Pvt. Manning to Get Transferred? How Gender Change Works 
Pvt. Chelsea Manning, frmerly known as Bradley Manning, is seeking gender reassignment and has requested to be known as Chelsea Manning.
Credit: YouTube screengrab from The Real News Network

U.S. Army Pvt. Chelsea Manning, who was sentenced last August to 35 years in military prison after being convicted of releasing highly sensitive U.S. military secrets to Wikileaks, may get the OK from the Pentagon to be transferred to a civilian facility to undergo gender reassignment therapy, according to news reports.

Reportedly, Defense Secretary Chuck Hagel has approved an Army request to "evaluate potential treatment options for inmates diagnosed with gender dysphoria," The New York Times reports.

Manning, formerly called Bradley, announced that she was a female named Chelsea and would like to undergo hormone therapy to transition to a woman, less than a day after her sentence was handed down. The request put the Defense Department in a bind as transgender people are not permitted to join the U.S. military and Manning couldn't be discharged while in prison, reports Breitbart.com. (Military prisons, as such, do not provide gender reassignment treatment.)

So what's in store for Manning during the transition to a female?

The military has not released a therapy plan, but according to Breitbart, Manning had suggested they consider three types of treatment: real life experience, which wouldn't really work in a prison but would involve Manning living as a woman without any medical intervention; hormone therapy, which doesn't involve any genital or other surgeries; and sex reassignment surgery. [How Gender Reassignment Therapy Works (Infographic)]

Gender reassignment, sometimes called sex reassignment, can be performed for numerous reasons and can involve various procedures. People who are born with ambiguous genitalia — internal and/or external sex organs that display characteristics of both male and female sex organs — are often assigned a gender shortly after birth that they later decide isn't right for them. These people may choose to have surgery that will give them the sex organs of their chosen gender.

Sex reassignment is also an option for people with a condition known as gender dysphoria, also called gender identity disorder, or GID, which causes a person to develop a strong personal identification with the opposite sex. People with GID — who may be heterosexual, bisexual or homosexual — often have an interest in altering their genitals and may adopt the dress and mannerisms typically associated with the opposite sex, according to the National Institutes of Health. [Top 10 Stigmatized Health Disorders]

Manning had been diagnosed with GID, and Manning's struggles with the condition have been an issue throughout the court-martial process. Shortly before Manning's arrest in 2010, Manning (who was openly gay for much of adulthood) sent an email to another soldier that included a photo of Manning in a blonde wig and makeup; the email was titled, "My problem," according to ABC News.

People with GID may also live with depression, anxiety and feelings of isolation. According to several accounts of Manning's life, Manning frequently complained of feeling desperate and isolated, due in part to the U.S. military's "Don't Ask, Don't Tell" policy toward gays and lesbians.

Sex reassignment or "sexual transitioning" usually involves a team of experts, beginning with mental health professionals who conduct psychological evaluations, counseling sessions and screenings to determine if a diagnosis of GID is appropriate.

Hormone therapy under the guidance of an endocrinologist is another essential component of sexual transitioning. Estrogen therapy will suppress male characteristics and encourage the development of female characteristics for male-to-female candidates such as Manning. Because estrogen therapy doesn't remove facial or body hair, electrolysis is usually required.

Hormone therapy may begin after, or be concurrent with, a period known as a "testing" or "real life," during which the individual lives openly according to his or her identity, though that option is impractical for a person in prison. This period may last from several months to two years or more. Because of the emotional and behavioral changes that occur during hormone therapy, it's critical that psychological counseling needs are addressed throughout this period and the whole sexual transitioning process.

If male-to-female genital reconstructive surgery is chosen, estrogen treatment temporarily stops a few weeks before surgery because hormone treatment can interfere with blood clotting. The operation can preserve genital sensation by using the head of the penis to create a clitoris, and the scrotum can be used to create labia (the testes are removed). After the operation, acrylic inserts known as dilators are used during healing to maintain the opening of the new vaginal canal.

The entire process for male-to-female reconstructive surgery may require two or more operations, plus regularly scheduled assessments and checkups over a period of years; hormone treatment continues for life. Some people may also choose to have breast implants, tracheal shaving to minimize the size of the Adam's apple, and other cosmetic procedures.

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