When president Donald Trump announced his intention of banning transgender people from serving in the US military, he blamed “the tremendous medical costs [..] that transgender in the military would entail.” Many noted that in fact those costs were tiny: On its existing transgender personnel the military spends $8.4 million at most, or 0.13% off its total medical budget.
To prove just how little that is, one comparison stood out: The military spends 10 times as much ($84 million) on medications for erectile dysfunction, half of which on Viagra alone. Quickly, the mocking outrage around the fact that “the military spends five times as much on Viagra as it would on transgender troops” took off.
The numbers are correct. According to the Defense Health Agency, quoted by the Military Times, in 2014 alone military beneficiaries (active military personnel, veterans, and dependents) filled 1.8 million prescriptions for erectile dysfunction drugs, such as Viagra, Cialis and Levitra.
The reason, however, is hardly a laughing matter. In many cases, erectile dysfunction is a consequence of post-traumatic-stress disorder (PTSD), a condition that disproportionately affects active troops and veterans. Veterans—both men and women—with PTSD have a high likelihood of developing sexual dysfunction, according to a 2015 study in the The Journal of Sexual Medicine. A 2002 study in Urology found that 85% of male veterans with PTSD suffered erectile problems; among veterans without PTSD the rate was 22%. According to a 2012 report, 257,000 of the 1.5 million veterans from Iraq and Afghanistan had had a diagnosis of PTSD.
Viagra was made available to the troops in 1998. The pill, then costing up to $10 a dose (the cost is now $25), was prescribed for sexual impotence “only after a thorough evaluation” and limited to six per month.
Adrian Bonenberger, who served in Afghanistan between 2007 and 2010, says he was prescribed Viagra after leaving the military while undergoing PTSD therapy. “It was embarrassing to ask and it’s embarrassing to admit it, but sex was impossible for me without it,” he wrote in a Facebook post, which he gave Quartz permission to quote. The therapy helped him as part of his recovery process, and continues to do so for many others. “That stuff helps traumatized combat vets,” he wrote, “I’m living proof.” In the post’s thread, other veterans talked about having had similar experiences.