A new Defense Department policy handbook gives transgender service members and their commanders a road map for gender transition in the active-duty military and Guard and Reserve.

The 71-page policy, released Sept. 30, lays out the medical process for service members who wish to change genders. A second section gives commanders a framework for working with transgender troops in their units, including a guide to gender pronouns and physical fitness standards for troops in transition.

"The handbook is designed to assist our transgender Service members in their gender transition, help commanders with their duties and responsibilities, and help all Service members understand new policies enabling the open service of transgender Service members," it says. "The handbook includes advice, questions and answers, and scenarios."

A ban on openly serving transgender troops was lifted in late June. The Pentagon will pay for "medically necessary" transgender treatment, including sex-change operations, as part of that decision, officials said.

Tricare, which provides health care to military family members and retirees, covers hormone therapy and mental health counseling for transgender issues, known clinically as "gender dysphoria," but by law cannot cover sex-change operations.

To undergo transgender treatment, the service member must first receive or confirm a diagnosis with a military medical provider, the handbook states.

The request for gender transition is then sent to his or her commander to sign off on timing, a decision based on deployment schedules and unit readiness. Once that signature is obtained and the service member goes through a transgender medical treatment plan, he or she can request a gender marker change in the defense personnel data system.

When that change is completed, the service member will be held to the standards of his or her new gender, including physical fitness and uniform requirements, the handbook states.

The process is almost identical for non-active Reserve and Guard members, the handbook says, with one key difference. Rather than work exclusively with a military medical doctor, those troops must receive care from a private physician under separate, non-DoD health insurance, and then work with the command to change genders in the defense personnel system.

The guide advises transgender troops to be "open and honest" with their commander and colleagues. For example, troops could consider asking their commander to host a unit meeting explaining their decision to change genders, the guide states.

"It is important to remember that while you have had many months, probably years, to understand your need to transition, this may be the first time your colleagues have encountered gender transition," it says. "They may have difficulty understanding the reasons and the process."

For commanders, the handbook lays out rules about working with transitioning troops, including enforcing physical fitness standards.

"In the course of your duties, you may encounter a transgender Service member who wants to transition gender. It is important that you are aware of your obligations and responsibilities with regard to the support and management of Service members who are transitioning gender," the guide tells commanders.

"You are responsible and accountable for the overall readiness of your command," it states. "You are also responsible for the collective morale and welfare and good order and discipline of the unit and for fostering a command climate where all members of your command are treated with dignity and respect."

Commanders are to hold troops transitioning gender to the PT standards of their birth-gender until they have officially changed over in the personnel system. But if hormone therapy is impacting their performance, commanders are to take "medical conditions" into account, the handbook states.

"Individuals undergoing cross-sex hormone therapy may experience changes to their body shape and physical strength, which may have a notable effect on their ability to maintain standards. If that is the case, consult with the individual and the MMP as you would for any other Service member with a medical condition affecting their ability to meet physical fitness standards," the handbook states.

Commanders are also to make special concessions for transgender privacy, it says.

"If concerns are raised by Service members about their privacy in showers, bathrooms, or other shared spaces, you may employ reasonable accommodations, such as installing shower curtains and placing towel and clothing hooks inside individual shower stalls, to respect the privacy interests of service members," it says.

"In cases where accommodations are not practicable, you may authorize alternative measures to respect personal privacy, such as adjustments to timing of the use of shower or changing facilities," it says.

Officials with the Palm Center, which advocates on transgender issues, said the handbook helps the military take care of its personnel and, as a result, be more effective.

"The military's continued progress in integrating transgender service members is a tribute to core principles and values," officials said in a statement. "The new guidance that the Pentagon issued last week is another step in enhancing readiness."

Transgender in the Military - Amy Bushatz Headlines