Bradley Manning's latest bombshell - that the convicted Army private wants to live the rest of his life as a woman named Chelsea and begin hormone treatment soon - has exposed rifts in the way the government and society view transgender men and women.
Manning, 25, received a 35-year prison sentence on Wednesday for leaking a trove of classified information to the website WikiLeaks. On Thursday, Manning revealed in a statement to NBC's Today show that he will now be known as Chelsea and live as a woman.
"I am Chelsea Manning. I am a female," the Army private wrote in a statement read by his attorney, David Coombs. "Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible. I hope that you will support me in this transition."
"I also request that, starting today, you refer to me by my new name and use the feminine pronoun (except in official mail to the confinement facility)," he continued in the statement posted on the show's website. "I look forward to receiving letters from supporters and having the opportunity to write back."
Manning signed the letter "Chelsea E. Manning."
Legal, medical and mental health professionals, even the Veterans Affairs Department, recognize that transgender men and women can qualify for medical treatment. The VA won't pay for veterans to have sexual reassignment surgery but it will pay for hormone treatment and counseling for those who qualify.
It's unknown how many transgender troops are serving. From 2001 to 2011, there were 3,177 veterans diagnosed with gender identity disorder, according to the VA. The number is increasing annually, it says. About one in 11,000 male babies and one in 30,000 female babies are born with gender identity disorder, according to the Veterans Health Administration.
The Pentagon, meantime, refuses to accept transgender troops or offer them treatment. Gay and lesbian troops may now serve openly, but transgender soldiers get discharged. And the Army says it will not treat Manning for transgender issues during the private's sentence at the Army's Fort Leavenworth prison - a male-only facility.
Activists and lawyers say the Pentagon is fighting a rear-guard action that it can't win. It can't deny a prisoner legitimate, recognized therapy, they say. If Manning receives a diagnosis that he needs gender treatment, he'll be entitled to therapy in prison, says Mara Keisling, executive director of the National Center for Transgender Equality.
"It's really clear-cut," Keisling said. "If a person gets diabetes, you treat the diabetes," she said. "If you break a leg, that gets treated. If you have schizophrenia, that gets treated. It doesn't matter if it is a mental or physical health problem."
Denying therapy or surgery "is the initial reaction most prisons have had. ... It's regularly been rejected by courts because the courts say the Constitution requires prisoners be given adequate care," said Neal Minahan, a Boston attorney who has worked on similar cases.
"You can't just have a blanket ban on a medical procedure without some doctor involvement," Minahan said.
Manning's announcement comes at a time of tremendous change in medical and cultural attitudes toward transgender people.
In March, the psychiatric profession's diagnostic manual eliminated the term "gender identity disorder" from its list of mental health disorders. That change reflects the profession's recognition that transgender people, who do not identify with the sex with which they were born, are not mentally ill, says Jeffrey Parsons, a professor of psychology at Hunter College in New York.
The newest version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, does include the term "gender dysphoria," or "the emotional stress somebody might experience because there is a discrepancy between their assigned gender, which they were born with, and the gender they feel they are."
Hormones called anti-androgens can diminish male characteristics, such as baldness, and help redistribute body fat, leading to breast swelling, says Loren Schechter, chief of plastic surgery at Chicago Medical School, who performs gender reassignment surgery, also known as gender confirmation surgery.
Some transgender people take hormones to modify their appearance in preparation for surgery. Others have no interest in surgery, or seek out less extensive surgeries, says Schechter, a spokesman for the American Society of Plastic Surgeons.
Although gender reassignment surgery has been performed since the 1950s, there are still only a handful of hospitals in the USA that offer it, Schechter says.
Troops serve in silence
Another transgender soldier says Manning's crime shouldn't be conflated with transgender issues. This transgender sergeant is a reservist who works a civilian job as a man and reports for military duty as a woman. The sergeant is taking synthetic testosterone hormones, under a private doctor's supervision, paying for it out of pocket.
"Most of us strive to excel simply to combat any negative perception of our individuality," the sergeant said Thursday. "Because at the end of the day, the only thing most people care about is our ability to do our job. Jeopardizing that mission by compromising national security, no matter what (Manning's) intent was, seems incongruent with the honorable character of the majority of trans people serving whom I know."
Transgender troops are spread throughout the ranks, serving silently, the sergeant says.
"I know of countless examples of those who've served, fought honorably, climbed in rank and responsibility and even retired after decades of honorable service," the sergeant says. "For those of us still serving, we're respecting the process, trusting our leaders, persevering through discrimination and are committed to our mission."
For other troops, the transition isn't as smooth.
A lieutenant colonel with a Special Forces background told USA TODAY last month about his struggle in transitioning to a woman.
The lieutenant colonel spoke to USA TODAY last month about transitioning to a woman on condition of anonymity. Revealing that he wears heels, a skirt and makeup at nights and on weekends would get him kicked out of the Army.
The soldier, who served multiple tours in Iraq and on in Afghanistan, recalls feeling uncomfortable in his body from a young age. He feared being gay and sought out the toughest, most macho jobs to prove his masculinity.
"I have a pursued the hardest physical jobs, gotten married and have had kids," the lieutenant colonel said.
The transition to becoming a woman has upended his life: He lives alone, apart from his children, and is getting a divorce. He drinks a lot. He finds it hard to focus on his job and acknowledges that it's tough to do his job.
He was looking forward to a more settled future as a woman.
"Unlike gays who are kind of loud, proud and out, most trans people who are on the path to full reassignment are not necessarily activists. We want to transition into the body we think we should always have had. Get on with our lives in the other gender."
Contributing: Liz Szabo
Tom Vanden Brook and Jim Michaels, USA TODAY