The Pentagon is facing several challenges as it moves to end the ban on transgender troops serving openly in the military, including how to handle transition surgeries and fostering acceptance among the rank-and-file.

The policy change is the latest in a spate of efforts to make the military more inclusive, from the repeal of “Don’t ask, don’t tell” five years ago to opening combat jobs to women just last year, and comes at a time when transgender rights are being debated nationwide.

{mosads}The Pentagon officially lifted the ban Thursday, almost a year after Defense Secretary Ash Carter announced his intention to do so.

“We have reason to be proud today of what this will mean for our military  because it’s the right thing to do, and it’s another step in ensuring that we continue to recruit and retain the most qualified people ,” he said. “And good people are the key to the best military in the world. Our military and the nation it defends will be stronger.” 

The new policy will allow enlisted transgender troops to begin serving openly immediately. In 90 days, they’ll have access to medical care and be allowed to change their gender in the Pentagon’s personnel system. 

The 90-day period will also allow military leaders time to craft a guidebook for commanders. The services will then have nine months to train their forces on the new policy.

The military will consider gender transitions as beginning when a doctor diagnoses that medical care is necessary. Transition ends when troops’ genders are changed in the military healthcare system’s database and when troops are recognized as the gender with which they identify. 

At that point, troops will be allowed to follow the military standards of their gender identity and use bathrooms, showers and other facilities of their gender identity.

Critics say the succession of changes in recent years is too much for the military to handle and could affect military readiness. 

Rep. Mac Thornberry (R-Texas), chairman of the House Armed Services Committee, cited readiness as his chief concern in opposing Thursday’s announcement. 

“Our military readiness — and hence, our national security — is dependent on our troops being medically ready and deployable,” Thornberry said in a written statement. “Over the next few weeks, we are going to continue to push for actual answers to the readiness questions we’ve been asking for nearly a year to which we have still not received a response. We will also be looking at legislative options to address the readiness issues associated with this new policy.” 

Rep. Adam Smith (Wash.), the ranking Democrat on the committee, rejected the readiness argument.

“The evidence indicates that modernizing our policy in this way will not meaningfully reduce readiness,” he said in a written statement. “In fact, according to research by the RAND Corporation and retired flag officers, it should enhance readiness by enabling commanders to better provide for the needs of the men and women they lead.” 

Experts on transgender issues say the policy change should be easy to carry out but aren’t predicting it will be.

Don Haider-Markel, a political science professor at the University of Kansas who has written a book on transgender policy, said allowing transgender troops to serve openly flows naturally from the repeal of “Don’t ask, don’t tell” and allowing women into combat jobs. So it shouldn’t be much of an extra burden for the military, he said.

For example, he said the inclusion of women in combat units means some bathrooms will already have to become gender neutral, making them less of an issue for transgender troops.

“While some people would react to all of this by saying it’s too much change for the military, it’s all too much, they’ve done it in a way the really kind of follows from each other,” Haider-Markel said. 

Still, the change will be a cultural shift for troops, which will make training the rank-and-file key, Haider-Markel said.

Estimates on how many transgender troops are in the military vary widely. A 2016 RAND Corporation study commissioned by the Pentagon put the number of active duty troops at 2,450. Meanwhile, a 2014 study by UCLA’s Williams Institute said there are about 8,800 active duty transgender troops.

The RAND study also found that providing medical services such as hormone therapy and surgery for transgender troops would cost $2.9 million to $4.2 million a year. About 65 troops annually would seek to transition, according to RAND.

An analysis published in the New England Journal of Medicine in 2015 found that medical costs for gender transitions would be about $5.6 million annually.

That analysis was conducted by Aaran Belkin, director of the Palm Center, an independent think tank that researches issues of gender and sexuality.

Prior to Carter’s announcement Thursday about lifting the ban, Belkin said successful implementation would hinge on three factors.

First, military leaders need to make clear they support the policy. As an example of what not to do, Belkin cited the announcement on opening combat jobs to women where Chairman of the Joint Chiefs of Staff Gen. Joseph Dunford was not present. When he was commandant of the Marines, Dunford recommended keeping some jobs closed.

“That silence sent a signal, loud and clear,” Belkin said.

Dunford was also absent at Thursday’s announcement on the transgender policy. Carter insisted the military leaders support his decision.

“We have arrived at it together,” he said. “I have a general principal around here, which is very important, which is it’s important that the people that have to implement decisions be part of the decision-making.”

Second, Belkin said, the policy needs to be transparent and based on medical science.

“Will decisions be made inside a black box where no one can see them or will they be based on science?” Belkin said. 

Third, he said, transgender troops need to be held to the same standards as other troops.

For example, the military already has a list of about 14 surgeries for which recruits need to wait six months after getting before enlisting. There’s no reason transition-related surgeries should be any different, Belkin said. 

“Two years, three years, 18 months — those are numbers based on fear and unfamiliarity,” Belkin said prior to the announcement, citing rumors that the grace period would be longer than six months.

Under the policy announced Thursday, transgender recruits who have undergone medical treatment will have to have a doctor certify they’ve been stable in their identified gender for 18 months. The Pentagon will review the 18-month wait period within two years to make sure it’s based on up-to-date science and lessons learned about the policy up to that point.

In his announcement, Carter said he is certain implementation will successful. 

“I am 100 percent confident in the ability of our military leaders and all our men and women in uniform to implement these changes in a manner that both protects the readiness of the force,” he said, “and also upholds values cherished by the military:  honor, trust and judging every individual on their merits.”