Why U.S. Military Veterans Deserve Viagra and Taxpayers Should Pay for It

Erections are a funny business. They're also big business: The global market for erectile dysfunction (ED) drugs was valued at over $4.39 billion in 2014. But they're not usually political, except when U.S. servicemen are involved.

After President Donald Trump announced in a series of tweets Wednesday that "the United States Government will not accept or allow…transgender individuals to serve in any capacity in the U.S. Military," the backlash was as predictable as it was messy.

As opposing factions fought it out on social media, one statistic gained more traction than any other: the curious detail that the Pentagon spends around $84 million a year making sure its hard men of war stay, well, hard.

According to the Military Times, U.S. military expenditure on ED medication, such as Viagra and Cialis, for veterans and active-service troops is approximately 10 times higher than its spending on sex reassignment surgery ($2.4 million-$8.4 million, according to figures published by Rand Corp.) and related care for active-duty transgender service members.

Editorials condemning the military for misjudgment and immorality swiftly followed. "Ban transgender soldiers? Why not just stop covering Viagra?" The Mercury News suggested.

"Maintaining the boners of cis men [men whose gender identity matches their birth sex] is a 'medical necessity' that often takes priority over the actual medical needs of anyone else," Glamour magazine chided.

But behind the headlines and hot air, a darker story emerges.

Chris Dougherty is a man who by his own admission doesn't mind "humiliating" himself in front of an audience. The 35-year-old Iraq war veteran tweets from the Twitter handle @DisabledWarVet_and regularly shares his experience of post-traumatic stress disorder (PTSD) with his more than 100,000 followers.

For Dougherty, a combat support and infantry service member during the U.S. invasion of Baghdad and beyond, his PTSD wasn't apparent until he returned home to Columbia, South Carolina, in 2004.

"It hit me like a dump truck," he tells Newsweek in a phone interview.

"I was hearing voices…I was angry and irate," he says. "People don't understand. They treat you like a freak, like you're an outcast."

Following his release from the military, he was single. "I wasn't capable of having a relationship at that time."

As for sexual drive, he had none. "When you're depressed, it's gone. There's nothing."

Dougherty's tale is reflected by a growing body of research that suggests around a third of post-9/11 veterans are likely to suffer from erectile dysfunction or other sexual problems.

For men with combat PTSD, that figure is three times higher.

A San Diego Veterans Affairs 2010 study found that the psychological isolation that frequently accompanies PTSD strongly correlates with sexual dysfunction.

One of the major problems, Dougherty says, is that so few former service members are willing to talk about it.

"We have this puritan background [in the United States]. Even the VA [Veterans Affairs Department] clams up. Everything's taboo."

Americans with no military experience may crack jokes about the little blue pill, but its reach is far greater than that, Dougherty explains.

"Sometimes, when a veteran's been through hell, he brings it with him. Veterans [with PTSD and ED] have a much higher chance of divorce. You need to have an outlet for the buildup of frustration."

In Dougherty's experience, it's not only veterans who suffer but also their partners and families.

"I've heard from wives who haven't had sex in eight or nine months. Eventually they have an affair and go off with someone else."

When that happens, Dougherty says, the fallout can be fatal.

"Vets are often the chest-beating type of guys. When they don't have a family or any kind of sexual function anymore, they think, 'That's it.'"

It isn't just veterans whose sense of themselves as men is shored up by their sexual prowess. But it might provide part of an answer to why, according to a 2016 study from the federal VA department, some 20 veterans commit suicide every day, around a fifth (18 percent) higher than the suicide rate in the civilian male population.

The right treatment at the right time

Getting the right treatment at the right time is a lifesaver, as Andy Rubenstein knows firsthand. The 48-year-old served in President George H.W. Bush's Operation Desert Storm as part of the coalition force that pushed Iraqi troops out of Kuwait in the first Gulf War, in 1991. Like Dougherty, he received a diagnosis of PTSD only after returning to the States.

"I started getting symptoms a few years after I left the military," Rubenstein tells Newsweek over the phone from his home in Plantation, Florida, a small city whose principal claim to fame is as a filming location in the movie There's Something About Mary.

Rubenstein has just returned from a game of tennis, an activity that only a few years ago would have been unthinkable, he says.

That's because until last summer he was 140 pounds heavier. An unshaven man sporting a blue baseball cap and several chins has been replaced with a suave, trim figure in a sharp white jacket and belted black jeans.

A picture marking his transformation is pinned to his Twitter profile.

"My PTSD symptoms—nightmares, mood swings, depression—were at their worst when I was at my biggest," Rubenstein says.

"Over the years I've learned how to cope [with my symptoms] through exercise and diet."

Rubenstein, along with almost half (44 percent) of his Gulf War cohorts, has suffered medically unexplained illnesses since serving; PTSD was not the only unwanted souvenir he took back with him.

Despite 19 years of marriage, he and his wife have no children. Rubenstein is infertile—and is convinced that cocktails of prophylactic drugs, combined with the nerve gas troops were exposed to in Iraq, are responsible.

"Many of the guys who served with me are in the same position; I know of at least 10 guys who can't have kids."

Veterans, he says, deserve all the help they can get—and that includes ED medication.

"If a vet serves their country and they do so honorably, [the government] needs to do everything they can to keep their healthcare provisions to the maximum."

Rubenstein admits he would likely not be around without the excellent medical attention he received from the VA, which provides healthcare and psychological support to veterans and their families.

"My doctor, she helped save my life. There's no doubt."

But not all veterans share Rubenstein's positive experiences of the VA and its support network.

Women and minorities are at risk

Women, people of color and transgender individuals are at risk of discrimination and systemic sexism, racism and transphobia, says Courtney Hurd, 31, a former Marine.

"The VA is still very much a man's world, with care directed toward them and not always the female and other minority veterans… The general perception in society is women aren't 'real' veterans and therefore do not receive adequate, equal care to our male counterparts," Hurd tells Newsweek over the phone from Nebraska.

"Women's issues are very much ignored by the military, by the VA, by our government, and by the public… This cookie-cutter image of a [white, male, straight] combat veteran needs to end."

Women account for around 15 percent of active-duty service members in the U.S. military; that number drops to just 7.6 percent in the Marines.

The suicide rate of women veterans is 2.4 times higher than the civilian adult female population. This doesn't surprise Hurd.

"I think it is important to note PTSD is not limited to combat, and Military Sexual Trauma (MST) is a wound allowed to fester for too long. MST obviously comes with rampant sexual dysfunction, yet our primary focus is on ED and male genitalia. It is keeping with the male-focused trend," she clarifies in a later email.

Hurd's career in the Marines was cut short in 2006, after she was raped in her first year of military service. She was 21 years old.

"I was removed from the barracks and forced to sign a lease on an apartment I couldn't afford. I was completely ostracized…My life effectively ended at that point," she says.

Hurd was self-harming and suicidal.

"My commander kept trying to get me to tell him I was lying. I was balled up on the floor, crying my eyes out, and he was saying, 'You made this up, didn't you?'"

Hurd's attacker was provided with a lawyer, but she was not offered one, she informs Newsweek.

"They listened to him because he was a man."

It has taken Hurd 10 years to speak out. Her experience has informed her career: She is now a legal assistant applying to law school. She wants to be a veteran advocate for women and other minorities. Should her 5-year-old daughter choose to join the Marines as an adult, Hurd is determined that she will not confront the same horrors.

"The more diversity is embraced and acknowledged, the better our military and veteran services in this country will be."

In Hurd's view, the debate over providing Viagra to vets versus treatment for LGBT service members is a false one.

"It's not an either/or… trying to pit two different issues against one another. Transgender individuals deserve proper medical treatment just as much as a veteran with [erectile dysfunction and] PTSD."

Rubenstein agrees. The issue, he says, is not one of politics but of honor. "If you can afford to go to war, you can afford to look after your military when they come back."