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Will Manning be treated as a woman in prison?

Bradley Manning says “I am a female,” but when it comes to how Chelsea Manning will be treated by the military and the federal prison system, saying it doesn’t
Bradley Manning is escorted out of court  - 08/22/2013
Private First Class Bradley Manning is escorted out of court after testifying in the sentencing phase of his military trial at Fort Meade, Maryland August 14...

Bradley Manning says “I am a female,” but when it comes to how Chelsea Manning will be treated by the military and the federal prison system, saying it doesn’t make it so.

The soldier who, while still known as Bradley, was sentenced on Wednesday to 35 years in prison after being convicted of espionage for leaking hundreds of thousands of documents to Wikileaks, will be sent to a male prison facility despite the mental and physical risks that could pose. She wrote in a statement read on TODAY, "Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible."  But she may have to sue to gain access to the hormone therapy she has requested.

On the TODAY show Thursday, Manning lawyer David Coombs said that he hopes the prison staff at Fort Leavenworth will voluntarily provide his client with the medical care she needs. If not, he warned, "I will do everything in my power to make sure they are forced to do so."

Statements from the army suggest Coombs may have to do just that. An army spokesperson responded to Manning’s announcement by confirming that while the prison does offer mental health services, it doesn't provide hormone therapy to inmates--a distinction that Cecilia Chung, senior strategist at the Transgender Law Center, says violates protection against cruel and unusual punishment. “Prisoners are entitled to adequate care,” Chung said. “That’s considered a constitutional standard.”

Something else to consider is who foots the bill for prisoner care during incarceration. The cost for gender reassignment surgery is estimated between $12,000 and $30,000, plus up to $200 a month for hormone therapy. Psychotherapy adds to the total. The Army has already said that they "won't be footing the bill for Manning's gender reassignment," which means the financial burden would fall to taxpayers.

There are states that require transsexual prisoners the option of a taxpayer-funded sex change. In September 2012, a federal judge ruled that Massachusetts must provide the aforementioned care provided it is deemed "the only adequate care for the inmate's gender identity disorder." The landmark ruling stated, "Denying adequate medical care because of a fear of controversy or criticism from politicians, the press, and the public serves no legitimate penological purpose. It is precisely the type of conduct the Eight Amendment prohibits." The ruling was quickly repealed and remains in limbo.

A similar case, this one in Virginia, could also affect Manning's case for surgery behind bars. Ophelia Azriel De'lonta, who was previously granted psychological counseling, hormone therapy, and permission to dress and live as a woman behind bars, filed a second case in 2011 arguing that those prior provisions did not ease her "extreme distress" and that surgery was the next option.

"By analogy, imagine that prison officials prescribe a painkiller to an inmate who has suffered a serious injury from a fall, but that inmate's symptoms, despite the medication, persist to the point that he now, by all objective measure, requires evaluation for surgery," Judge Albert Diaz wrote. The court upheld De'lonta's theoretical right to surgery but did not force the prison to provide it for her.

Both of the above cases could be cited if Manning were to request surgery, which so far she has not done. The National Journal points out that The World Professional Association for Transgender Health views "culmination of care for a transgender individual" as sex-reassignment surgery.

Since Manning is expected to serve only about a decade of her 35-year sentence, hormone therapy may suffice during her incarceration, and she could choose surgery after her release. "The ultimate goal is to be comfortable in her skin," Coombs said Thursday on TODAY.

According to Army manuals, trans men and women suffer from a mental disorder that makes them subject to expulsion from the military. Transgender soldiers did not enjoy the benefit of the repeal of Don’t Ask Don’t Tell; they can still be turned down for enlistment or thrown out of the service.

"As I transition into the next phase of my life, I want everyone to know the real me, " Manning wrote. "I am Chelsea Manning. I am female."