Internal Defense Health Agency records obtained through federal litigation reveal that gender dysphoria patient counts nearly doubled in the military during President Biden's first year in office, and that thousands of minor dependents were included in the caseload.
The numbers, drawn from a DHA dataset covering 2014 through 2022, show 2,221 patients carried a gender dysphoria diagnosis in 2020. By 2021, the year Biden signed an executive order lifting restrictions on transgender military service, that figure had jumped to 4,034, a roughly 82 percent increase in a single year. The 2021 count was more than eight times the number recorded in 2014, the first year of the dataset.
The Center to Advance Security in America, a conservative oversight group known as CASA, pried the records loose through Freedom of Information Act litigation and provided them to the Daily Caller News Foundation. In total, the DHA dataset logged 17,596 unique patients diagnosed with gender dysphoria over the nine-year window. Of those, 3,807 were minors, dependents under the age of 18 receiving care through the military health system.
Five days after taking office, Biden signed Executive Order 14004 on January 25, 2021. That order revoked a March 2018 Trump presidential memorandum that had authorized restrictions on transgender service in the armed forces. The patient-count surge followed almost immediately.
Internal Air Force staffing documents obtained alongside the DHA data put the spike in even starker terms. One document states flatly: "New patients in 2021 exceed previous 3 years' combined." The Air Force had already stood up a specialized unit, the Transgender Health Medical Evaluation Unit, or THMEU, to manage transgender health care. That unit traces its origins to an Air Force Surgeon General initiative launched in 2019, though a related program under the Air Force Medical Operations Agency may have existed as early as 2016.
The 2021 surge forced the Air Force to seek additional staff. Internal documents show the service requested more nurses, a social worker, an administrative technician, and a licensed vocational nurse to handle the increased workload.
James Fitzpatrick, CASA's director, told the Daily Caller News Foundation that the timing left little room for ambiguity about the Biden administration's priorities:
"It just shows that the Biden administration was prioritizing this. They were; the numbers seem dramatically increased just immediately as he came in."
Among the 17,596 patients in the DHA dataset, the 3,807 listed as under 18 were dependents, children of service members receiving care through the military health system. The breakdown by age: 2,081 were 15 or younger, 833 were 16, and 893 were 17.
The dataset does not specify what treatments those minors received. But a separate set of Defense Department emails, previously obtained by the Daily Caller News Foundation, addressed the legal exposure that could follow. A department memorandum discussed potential liability for providing what S1 describes as gender-affirming care to minors. Those emails indicated the department might protect civilian employees or service members from legal proceedings tied to such procedures and could cover any resulting settlement or claim.
That revelation carries particular weight as courts at every level continue to grapple with transgender-related policy questions, from athlete eligibility to medical interventions for minors. The Pentagon's willingness to absorb legal risk on behalf of providers performing these procedures on children suggests the policy was not merely permissive, it was actively shielded.
Fitzpatrick went further in his interview, raising the possibility that the military's open posture on transgender care may have created a perverse incentive.
"I think there could have been something going on where people may have been joining the Air Force or military in general in order to get this care and then exit."
He did not cite specific evidence for that claim, but framed it as a concern consistent with the broader pattern visible in the data. The numbers alone do not prove the point, though a jump from roughly 500 patients in 2014 to more than 4,000 in 2021 is difficult to explain through organic growth alone.
Fitzpatrick also drew a contrast between the Biden-era approach and the current administration's direction. He told the Daily Caller News Foundation:
"I think that Secretary Hegseth and President Trump are getting us back to the thought that the military exists to fight and win the nation's wars, to kill our nation's enemies, right? To portray power on the world stage and to accomplish our goals in the world, it doesn't exist to be this experimental lab for those undergoing gender dysphoria and think that they may be of a different gender."
Fitzpatrick's characterization of the military as an "experimental lab" is his own framing, but the underlying data, an eightfold increase in diagnoses over seven years, a dedicated medical unit, requests for additional staff, and internal memos addressing liability for procedures on children, paints a picture of an institution that did far more than passively accommodate a small population.
President Trump revoked Biden's Executive Order 14004 on January 20, 2025, the day he returned to office. One week later, on January 27, he signed a separate executive order establishing new military policy on transgender service. The combination effectively restored and expanded the restrictions Biden had lifted four years earlier.
White House spokeswoman Olivia Wales framed the reversal in blunt terms:
"Joe Biden allowed transgender insanity to run rampant in our military; President Trump restored lethality and readiness to our warfighters. The United States Military is the greatest in the world, and President Trump is keeping it that way by focusing on elite readiness standards, not DEI or woke gender ideology."
Rep. Nancy Mace echoed that position. In a September 2025 post on X, Mace wrote that the military "isn't a playground for Left-Wing gender bending ideology" and said she had introduced legislation to end taxpayer-funded gender procedures in the armed forces. The full scope and status of that legislation were not detailed.
The broader legal landscape around transgender policy remains unsettled. Federal courts have been active on related questions, and some judges have openly resisted higher-court directives on politically charged issues, a pattern that could complicate enforcement of the new military restrictions.
The Pentagon declined to comment on the documents, citing ongoing litigation. Air Force Public Affairs referred questions to the Defense Health Agency, which could not provide a comment before publication. The Office of the Air Force Surgeon General and Air Force Medical Service Public Affairs did not respond at all.
That wall of silence leaves significant questions unanswered. The dataset ends in 2022, so it remains unknown whether patient counts continued climbing, plateaued, or declined before Trump's executive orders took effect. The records also do not break out how many of the 17,596 total patients were active-duty service members versus dependents, a distinction that matters for understanding both the readiness implications and the scope of taxpayer-funded care.
Nor is it clear what specific procedures or treatments the nearly 4,000 minor dependents received. The gap between a diagnosis of gender dysphoria and surgical intervention is wide, and the documents as described do not close it. But the existence of internal memos discussing legal liability for procedures on minors suggests the question was not hypothetical inside the department.
The case also touches on deeper tensions about how government institutions handle politically sensitive records. CASA had to sue to obtain data that, in a functioning system, should be available to the public and to Congress through routine oversight. The fact that a private organization needed federal litigation to extract basic patient-count data from a government health agency tells its own story about institutional transparency, or the lack of it. Similar patterns of institutional resistance to accountability have surfaced in cases where courts have had to intervene against government officials who stonewalled or targeted groups seeking information.
Fitzpatrick summed up the broader pattern in his most pointed comment to the Daily Caller News Foundation:
"I think this is just something at the top of their list that they prioritized from day one. They weren't shy about it. They proudly wanted to push trans ideology and trans medical care in our military, and that includes to spouses and to children, and they were not shy about spending government resources."
The DHA records bear out at least the numerical claim. A program that covered roughly 500 patients in 2014 grew to serve more than 4,000 by 2021. The Air Force built a dedicated medical unit, hired additional staff, and, according to internal emails, prepared to shield providers from lawsuits. All of it ran on the defense budget.
Whether that constituted sound medical policy or an ideological project imposed on an institution designed for national defense is a question the data alone cannot settle. But the scale, the speed, the staffing demands, and the legal maneuvering around minors all point in one direction. The Biden administration did not merely permit transgender care in the military. It built an infrastructure for it, quietly, quickly, and at public expense.
As the Supreme Court continues to navigate deep internal divisions on questions that touch cultural and constitutional fault lines, the military's transgender health apparatus stands as one more institution reshaped by four years of policy choices that prioritized ideology over the mission taxpayers actually fund.
A military that cannot explain its own records to the public has no business asking that same public to trust its priorities.
