NEW YORK -- Chelsea Manning's lack of access to hormone therapy in military prison could spark a lawsuit and potentially set a military-wide precedent for transgender servicemembers.
On Thursday, one day after she was sentenced to 35 years in prison for sending classified documents to WikiLeaks, Manning confirmed what had been suspected for years: that she identified as a woman and no longer wanted to be called Bradley. But as Manning arrived at military prison in Fort Leavenworth, Kan., officials there said that they do not offer the hormone therapy that Manning has said she wants, and which accepted medical practice says could be used to treat her diagnosed gender dysphoria.
Manning's defense attorney David Coombs vowed Thursday to do "everything in my power to make sure they are forced" to provide her hormone therapy at Fort Leavenworth. But because the prison is citing an Army regulation banning transgender people serving in the military as its basis for denying Manning treatment, it will only provide her hormone therapy if it is forced to.
"Chelsea Manning's refusal of treatment by the military could turn into a very, very interesting game-changer," said Brynn Tannehill of the LGBT servicemember group SPART*A. "This is a lawsuit waiting to happen."
The ACLU said in a statement following Manning's announcement that denying her treatment might violate her constitutional rights.
Manning will not be eligible for parole for at least eight years, potentially leaving her without access to appropriate care for the gender dysphoria, intense stress caused by discomfort with one's assigned gender, that a military psychologist diagnosed her with just before her arrest.
Although the military ended its Don't Ask, Don't Tell policy barring openly gay servicemembers in September 2011, the Army still bars transgender servicemembers as "administratively unfit." The official Army regulation uses medically outdated terminology referring to "transvestism, voyeurism, other paraphilias, or factitious disorders, psychosexual conditions, transsexual, (or) gender identity disorder."
Transgender servicemembers are supposed to be administratively separated from the Army, and cannot receive treatments for gender dysphoria like hormone therapy or sex-reassignment surgery. But administrative separation is not an option for soldiers sentenced to prison like Manning, whose rank will soon be reduced to Army private.
A Fort Leavenworth spokeswoman confirmed to HuffPost on Thursday that the military's refusal to provide hormone therapy to its prisoners is derived from that official Army regulation, not simply a matter of prison policy or practice.
Army regulation stands in sharp contrast to the policies of the American Psychological Association, the American Psychiatric Association and the Endocrine Society, all of which acknowledge hormone therapy as an effective treatment for people who need to transition because of gender dysphoria.
"To deprive someone of this treatment is simply inhumane, and it's no different than denying someone of their blood pressure medication or antibiotics," said Lauren McNamara, an activist who exchanged Internet chats with Manning in 2009, before she sent files to WikiLeaks and before they both came out as transgender.
"Not allowing people people to have access to this is basically holding them hostage to their own bodies and denying them their autonomy," said McNamara. "It is really no different than taking a woman and involuntarily exposing them to testosterone."
There are a wide range of views within the LGBT community about how Manning's decision to send files to WikiLeaks should be viewed. Some fear that her actions could be used to paint other LGBT servicemembers as traitors, and groups that are generally referred to as mainstream, like the Human Rights Campaign, kept their distance throughout his trial. To other activists, however, she is a hero.
Nevertheless, the military's post-sentencing treatment of Manning seems to be uniting LGBT groups. The Human Rights Campaign issued a statement calling for her to receive appropriate care.
Tannehill was careful to state that Manning's identity does not mitigate the charges on which Manning was convicted. But, she said, "I want for any prisoner to be treated with accepted medical standards of ethics, and that's regardless of what she did."
The Palm Center, a think tank at the University of California, Santa Barbara, was awarded a $1.35 million grant to study transgender military service in July. The Palm Center's research also laid the groundwork for the repeal of Don't Ask, Don't Tell.
But that's about as much progress has been made on official acceptance of open transgender servicemembers, Tannehill said.
Talks with military officials are "informal, below the water lines, one-on-one," and she said that even under the best of circumstances, she can only imagining the Army repealing its outdated regulation in five years.
Tannehill and some others in the transgender community are concerned that the intense publicity around Manning's decision to come out as a woman could set back the cause of allowing transgender servicemembers to serve openly.
"I don't know if this is going to be the best test case for that both in terms of publicity and focus," said Nathaniel Frank, who wrote a widely-cited book about Don't Ask, Don't Tell in 2009. He doubts that a lawsuit aimed at Manning's prison conditions would have an impact on the wider Army regulation.
Still, he said, "I do think because of the publicity around Manning, this could be a test case for how transgender people are treated when incarcerated."
Access to hormone therapy and sex reassignment surgery are contested issues far beyond the military. Many state prisons do not provide one or both, and the Federal Bureau of Prisons only reached a settlement in 2011 to allow prisoners to start hormone therapy while incarcerated. Transgender inmates everywhere, meanwhile, face disproportionate exposure to the rape endemic to America's prisons.
"I do think the publicity focused around this, even though some of it is negative, both reflects the pace of change and could help focus attention on the experience and needs of transgender people," Frank said.