Air Force Staff Sgt. Logan Ireland is among the transgender service members presently serving in the military. (Photo courtesy of Logan Ireland)

Defense Secretary Ashton B. Carter repealed the U.S. military’s ban on transgender service members Thursday, but the Pentagon still has a number of decisions to sort through in the coming months.

In his remarks, Carter focused heavily on why he thought the repeal was the right thing to do, noting there are presently at least 2,500 transgender troops on active duty. But he also laid out a multi-layered implementation process that requires numerous decisions in coming months by service chiefs and senior civilian officials in the Pentagon alike.

They include:

1. Forming rules for restrooms, showers and other day-to-day functions
Senior defense officials, speaking on the condition of anonymity to speak frankly, said after Carter’s announcement Thursday that commanders will be given wide latitude to decide how to best equip their facilities for transgender service. In many cases, the officials said, that could be as simple as putting up new privacy curtains in some bathrooms or setting specific shower hours for different kinds of troops.

But other facilities, particularly in basic training environments, may get a look for additional changes. Communal showers still exist on numerous installations, with multiple shower heads in a single room, for example. It’s unclear how that issue will be handled, but Pentagon officials acknowledged Thursday that there may be some one-time costs associated with opening the military to transgender service.

“We’re not sure yet how much, if any, alteration of facilities is going to be involved,” said one senior defense official. “It would be double-digit millions of dollars if there were a decision to take on kind of the maximum facilities alterations.”

Defense officials will recoup at least some of that money by not discharging transgender service members who already have been trained. It’s also likely that commanders won’t seek the most expensive fixes required.

2. Finalizing details on joining the military while transgender
One of the more thorny issues senior defense officials weighed over the past year was when to allow a transgender individual to join the military after changing their gender. The Army and Marine Corps were both in favor of making potential recruits wait 24 months after a doctor determined they were stable, while the Air Force and Navy thought 12 months were acceptable, numerous defense officials said.

Carter ended up splitting the difference, deciding that 18 months was the right number. But there are more issues to address on a case-by-case basis.

In one example, the military must decide how to handle any individual it determines joined the military specifically to have a gender transition treatment covered by their benefits. All service members must meet all health standards to join the military for 180 days after enlisting, which includes being stable in your new gender, defense officials said.

“The question will be, ‘Did they reasonably know when they came in, and if they did reasonably know, were they hiding a significant medical fact?'” one Pentagon official said. If they did “it could be a basis for terminating and erroneous or fraudulent enlistment.”

Those cases would probably be few and far between, however. A newly released study by the Rand Corp. cited by Carter found that between 29 and 129 service members are likely to seek some form of transition-related care each year. Advocates for the ban also have pointed out that there are many other ways to get transgender health care covered. Large companies such as Kroger have begun to offer coverage in recent years.

Defense Sec. Ash Carter said June 30 that transgender service members are "talented and trained Americans who are serving their country with honor and distinction." At a news conference, Carter explained why the Pentagon had chosen to do away with the ban on allowing openly transgender troops to serve. (Reuters)

3. Handling physical fitness requirements
The U.S. military presently has a variety of separate rules governing issues such as grooming and uniform usage for men and women. It is believed that those will be easy to address: If you identify as a man, you will be required to adhere to the male standards, and if you identify as a woman, you will be required to adhere to the female ones.

Addressing how to handle physical fitness requirements could require more specifics. In the Marine Corps, for example, a man between 17 and 26 must complete a minimum of three pull-ups, 50 crunches and a three-mile run in under 28 minutes. A woman the same age must hang from a bar for a minimum of 15 seconds rather than completing pull-ups, complete at least 50 crunches and run three miles in less than 31 minutes.

The Rand study recommended that the services define when a transgender service member must meet the job requirements for their new gender.

“Evidence from Canada and Australia suggests that transgender personnel may need to be held medically exempt from physical fitness testing and requirements during transition,” the Rand report said. “However, after completing transition, the service member could be required to meet the standards of the acquired gender.”

4. Figuring out a plan for deployments
The Rand study noted that in foreign militaries, commanders have reported that those who transition genders can do their jobs effectively. But the study also suggested that it can be a complicating issue during deployments, especially for those in the infantry or other units that do not readily have access to refrigeration needed for some medication.

“Other countries have found that, in some cases, it may be necessary to restrict deployment of transitioning individuals to austere environments where their health care needs cannot be met,” the Rand study said. “Deployment restrictions may also be required for individuals seeking medical treatment, including those seeking hormone therapy and surgical treatments.”

As with many other aspects of transgender military service, the issue has been handled in the past on a case-by-case basis.

5. Determining what to do about transgender service in Tricare
U.S. troops and families primarily receive health care through the Military Health System, which includes hospitals and clinics on U.S. installations around the world. There are some troops, however, who seek medical care through Tricare, a health-care program for active-duty troops, their families, military retirees and Defense Department employees.

According to defense officials, military hospitals will be able to provide gender transition surgery when required. But those seeking it through Tricare will run into problems. Under existing law, gender transition surgery is not allowed by Tricare.

The Defense Department indicated in February on the Federal Register that it wants the policy changed. But doing so is likely to require congressional involvement.