Manning’s fight for hormone therapy brings transgender health issues into the spotlight


Chelsea Manning, formerly known as Bradley, came out on August 22 as transgender, after being sentenced to thirty-five years in a military institution for the largest leak of classified information in American history. Manning’s lawyer, David Coombs, told the Associated Press on Monday that she did so in the hopes of receiving hormone therapy while serving her prison sentence, in order to transition and be able to live her life as a woman.

The Courthouse News Service, quoting prison spokesperson Kimberly Lewis, reported that the military will not be providing Manning with estrogen while she serves her time in prison.

“The Army does not provide hormone therapy or sex-reassignment surgery for gender identity disorder,” said Lewis in an email to Courthouse News.

In the last few years, there has been a change in the way that transgender people have been treated by the American prison system. Court cases have been won in favor of trans people seeking hormone therapy and gender confirmation surgeries while serving time. These cases are won on the basis that hormone therapy and in some cases gender confirmation surgeries are necessary for people diagnosed with gender dysphoria, formerly known as gender identity disorder.

The Standards of Care published by the World Professional Association for Transgender Health (WPATH) state that the general goal of medical care for transgender persons is “lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.”

As to the necessity of hormone treatment, WPATH’s Standards of Care states that “hormones are often medically necessary for successful living in the new gender. They improve the quality of life and limit psychiatric co-morbidity, which often accompanies lack of treatment.”

Following this line of thought, several courts in the US have ruled that withholding hormone therapy from persons diagnosed with gender dysphoria in the prison system is medically negligent and endangers the lives of those prisoners.

In a decision made in January of this year, the 4th circuit court ruled that the state of Virginia may have trampled on the rights of Ophelia Azriel D’Lonta when the state’s prison system denied her request for gender confirmation surgery.

Judge Albert Diaz, one of the three judges who sat on the panel for her case, made an analogy between treatment for gender dysphoria and treatment for an injury to explain why the decision had been reached unanimously.

“Imagine that prison officials prescribe a painkiller to an inmate who has suffered a serious injury from a fall, but that the inmate’s symptoms, despite the medication, persist to the point that he now, by all objective measure, requires evaluation for surgery,” he wrote in a statement issued by the court. “Would prison officials then be free to deny him consideration for surgery, immunized from constitutional suit by the fact they were giving him a painkiller? We think not.”

Similarly, US District Judge Mark Wolf ruled that the state of Massachusetts must provide gender confirmation surgery for Michelle Kosilek, finding that the prison must provide necessary medical treatment for its inmates, regardless of whether it is publicly or politically unpopular to do so.

The controversy over Manning’s request to receive hormone therapy stems from the fact that since she is serving time in a military facility, the decisions made by the US court system pertaining to the Federal Prison System do not apply.

Current US military policy does not allow for transgender persons to serve in the military, and medical services provided for soldiers by the army does not include any treatment for gender dysphoria.

Many trans* advocacy groups around the country have called out the unfairness of such a policy.

“This is the United States. We do not deny medical treatment to prisoners,” said the executive director of the National National Center for Transgender Equality, Mara Keisling, to the Guardian.

She recalled the medical field’s stance on treatment of gender dysphoria. Considered a serious condition with an established standard of care, treatment should facilitate transition in order to promote the well-being of transgender persons. “The medical community is now unified that transition-related care is legitimate medical care that can successfully treat a serious underlying condition,” said Kesling.

The question for the US military seems to revolve around the legitimacy of the trans* identity, and the need for medical treatment, which puts it quite a few years behind the recent court rulings made by district courts in the US.

Chelsea Manning’s prominence in the news brings new light and further advocacy for trans* health issues and how they are dealt with in medical institutions. Her lawyer, David Coombs, vows to change the military’s stance on transgender health care.

“If Fort Leavenworth does not [elect to provide hormone therapy], then I’m going to do everything in my power to make sure they are forced to do so,” he said in a statement on NBC’s today show.


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