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Bradley Manning may want to live as a woman, but the young man sentenced to prison this week for leaking hundreds of thousands of secret government documents will face a difficult — if not impossible — task of beginning to switch his gender behind bars. The move raises a host of questions about Manning, about transgender inmates in the U. Here are answers from experts and advocates familiar with sex-change issues.

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Can Manning get hormone therapy in a U. Manning is being held at the military prison in Fort Leavenworth, Kan. Coombs said that Manning hasn't discussed whether to pursue sex-reasment surgery while in prison. I hope that you will support me in this transition. Have other prisoners received hormone therapy or sex-change surgery? No inmates have received sex-reasment surgery while in U. In the highest-profile case so far, a Boston judge told Massachusetts officials to grant the procedure last year to a transgender prisoner, Michelle Kosilek.

Kosilek, formerly known as Robert, is facing a life sentence for the murder of wife Cheryl Kosilek.

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Kosilek's doctors have said that surgery is the only treatment that will fully address her gender identity disorder; she attempted castration and tried to commit suicide twice while held in an all-male prison. That court decision is pending on appeal. Kosilek has already received hormone therapy and laser hair removal. Other inmates have received hormone therapy and other care for transgender issues. Under old rules, transgender inmates housed by the federal Bureau of Prisons were treated only for their existing conditions when they were admitted to prison.

If they took hormones, for instance, that was maintained.

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But inafter a lawsuit, the prison bureau changed its policy to allow treatment and care for problems diagnosed after incarceration. That opens the door to new options, including surgery. Very little is known about transgender inmates in military prisons, advocates say. Manning's request may even be unprecedented.

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No one knows how many of the nearly 2. A study by the California Department of Corrections identified more than transgender inmates in a population of about , equal to about 0. But the National Center for Transgender Equality estimates that the actual figure may be much higher. Why is this the prison's problem? Doctors who treat transgender people and advocates who lobby on their behalf say that inmates are legally entitled to health care while incarcerated -- including services for gender identity issues.

Sherman Leis of the Philadelphia Center for Transgender Surgery, who performs sex-change operations three days a week. Just as diabetics need Women want sex Bradley and people with heart problems need surgery, inmates with gender identity-related health problems require the most appropriate treatment, said Mara Keisling, executive director of the National Center for Transgender Equality. What happens if they develop schizophrenia? It is illegal to withhold those treatments. For those in and out of prison, switching genders is a protracted, complicated process that involves years of psychiatric counseling, hormone therapy and -- sometimes, but not always -- surgery, experts say.

Male-to-female transgender people typically take the female hormone estrogen in sufficient doses to influence the development of breasts and other secondary sex characteristics. They must receive adequate regular doses for the rest of their lives to maintain their new gender. They often also undergo laser hair removal.

If surgery is indicated, it can involve a range of procedures including removal of the original sex organs and reconstruction of new genitals. Other surgeries can include removing or augmenting breasts and reshaping facial contours, Leis said. If a prisoner receives care while incarcerated, the taxpayers would foot the bill, advocates say. Can this be a ploy for men to get into a women' s prison? GID is diagnosed by a doctor and the life-altering treatment must be prescribed.

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Besides, prisons usually go by birth gender when asing inmates, so even after gender reasment, a newly female prisoner could end up in a male population— or in isolation for her own protection. Fort Leavenworth spokesman George Marcec told the Associated Press that Manning would need to petition for a transfer to a federal prison to receive hormone treatment.

In addition, the prison staff can separate high-risk prisoners from the general population based on the level of security risk to the inmate and others, he added. Officials with the United States Disciplinary Barracks said that they have procedures to ensure that Manning and any other transgender inmates are protected from abuse and assault while in custody.

IE 11 is not supported. For an optimal experience visit our site on another browser. Share this —. Follow NBC News. We apologize, this video has expired. Bradley Manning: I want to live as a woman Aug. JoNel Aleccia.

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