I've got an interesting story relating to that.
Guy I knew 20+ years ago. Was in the army. Retired out as a captain after at least one, possibly two tours in the sandbox. Came back with complex PTSD (shocking, I know).
Local (Portland) VA docs managed to convince (browbeat) him that his symptoms weren't due to his service connected PTSD, but rather because he was secretly a woman in a man's body. As far as I know he hasn't had any surgical alterations but he lives as a woman now (which led to his divorce and estrangement from his children) but is taking hormone therapy.