Summary:
This report examines the Australian Defence Force’s (ADF) gender inclusion policies, with a focus on the operational implications of allowing transgender and non-binary personnel to serve openly and undertake fitness assessments based on their affirmed gender. Drawing on a recent Daily Telegraph exclusive, the report outlines the ADF’s approach to gender recognition and fitness standards, summarizes critiques from defence commentators, and provides a comprehensive analysis of the medical and psychological risks associated with the range of medications commonly prescribed to transgender and non-binary service members. The operational risks of hormone replacement therapy (HRT), anti-androgens, GnRH agonists, and psychiatric medications—including SSRIs—are detailed, with attention to side effects relevant to combat readiness and deploy-ability.
Detailed Report
1. Overview of ADF Gender Inclusion Policies
The ADF’s gender inclusion policies are articulated through the Defence Inclusion Guidance and related documents, which collectively aim to foster a diverse and equitable military environment. Since 2010, transgender and gender-diverse individuals have been permitted to serve openly, with policies ensuring recognition of affirmed gender in official records, access to medical support for gender transition, and protection from discrimination. The Defence Inclusion Guidance mandates respect for individual gender identity, the use of affirmed names and pronouns, and the provision of reasonable accommodations in recruitment, deployment, and daily service life. These measures are positioned as both a legal obligation and a strategic imperative to broaden the recruitment pool and reflect the diversity of Australian society.
2. Affirmed Gender Fitness Testing: Insights from Daily Telegraph FOI Exclusive
A recent exclusive by The Daily Telegraph, based on Freedom of Information documents, revealed that transgender and non-binary recruits may undertake pre-entry fitness assessments according to their affirmed gender. For example, a transgender woman would be assessed against female fitness standards, which are generally less stringent than those for males. The policy applies at the point of entry and is determined by the gender marker in Defence records. The ADF has defended this approach as consistent with anti-discrimination law and its commitment to inclusion, while critics have argued that it represents a significant departure from traditional military standards.
3. Critiques of Affirmed Gender-Based Fitness Standards
The policy of allowing fitness testing based on affirmed gender has attracted pointed criticism from several public figures and defence commentators. Andrew Hastie, Shadow Defence Minister and a former SAS officer, has argued that the policy risks undermining the physical standards required for military service, particularly in combat roles. He has suggested that the ADF’s approach could erode the principle of equal standards for all, potentially leading to perceptions of unfairness and diminished morale among serving personnel. Hastie has also raised concerns that the policy may be driven more by social engineering than by operational necessity, warning that the primary focus of the military should remain on warfighting capability and readiness. Lincoln Parker, a defence analyst and former chair of the Liberal Party’s Defence and National Security Policy Branch, has echoed these concerns, stating that the adaptation of fitness standards for transgender and non-binary recruits could create inconsistencies in the assessment of physical capability. Parker has argued that the policy may allow individuals to be assessed against less demanding standards, which could have downstream effects on unit cohesion and operational effectiveness, particularly in high-stress or physically demanding environments. Both Hastie and Parker have emphasized the importance of maintaining competency-based, role-specific standards to ensure that all personnel are capable of meeting the demands of military service.
4. Operational Risks Linked to Medical and Psychological Factors
While fitness standards are a critical component of military readiness, the operational risks associated with medical and psychological factors must also be considered. For transgender and non-binary personnel, the use of hormone replacement therapy (HRT), anti-androgens, GnRH agonists, and psychiatric medications such as SSRIs introduces unique challenges. These medications, carry potential side effects that may impact combat readiness, decision-making, and deploy-ability.
4A. Medication Use Among Transgender and Non-Binary Military Personnel
While this report focuses on the ADF, data from the U.S. military is useful in understanding the broader implications of transgender inclusion in the armed forces. Transgender and non-binary personnel in the ADF are more likely than their peers to be prescribed a combination of gender-affirming hormone therapies and psychiatric medications. According to a 2020 descriptive study of transgender active-duty U.S. military personnel, approximately 70% reported current or past use of gender-affirming hormone therapy, with 35% using testosterone, 25% using estrogen, and 21% using anti-androgens such as spironolactone or bicalutamide. GnRH agonists like leuprolide and goserelin are also used, particularly for androgen suppression or puberty blockade. Psychiatric medication use is also notably higher in this population; with a 2023 study by Tiefenthaler and colleagues finding that 38–40% of transgender and non-binary individuals diagnosed with gender dysphoria and a comorbid mood or anxiety disorder were prescribed SSRIs, with other antidepressants and mood stabilizers also present, albeit less frequently.
4B. Clinical Side Effects Relevant to Operational Contexts
Each medication class carries side effects with direct relevance to military readiness:
· Spironolactone (anti-androgen): Common side effects include fatigue, dizziness, electrolyte imbalance (notably hyperkalemia), mood swings, and cognitive fog. These effects may be exacerbated in physically demanding or dehydrating environments, and can impair alertness and decision-making.
· Bicalutamide (anti-androgen): While generally well-tolerated at lower doses, bicalutamide can cause fatigue, depression, and, rarely, hepatotoxicity. Regular liver function monitoring is recommended, especially in younger or medically fragile individuals.
· GnRH Agonists (leuprolide, goserelin): These medications are associated with mood swings, depression, emotional lability, fatigue, and cognitive impairment. A 2025 pharmacovigilance study in PLOS ONE and FDA label warnings for leuprolide highlight increased risks of psychiatric events, including emotional lability, irritability, and, in rare cases, suicidal ideation. Cognitive impairment, such as difficulties with working memory and executive function, has been observed in patients undergoing androgen deprivation therapy.
· Estrogen HRT: Systemic estrogen therapy is linked to mood disorders, with a 2025 analysis of FDA adverse event data by Chen and colleagues finding an 83% increased risk of mood disorder-related adverse events compared to local administration. Risks are highest in individuals under 40, a demographic that would include many ADF personnel.
· Testosterone HRT: While generally associated with improved mood and increased assertiveness, testosterone therapy can also lead to irritability and, in rare cases, heightened anger or impulsivity.
· SSRIs: Up to 60% of patients on SSRIs experience emotional blunting, characterized by reduced emotional responsiveness and motivation, as reported by Edinoff and colleagues in 2021. Research from the University of Cambridge in 2023 demonstrated that SSRIs can impair reinforcement learning, reducing sensitivity to feedback and potentially slowing adaptive decision-making. Additional side effects include fatigue, somnolence, and impaired alertness, which may be operationally significant, especially during the early phase of treatment or after dose changes.
4C. Combat Readiness and Deployment Risks
The use of HRT, anti-androgens, GnRH agonists, and psychiatric medications introduces specific operational risks for military personnel. All these medications require ongoing, uninterrupted access and regular medical monitoring, which may not be feasible in deployed or austere environments. Military medical policy in Australia and allied countries generally requires personnel to demonstrate stability on any necessary medication—typically for a period of three to twelve months—before being cleared for deployment or high-responsibility roles. Any recent medication changes, side effects, or need for frequent monitoring can result in deploy-ability restrictions or temporary removal from duty, as noted in the ADF Defence Inclusion Guidance and US Department of Defense clinical practice guidelines. The risk of medication interruption due to supply chain issues or loss in the field can lead to withdrawal symptoms, destabilization, or recurrence of underlying mental health conditions. For SSRIs, abrupt discontinuation can precipitate discontinuation syndrome, with a 2024 qualitative study in BMC Psychiatry reporting that more than half of individuals discontinuing SSRIs experienced withdrawal symptoms, and nearly half rated them as extremely severe. Symptoms can include agitation, dizziness, and emotional instability, which may be operationally significant if medication access is disrupted during deployment. Sudden cessation of HRT can also result in mood instability, fatigue, and a rapid return of endogenous hormone effects. Combined medication effects, such as QT interval prolongation from estrogen and SSRIs, and bone density changes from anti-androgens and GnRH agonists, further complicate risk management.
4D. Critiques from Defence Think Tanks and Policy Experts
The Center for Military Readiness, led by Elaine Donnelly, has argued in its 2019 and 2020 policy analyses that the need for ongoing hormone therapy and psychiatric medication introduces dependencies that may be incompatible with the demands of combat service, citing the requirement for regular medical oversight and the risk of side effects affecting judgment or emotional stability. The Heritage Foundation, in its 2020 commentary “Think Twice Before Changing the Military’s Transgender Policy” and its 2023 “Report of the National Independent Panel on Military Service and Readiness,” has similarly cautioned that accommodating ongoing medical needs could compromise readiness and effectiveness, especially where medical support is limited.
Conclusion
The ADF’s gender inclusion policies, including affirmed gender fitness testing and support for transgender and non-binary personnel, reflect a broader commitment to diversity and inclusion. However, the operational risks associated with the range of medications commonly prescribed to this population require careful management. Documented side effects, medication dependencies, and the risk of withdrawal or destabilization in deployed environments present challenges for combat readiness and deploy-ability. Defence policy organizations and military medical standards underscore the need for individualized risk assessment, ongoing monitoring, and contingency planning to ensure that operational effectiveness is not compromised.