈥淚 fell into that trap, and boy, did that hit me after I left the Army.鈥�
Now a disabled veteran living in Texas, Kastner said the Department of Veterans Affairs won鈥檛 perform the operation, and she would have to leave the state to get it privately. Two years ago, she said she severed an artery when she attempted to cut off her genitals in her own bathroom.
鈥淚 wanted to fix myself,鈥� Kastner said. 鈥淚t wasn't about suicide or anything like that. It was, 鈥業 wanted to fix myself.鈥� And I knew the VA would not pay for that.鈥�
The VA doesn't provide or pay for gender affirming surgery for transgender veterans, even though many of the same operations 鈥� like hysterectomies and plastic surgery reconstructions 鈥� are provided for other health reasons. Secretary Denis McDonough announced in 2021 the VA would change that rule, but transgender veterans are still waiting.
Now, The Transgender American Veterans Association (TAVA) is suing over the VA鈥檚 unfulfilled promise to provide and pay for gender affirming surgeries.
鈥淲hat the VA鈥檚 delay has done is consigned these veterans to essentially a lifetime of suffering with gender dysphoria after it promised to take care of them,鈥� said Alex Johnson of Yale Law School鈥檚 Veterans Legal Services Clinic, which represents TAVA.
Johnson said the VA鈥檚 failure to act is illegal and dangerous to the health of transgender veterans. She said even veterans who can afford to bypass the VA and pay for surgery privately end up stuck.
鈥淪ome VA doctors have even been reticent to provide these referral letters because they're scared it will run afoul of this categorical exclusion,鈥� Johnson said.
As late as this past summer, Secretary McDonough took ownership for the delay 鈥� and acknowledged the political firestorm around the issue of trans rights.
鈥淭he bottom line is that when I make the decision, it鈥檒l be my job to defend it and so I want to make sure I鈥檓 best positioned to do that.鈥�
At a news conference announcing the lawsuit, activists said the reason for the delay doesn鈥檛 matter.
鈥淩egardless of their excuses or reasons they have internally doesn鈥檛 disregard the fact that we have been misled [and] misinformed,鈥� said Josie Caballero, vice president of TAVA. 鈥淭hey can give us all the excuses in the world, but we know they are in violation.鈥�
A VA spokesperson said the agency is still working on the change and declined to comment on the lawsuit.
Transgender veterans are able to access other kinds of gender affirming care through the VA like hormone therapy and mental health support.
For Caballero, that鈥檚 just not enough.
鈥淲e are in crisis,鈥� she said. 鈥淓very day that goes by, another trans veteran suffers. We cannot take empty promises or excuses any longer. This isn鈥檛 a political issue. This is a veteran issue.鈥�
The VA estimates that more than 130,000 veterans are transgender. Not all of them want gender affirming surgery, but for the ones who do 鈥� and can鈥檛 get it 鈥� Kastner said she鈥檚 worried they鈥檙e at risk of losing their lives.
鈥淭hey say that our suicide rate is high,鈥� Kastner said. 鈥淚 can only imagine how many of those suicides weren't suicides. How many of those suicides were actually accidental because those veterans took it in their own hands like I did to fix themselves.鈥�
While the lawsuit moves through the federal court system, Kastner said she鈥檒l have to keep doing what she鈥檚 been doing: wait.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans.
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