Abstract
We offer a theoretical framework to advance our understanding of the psychology of transgender service members-the most understudied and mysterious class of US military personnel. Using grounded theory methods with interview data collected from clandestinely-serving active-duty, guard and reserve military members from the US Army, Navy, Air Force and Marine Corps who self-identified as transgender or transsexual, we reveal a latent structure of Self Determination Theory (Deci & Ryan, 1985; . The variance in our data heavily centers around the concepts of autonomy, competence and relatedness, illustrating how post-DADT military personnel policy, which excludes open transgender service, impacts the mental well-being of transgender service members.
I. INTRODUCTION
Equality across the various classes of American citizens has advanced significantly since the passage of the Civil Rights Act of 1964. One recent example occurred in 2011 with the repeal of "Don't Ask, Don't Tell" (DADT) as the United States joined dozens of other countries that had previously lifted homosexual bans on military service. Prior research had shown that the culture of the US military had been ready to accept openly gay and lesbian service members for quite some time, despite the long-standing rhetoric that doing so would threaten good order, discipline, unit cohesion and morale [1] . Moreover, DADT lasted as long as it did primarily because it allowed no mechanism to assess the policy's impact on military effectiveness [2] .
Although the rhetoric of DADT repeal was celebrated as the emancipation of LGBT service members, the reality revealed that little changed for transgender men and women in uniform [3] . "The United States has a stated policy of discrimination against transgender people that leads to their marginalization, induces fear and the need to hide, leaves them unprotected from harassment, and deprives veterans of benefits" [4] . The proportion of transgender and transsexual service members is unknown and impossible to estimate precisely given current policies, though a recent study estimated that approximately 15,500 transgender personnel serve in *Address correspondence to this author at the Department of Economics and Business, 14 E. Cache La Poudre St, Colorado Springs, CO, 80903, USA; Tel: 214.431.9795; E-mail: ccampos@example.org the US military [5] . In addition, previous studies have indicated that transgender incidence in the military is likely higher than that of society [6] [7] [8] [9] . Even the proportion of adults in the US who are transgender varies and is extraordinarily difficult to measure. According to the Williams Institute, approximately 1 out of every 333 adults living in the United States are transgender [10] though most experts acknowledge that current figures are likely under-representative of actual transgender prevalence [11] [12] . In 2008, the National Transgender Discrimination Survey collected responses from 6,456 transgender and gender nonconforming people in the US using a 70-item instrument, the largest survey of its kind to date. Nine percent of respondents who indicated prior military service indicated being discharged for their gender nonconformity [13] .
Medical Standards
"Department of Defense regulations don't allow transgender individuals to serve in the U.S. military, based upon medical standards for military service" [14] . Any individual who has undergone sex reassignment surgery is considered unfit as having a "major genital abnormality or defect" [15] [16] . The policies that drive exclusion from military service are primarily derived from the current state of medical knowledge about psychological disorders. However as noted by Elders et al., the long-standing ban towards transgender service members is in fact, unjustified [17] . This is further supported by the recent revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), which is commonly regarded as one of two primary diagnostic resources relied upon by medical professionals. The other primary resource is the International Statistical Classification of Diseases and Related Health Problems (ICD), published by the World Health Organization (WHO).
The DSM is widely viewed as the definitive resource for the standardization of classifying psychiatric diagnostic categories and criteria within the United States. Over the decades, it has evolved to remain relevant with evidence-based research on sex and gender. Long viewed as a mental disorder, homosexuality was removed from DSM-II and reclassified as Sexual Orientation Disturbance in 1973. The publication of DSM-III in 1983 eliminated homosexuality entirely as a disorder [18] . A similar trend has emerged with respect to diagnosing and treating transgender people. In the 2000 text-revised edition of DSM-IV, which had been originally published in 1994, the primary diagnosis of transgender persons was "gender identity disorder," or GID [19] . Because GID was a medical diagnosis of a mental disorder, the military treated GID in a similar fashion to all psychological disorders, with the notable exception of not offering a medical waiver to doctor-authorized recruits [20] [21] . In the current and most recent edition published in 2013, DSM-5 removed GID as a mental disorder and replaced it with a new diagnosis of "gender dysphoria" [22] .
As the international compliment to the DSM, the ICD is "the standard diagnostic tool for epidemiology, health management and clinical purposes" [23] . The most current volume, ICD-10, has not been revised by WHO [24] .
Like the evolution of how homosexuality came to be understood, the trends in the medical literature signify a similar shift in the direction of acceptance and inclusion as the collective medical understanding of gender dysphoria evolves. Similar trends are increasingly evident in the media and popular press, lawmaking, court rulings, healthcare coverage, prison reform, and policy changes within the federal government. As the evidence continues to build, it is increasingly likely that the military will face greater pressure to reevaluate current military policies that exclude transgender men and transgender women from military service on the sole basis of a gender dysphoria diagnosis as currently dictated by military regulations.
Military Regulations
Transgender men and women are currently prohibited from serving in the US military because they lack the medical qualifications [25, 26] . In addition, transgender service members are subject to punishment under the Uniform Code of Military Justice if they do not adhere to gender binary uniform regulations. However, given both the domestic [27] and international [28] medical communities' removal of transgender identity as a mental disorder, it is only a matter of time before military leaders are asked to evaluate the efficacy of allowing transgender service members.
Already, the Veterans Administration provides support and medical services to transgender veterans and for the first time, the Department of Defense has begun allowing transgender veterans to have their official military records changed [29] . Although the US military appears to be moving in the direction of inclusion and acceptance, it still lags behind many of its allies [30] . Open transgender service in the military is not without precedent. There are currently eleven nations that permit transgender persons to serve openly: Australia, Belgium, Canada, Czech Republic, Israel, the Netherlands, Spain, Sweden, Thailand, the United Kingdom [31] , and Uruguay [32] . Some of these countries have formal policies regarding transgender service, while others consider transgender applicants on a case-by-case basis [33] .
Purpose of Study
In light of the recent shifts in the collective understanding that gender dysphoria is no longer a psychological disorder and an openness of the US military to allow openly gay and lesbian service members without any noted negative impacts [34] , the purpose of this paper is to explore the issues associated with transgender service in the US military. Specifically, we aimed to explore the post-DADT repeal impacts on self-identified transgender men and women in the US military given so little is known about the challenges they face.
In the following paragraphs, we explicate an empirical study of transgender men and women who serve in the US armed forces. In Section II, we describe our approach to data collection and methodology. Then, in Section III, using grounded theory techniques [35] [36] , we analyze the data and offer a theoretical application of Self Determination Theory. Sections IV and V discuss and conclude.
II. METHODS

Sample
The data for this study was initially reported on in an earlier study exploring the phenomenology of transgender service in the US military [37] . The sample was obtained through advertising to a clandestine online network of transgender service members. Although the size of this network was undisclosed, fourteen volunteers replied to an anonymous online survey using fictitious names and anonymous email accounts. The resultant interviews yielded 142 pages of transcripts used for analysis. Participants came from all branches of the US armed forces, with the exception of the Coast Guard. More than two-thirds of interviewees were enlisted personnel, with the other third identifying as either a commissioned officer or officer candidate. Sixty-one and a half percent of the subjects self-identified as female-to-male (FTM) with the remainder identifying as male-to-female (MTF), with the exception of one subject who self-identified as a cross dresser. None of the subjects had undergone sex reassignment surgery. Approximately half of the subjects had previously taken or were currently pursuing hormone treatment. In one case, a subject admitted to obtaining hormones from the black market.
Procedure
Using Grounded Theory methods [38] [39] , we initially open-coded all transcripts to identify major themes, concepts and events, from which we developed a set of axial codes. All transcripts were then coded using the axial codes and memos were constructed by each of the co-authors independently. Once completed, the co-authors gathered and developed a second set of memos identifying the commonly observed concepts and themes. Using the second set of memos, we arrived at a tentative core that spanned the work-life spectrum comprised of the following elements: (1) acceptance/non-acceptance; (2) performance; and (3) freedom/lack of freedom to present as one identifies. Upon further analysis, we noted the core elements from our analysis closely aligned with the innate psychological needs proposed in Self-Determination Theory [40] [41] . We found no significant differences between MTF (male-to-female) and FTM (female-to-male) transgender subjects.
Measures
To ensure reliability of the data, all three researchers coded the transcripts as noted above, and then gathered for an open discussion of the coding results. Where consensus could not be reached, the code was eliminated. All resultant reported codes were obtained by unanimous agreement of the co-principal investigators. Validity of the data was justified in the method of open dialogue with the subject through recorded conversations transcribed word-for-word in written transcripts. No follow up questions or dialogues with the participant subjects were deemed necessary by the researchers.
III. THEORY AND FINDINGS
Self-Determination Theory (hereafter, SDT) posits that the optimal social condition is one in which three innate psychological needs are met: autonomy, competence, and relatedness -and when they are not, the well being of the individual is threatened. "Human beings can be proactive and engaged or, alternatively, passive and alienated, largely as a function of the social condition in which they develop and function" [42] . Moreover, the theory argues, "Conditions supporting the individual's experience of autonomy, competence, and relatedness are argued to foster the most volitional and high quality forms of motivation and engagement for activities, including enhanced performance, persistence, and creativity" [43] . The theory further suggests that "human needs specify the necessary conditions for psychological health or wellbeing and their satisfaction is thus hypothesized to be associated with the most effective functioning" [44] . Autonomy, competence, and relatedness are all necessary for the optimal functioning of all service members.
Autonomy
SDT embraces the notion that innate psychological needs are essential for psychological growth and well being [45] . One such need, autonomy, involves selfregulation and volition [46] . The hierarchical nature of the military is not typically regarded as an organizational exemplar of freewill and autonomy. The need to obey orders, live on base, wear uniforms and attend a variety of mandatory formations renders one's autonomous expression as limited. Nevertheless, in an all-volunteer force, a sense of pride emerges when service members can say they've chosen to serve their country. Admittedly, military bureaucracy restricts and bounds individual freedom, but within those bounds there is a surprising sense of freedom and autonomy. Flexibility in how a person chooses to do an assigned task is common in many decentralized managed organizations.
Most of the transgender men and women in our study did not experience the same sense of autonomy as other service members. The fundamental need to express their identity was demonstrably thwarted. They did not have the freedom to express their gender through speech, action, or appearance.
In fact, transgender service members faced considerable risk should their transgender status become known as described by "Bob," a transgender male Naval officer: Many of the people in this study described lacking autonomy as painful, while expressing relief in taking steps toward gender transition. 
Most of my transition process was during a deployment, and I've recently read a lot of articles about Marines doing it during

MTF, Navy enlisted, "Michelle"
The fact that the repeal of "Don't Ask, Don't Tell" liberated gay and lesbian service members without addressing the rights of transgender service members was difficult to reconcile. This put an additional strain on subjects like "Xavier" and "Michelle" as they independently described what it is like to be a transgender service member in the post-DADT repeal era: 
FTM, Navy enlisted, "Alex"
For others, simply being able to speak the truth about oneself can be a powerful autonomous act. "Alan" a transgender male officer candidate shared this experience he had with his doctor:
So anyway, we ended up talking about other things in my life. And I prayed and prayed about my, you know, the trans situation, and I finally told him. I was like, "I'm just going to tell you this." And from that point on it was like the biggest burden was lifted off of me.

Competence
According to SDT, a perception of competence or the ability of a person to make progress towards one's goals is associated with personal well-being [47] Competence is enhanced by social-contextual events such as feedback and validation where a person's intrinsic motivation is enhanced or diminished for a particular action. Within a military context, indoctrination training programs are routinely designed to turn citizens into soldiers, to take young and untrained men and women and provide competences and skills in short order. Sailors, soldiers, airman and Marines literally wear their competences and achievements on their uniforms. Ribbons and medals signify major achievements; badges depict career specializations, and military rank depicts competency level and where they fit into organizational hierarchy.
The transgender men and women in this study discussed often their sense of pride in their accomplishments. They stated that it was the ability to do the job that was of foremost importance and not one's gender that mattered. Knowing that they could be terminated from military service should it become known that they are transgender, subjects often linked their perceptions of security to their level of competence.
I do my job well, so no one is really like seeking to kick me out of where I'm at right now and I'm fairly well liked among my enlisted guys.

FTM, Navy officer "Bob"
For some subjects competence goes beyond a psychological need that brings about well-being. For these subjects competence is linked to their survival within the organization as "Jamie," a transgender female enlisted Army troop notes when discussing others' perceptions of her: Some subjects sought out military service in order to achieve something that they could embrace and of which they could be proud: 
MTF, Army enlisted, "Alia"
For the service members in this study, competency went beyond an innate psychological need; it was linked to survival within an organization that did not accept them for who they were.
Relatedness
According to SDT, the third innate psychological need necessary to promote healthy psychological development is relatedness. Relatedness occurs where people feel a personal connection to others within their social contexts. Without sufficiently authentic and meaningful relationships, intrinsic motivation can be undermined, threatening self-regulation and general well-being. According to Ryan et The primary objective for any basic training course across the branches of the armed forces is to take a heterogeneous group of people from every sector of society, ethnic and religious group, and turn that disparate group into a cohesive team. Through systemsocialization [49] service members come to identify with their peers and commit themselves to selfless service. The social bonds forged both through rigorous training and during combat last a lifetime. Examples of the power conferred through feelings of relatedness, of connecting to others at extreme levels, are commonly denoted in military movies where soldiers give their lives to save those of others [50] . Transgender men and women serving in the U.S. experience this same sense of relatedness, but it is, arguably, not complete. Transgender service members forge tremendous bonds with others, but these bonds are somewhat illusory as they are established on a premise of false identity. Over and over again, the subjects in our study built relationships extremely slowly with painstaking care, or failed to make them at all while on duty.
Analysis indicates that both MTF and FTM transgender service members experienced relatively the same levels of competence within their professional contexts. However, many subjects in our study suffered from a reduced sense of autonomy and a profound degradation in relatedness. Those transgender male and female subjects who led double lives out of fear for preserving his or her career prospects exhibited significantly lower levels of relatedness. As an example, "Andy," a transgender male Army Guard Reserve officer, described his perceived isolation at work: 
IV. DISCUSSION
The data from this sample came from across the branches of military service, across the enlisted/officer rank continuum as well as from both active-duty and National Guard/reserve components. With only fourteen subjects in our sample, we cannot reliable concluded that our analysis definitively answers the question of what it is like to be a transgender officer or non-commissioned officer in any one of the service components. What is evident in the preceding analysis is a difference between the autonomy of members who serve on active duty where they are within the organizational context continuously (even on leave) and those who are serving in a part-time capacity as a National Guardsman or a reservist. These domains differ in their implications for privacy and the presentation of self.
For those on active duty, there is an implicit understanding and expectation that a person is "on duty 24x7." For guardsmen and reservists, although the same holds true while serving on orders, the latent expectations differ. There is an acknowledgement of the citizen-soldier relationship with deference given to the inherent privacy and rights of one who exists as a citizen. Although this right to privacy and right of free expression are often surrendered by those in uniform, the act of surrendering is seen as more temporary for the reservists and guardsmen as opposed to those who serve on active duty. This latter group is generally perceived to have indefinitely surrendered these privacy and expression rights because of the perceived indefiniteness of one's service commitment, even if finite.
With such perceptive differences between these two domains, at least what our limited insight through the sample of subjects has revealed, is a more open acceptance of differences and heterogeneity of expression in the reserve and Guard components as opposed to that of active duty where homogeneity is an expressed organizational desideratum.
V. CONCLUSION
The 2011 repeal of the US military's ban on open homosexual service was a major move towards creating a more inclusive environment for its members. However, the repeal failed to address transgender service members. Since repeal, the United States has continued to follow a similar pattern set by many other countries that first allowed openly gay service and only years later opened the doors to transgender service. In January 2013, the US military relaxed the gender restrictions on direct ground combat for female service members, signaling a willingness to disconnect duty performance from gender [51] . Additionally, recent and pending changes to the DSM and ICD give rise to the notions that it is increasingly less of a question of whether the military should alter existing policies to further integrate its transgender members into its culture, but rather how to do so and on what timeline.
The data for this study provided strong evidence that transgender service members, like all human beings, have very real needs for autonomy competence, and relatedness. The study is also among the first to demonstrate how these needs are met by transgender service members who desire to serve in the U.S. armed forces, but must do so in secret. The subjects of this study consistently articulated a desire for the same opportunities to meet competence needs as their non-transgender counterparts, but often had difficulty meeting relatedness and autonomy needs due to their inability to share the truth of their transgender identity with their colleagues.
The structure of this study made duty performance very difficult to assess by virtue of a small sample of self-reported data. However, sufficient evidence is beginning to emerge from studies of foreign militaries indicating the integration of openly transgender service members has yielded no negative effects on operational effectiveness or military readiness [52] . Transgender service members' motivation to serve is indistinguishable from all other classes of service members. They simply want to feel integrated and whole, but find it difficult to do so under existing policies. Although the military still regards gender as a rigid binary construct, the evolving medical and societal understanding indicates it is far more complex than previously regarded. Until a shift in both thinking and policy transpires, the choice for transgender men and women to serve in the US armed forces remains a choice to be purple in a black and white world.

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