How will Chelsea Manning's residency in a military facility affect her ongoing transition from male to female? Profoundly, because when it comes to medical issues of gender and identity, prison and military cultures still have a long way to go. In fact, Chelsea's residency in a military, rather than a civilian, facility will probably make her ongoing transition even more difficult. Below, an outline of the treatment Chelsea is likely to receive while serving her sentence. 

Hormone Therapy: Unlikely.  According to her lawyer, Manning, who went public with her decision this morning to change her name to Chelsea and live as woman, hopes to obtain hormone therapy while serving at Kansas' Fort Leavenworth, a request the military prison has already denied. Although transgender prisoners in civilian facilities often receive hormone therapy — the official Bureau of Prisons policy is to administer treatments to those who have received therapy before incarceration — Manning's request for hormone therapy while in Fort Leavenworth will likely be denied. "The Army does not provide hormone therapy or sex-reassignment surgery for gender identity disorder," Kimberly Lewis, a spokeswoman for the army prison told Courthouse News's Adam Klasfeld on Tuesday, before Manning made his official statement.

In a statement today, the American Civil Liberties Union suggests that denying Manning care "raises serious constitutional concerns." (As the statement explains, courts have found that not providing medically necessary care for the treatment of gender dysphoria violates the 8th Amendment of the Constitution, i.e. cruel and unusual punishment.) "Where inmates have been denied care, courts have said that’s unconstitutional," Jennifer Levi, director of the Transgender Rights Project at Gay and Lesbian Advocates and Defenders, told The Washington Post's Sarah Kliff. Adds Levi: "The fact that it is military prison does not absolve the government of its responsibility to provide adequate medical care." Manning's lawyer David Coombs told the Today show this morning that he's "hoping" Fort Leavenworth will "do the right thing" and provide the therapy.

Sex Reassignment Surgery: Highly Unlikely. Although Chelsea Manning has not yet requested a sex change, and her lawyer says he doesn't know if Manning wants one, it's unlikely that officials will even give her the option: Despite rulings to allow inmates to receive the surgery, no inmate has ever actually undergone such a procedure while serving a sentence, according to NBC News. It's even less likely to happen at a military-controlled institution like Leavenworth. The Army's statement today specifies that it does not provide "sex-reassignment surgery for gender identity disorder" and not even the VA will do the surgery, even though it does provide some medical treatment for transgender needs, like hormone therapy. 

Reassignment to a Female Prison: Unlikely. Some are wondering whether Manning's gender transition will be followed by reassignment to a female military prison facility. The answer? Probably not. Unfortunately, prisons "usually" place inmates in units based on their birth gender, according to both NBC News and The National Center for Lesbian Rights. (For what it's worth, the United States Disciplinary Barracks says that it has procedures in place to protect Manning and other transgender inmates from violence and abuse, saying in a statement today that "The USDB has implemented risk assessment protocols and safety procedures to address high risk factors identified with the Prison Rape Elimination Act.")

Psychological Treatment: Likely. Even if Manning won't get her requested hormones, the U.S. military has reiterated that it does provide psychological services for all inmates. "All inmates are considered soldiers and are treated as such with access to mental health professionals, including a psychiatrist, psychologist, social workers and behavioral science non-commissioned officers with experience in addressing the needs of military personnel in pre- and post-trial confinement," Leavenworth spokesman Lewis explained in her statement to Courthouse News.

Some argue that's nowhere near enough: "I don't think people understand what hormone-replacement therapy does," Lauren McNamara, a transgender woman who testified for Manning's defense, tells the news service. "This is something that's the best anti-depressant, anti-anxiety drug I have ever been on. Denying people access to this treatment just because they're in prison is simply inhumane."