Tim* (he/him) is a Veteran. As a young adult, he joined the military to both serve his country and strive for a better life. Tim is also transgender. He was assigned female at birth and grew up in an abusive household. During his service, transgender people were not permitted to serve openly in the military, so Tim hid his gender identity to serve. He deployed several times, sustained combat-related injuries, and survived military sexual trauma.

It was not until his discharge from the military that Tim began to openly identify and transition, enrolling in VA health care services and taking the first step towards healing. Tim took part in hormone therapy and other gender-affirming services provided by VA; but transitioning is not just physical transformation. He realized he had traumas and mental health challenges he needed to confront as well. Tim sought mental health treatment and was offered – and accepted – an innovative form of therapeutic writing called Trans-Affirmative Narrative Exposure Therapy (TA-NET) that was being developed and supported by the Veterans Health Administration (VHA) Innovators Network (iNET) Spark-Seed-Spread Innovation Investment Program.

TA-NET is a therapeutic approach for Transgender and Gender Diverse Veterans that puts emphasis on sharing personal narrative holistically. The program is not just focused on one trauma as most evidence-based treatments are, but on the entire life story, chronologically, across a Veteran’s lifespan. It focuses on how a lifetime of trauma impacts how a person views themselves and the world around them.

Through this process of therapeutic autobiographing, the intensity of Tim’s trauma-related symptoms substantially decreased. The ability to safely catalog and then unpack an entire lifespan of trauma, discrimination and shame in an affirmative, supportive environment over the course of these sessions has changed Tim’s life.

“I came into this not very hopeful. I buried my trauma,” said Tim. “But now the meaning is very different: I define my story.”

A Transition for VA

TA-NET is a fairly new concept at VA. In mid-2019, clinical practice guidelines didn’t exist to address the common experiences and complex traumas experienced by transgender Veterans. There was a critical need and Dr. Tiffany Lange of the Hampton VA Medical Center (VAMC) saw it regularly when working with the Veterans she served.

Dr. Lange grew up just outside of Toledo, Ohio, part of a large family that scattered across the Midwest. Like so many others, she has cousins and other family members who identify as LGBTQ+. At a very young age, she became uncomfortably aware of how the conversation shifted when that individual wasn’t in the room. As she grew older, Dr. Lange became a consistent voice of advocacy and support, fighting back against the negative commentary that she heard and that her LGBTQ+ family members experienced.

This drive for equity and advocacy ultimately led Dr. Lange to VA. As a licensed clinical psychologist and LGBTQ+ Veteran Program Manager at the Hampton VAMC, Dr. Lange works to embed LGBTQ+ affirmative care into clinical practice across VHA. There she began supporting LGBTQ+ Veterans, including launching PRIDE in All Who Served, a rapidly expanding program for LGBTQ+ Veterans. With TA-NET she hopes to build another key resource for for transgender Veterans and is once again finding support through the VHA Innovation Ecosystem (VHA IE) with a Seed Investment from iNET. Through this training and development support, Dr. Lange equips VHA clinical staff with the ability to deliver a validating and welcoming therapeutic space for VA’s many lesbian, gay, bisexual, transsexual, and queer/questioning (LGBTQ+) Veterans.

In addition to the work to expand access to TA-NET and programs like it, Dr. Lange is also working with her VA colleagues to advocate for another shift in narrative: the one that relates to what VA is and is not. “Over and over, I hear, ‘I cannot believe that there is any of this at VA,’” Dr. Lange said. “And I just want to shout from the rooftops that VA’s mission is to care for our Veterans. We are here to uplift and support the full spectrum of humanity that comes to our doors. Nobody needs to hide who they are. They served. They have more than earned the right to be here, and to receive knowledgeable and affirmative care.”

Support for All Who Served

There is an LGBTQ+ Veteran Care Coordinator (VCC) at every VA facility to help LGBTQ+ Veterans get the care they deserve. While programs may vary from facility to facility, VA health care includes, among other services:

  • Primary care
  • Hormone treatment
  • Mental health and substance use treatment
  • Treatment and prevention of sexually transmitted infections/PrEP
  • Intimate partner violence reduction and treatment of aftereffects
  • Heart health
  • Cancer screening, prevention and treatment
  • Gender affirming prosthetic devices and speech therapy

To learn more about support and VA services available for Veterans with lesbian, gay, bisexual, transgender, and related identities, visit https://www.patientcare.va.gov/LGBT or contact your local VA facility’s LGBTQ+ Veteran Care Coordinator.


Allison Amrhein is the director of operations for the VHA Innovators Network and communications lead for the VHA Innovation Ecosystem.

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10 Comments

  1. Daphne Diversidee Dove July 12, 2021 at 10:39 am

    Sorry. If you are not a medical professional, psychologist or LGBTQ you have no weight in the conversation. It would be wrong for me to tell you are crazy/I’ll just because you are ignorant and rant about things you know nothing about. Those who are LGBTQ tend to love more, live more, work hard and strive for the best for themselves and those around them. I think you may be a little confused.

  2. Edward Fake July 7, 2021 at 11:19 pm

    The CDC states that 20% of the adult population in the US is mentally ill. 5% of the US population is Gay and .4% of the population is transgender. The lgbtq population is mentally ill, gender dysphoria, according to DSM-5. To recognize their lifestyle as a viable lifestyle means we would have to recognize those individuals who claim to be Hitler, Elvis, or other famous individuals as “normal” and feed into their delusion rather than treat them. Recognition of the gay community as “normal” has been a politically correct lie. Not based on science and only supported by the government to avoid paying to treat those individuals, because of the high cost. Just think of the cost to pay for the treatment of 20% of the adult population. Years ago the mentally ill remained in their homes, and their families took care of them. Those who went to state hospitals were often maltreated and basically warehoused away from society. Now they are living out in society. And we live with their effect on society. Both the good, cheap labor for tedious tasks, and the bad, shooting up churches, burning houses down. What is the best way to deal with our mentally ill community, obviously treatment, but how do you pay for it all, and how do you support the families that have given up on trying to contain and support them, due to the high emotional and financial costs.

  3. Lee Becker June 24, 2021 at 11:13 am

    Proud of the VA for ensuring all Veterans are served and supported – and the emphasis in providing the very best experience! Keep up the great work! -Former Chief Hospital Corpsman

  4. Jason Bowden June 24, 2021 at 4:18 am

    How about we start unpacking my own transgender veteran story? In 2009, I came down with PTSD. I didn’t realize the depth of my problems until 2015 when I lost my place in college under the GI Bill from stress, lost my job, and lost my apartment. I went to Seattle in 2016, homeless, where I was finally diagnosed with PTSD. Also, I nearly died of an infection I had to go to the ER for while homeless.

    Social workers and counselors did their best to help me demand compensation for the condition, but I was denied under the bald-faced lying, discriminatory grounds that Gender Dysphoria as a pre-existing condition clears the VBA of all responsibility to me. In 2017, I was receiving HRT medication from the VA hospital in Seattle. But I had to move to Utah with my parents because I could no longer survive on $440 a month from my under compensation in Seattle while fighting my case.

    The St. George CBOC denied my all healthcare, citing, “You don’t have a doctor.” And, “We don’t have a doctor for you.” I was given the run-around for 18 months while the HRT involuntarily reversed and I became more depressed at what I saw in the mirror every month. I started male pattern balding again. And finally, I ended up in a pysche ward in Vegas, homeless again, just to be somewhere I could plead for help. Also, I nearly died of an infection I had to go to the ER for while homeless. Again. This time, with a Vet Center roommate who was obviously shooting heroin while prostitutes were actively visiting veteran barracks on the top floor. All against shelter policy and various laws in a facility poorly ran by suspiciously wealthy employees. Funded by charities and the good old VA.

    When I was in the military, several people with authority over me violated UCMJ left and right when I refused to have intimate relations with a drunk woman in a night club at Fort Hood when I was a designated driver for their benefit as a good battle buddy. They continued to falsely accuse me of being a gay malingerer when I was simply a good soldier who didn’t have sex at all due to gender dysphoria. A condition that did not affect my work ethic at all until I was harassed endlessly for refusing to become a rapist for their personal pleasure.

    Its 2021, and the VA owes me over $60k compensation backpay, damages for four years of denied HRT, damages for time spent traumatized further while homeless, and one hell of an apology. How’s that for “Unpacking the Story of Transgender Veterans?” Am I unpacking enough? Or should get into the part where I wasted nine months trying to get vocational therapy that Little Rock claimed to exist in 2015 over the phone that didn’t exist at all when I went to the advertised locations? How about the VA refusing to help me get transportation to appointments in 2018, when I was fighting to get HRT pills again?

    While we’re at it, why don’t we talk about VA coordinators being so incompetent, it took me an entire month to learn who to take my unpaid medical bills to while I had panic attacks over how to pay for them on an income of $440 a month without going hungry?

    You VA article writers need to stop claiming clout the VA doesn’t have. My life is hell, and you’re out here claiming a trans positive reputation this transphobic organization doesn’t deserve. I was effectively death paneled for five years, and its a miracle I have survived.

  5. Melanie Clark June 22, 2021 at 8:28 pm

    “(She) grew up in an abusive household.” That is the problem that needs to be addressed here.

  6. AJ June 22, 2021 at 7:45 pm

    Help veterans with BPD
    Sick of all this bullsht

  7. Bill Diller June 22, 2021 at 6:54 am

    Those that serve deserve our full support. Glad to read about this. Even happier to see that the military has taken a positive approach.

  8. Daphne Diversidee Dove June 21, 2021 at 8:41 pm

    Please provide a link to where transgender veterans go to get this therapy. I did not see anything in the article.

    Thanks

  9. Dusty Jarnagin June 21, 2021 at 4:44 pm

    Nobody is assigned their gender. They are either boy or girl. It’s the science I’m told.
    I’m tired of hearing all these stories about a mental condition that needs to be treated seriously instead of letting them pretend to be something they are not.

    • Crystal B. June 22, 2021 at 6:30 pm

      Well said!

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