National Geographic News
Picture of Bradley Manning

Convicted document leaker Bradley Manning, in file photo, says he would like to become a woman.

Photograph by Patrick Semansky, Associated Press

Susan Brink

for National Geographic

Published August 22, 2013

When the transgender pioneer Christine Jorgensen returned home from sexual reassignment surgery in Denmark in 1955, the tabloids were unforgiving: "Bronx GI Becomes a Woman!" Today, some still cluck and tsk, but the world is more prepared to hear about people who feel they are trapped in the body of the wrong gender.

Bradley Manning is the latest gender dysphoric person, or person who believes his or her body is the wrong gender, to declare his desire to live as a woman. Manning chose the name Chelsea and says that he wants to begin hormone therapy as soon as possible.

For Manning, the difficulties of getting his medical needs met are considerably more severe as a military prisoner, who was sentenced to 35 years.

Sex reassignment surgery can cost $20,000 or more, and the ongoing cost of hormone therapy can be about $200 a month. Such treatment is not provided by the military, so covering the costs is one of the many challenges Manning will face.

According to NBC News, no inmates have received sex-reassignment surgery while in prison in the United States, although dozens of lawsuits at the state and federal level have paved the way for the procedure.

How Gender Changes Work

Dr. Sherman Leis, a surgeon with the Philadelphia Center for Transgender Surgery, suggests that a patient be on hormone therapy and presenting herself as a woman for a full year before male-to-female sex reassignment surgery. By dressing and living as a woman, the patient will begin to feel the realities of living life as the opposite gender.

But Dr. Anne Lawrence, a psychotherapist in Seattle who has studied and treated many gender dysphoric people, says that not all transgender people need to live a public life as the opposite gender. "The so-called real-life experience is distinct from hormone therapy," she says. "The two can be seen as potentially separable aspects of therapy. Some people who cannot transition to live full-time as women still find comfort in hormones."

And historically, long before there were medical interventions to aid transgender people, some Native Americans and people in non-Western cultures lived as members of the opposite gender without the benefit of hormones or surgery.

But before a biological male can even get on hormone therapy, his endocrinologist or other medical specialist in hormone therapy will probably want a letter from a mental health professional confirming a diagnosis of gender dysphoria.

Those prescriptions for a male wishing to become a woman would usually include both estrogens and testosterone-blocking agents, called antiandrogens. Testosterone is available in small amounts in women, but in men it is secreted in the testicles and is responsible for men's greater muscle and bone mass and the growth of body hair.

The sex-change candidate will start taking the predominantly female hormones estrogen (and possibly also progesterone) in doses four or five times higher than, say, women using it to control hot flashes. The combination of less testosterone and more estrogen and progesterone will result in softer skin, less body and facial hair, fewer erections, and some breast growth.

"There are some immediate effects, but it may take as long as 12 to 18 months for the full effects to develop," says Lawrence.

Women who experience gender dysphoria would instead begin taking testosterone, which would make the voice deepen, the breasts get smaller, upper body strength to increase, the clitoris to enlarge, and sex drive to increase.

The Final Step

Following hormone therapy, many people want to take the next step: genital reassignment surgery. For men like Manning, that means castration surgery, and the creation of female-appearing genitalia.

"Before we do gender reassignment surgery, we like to have two letters from mental health experts diagnosing gender identity disorder," says Leis.

While Manning will face enormous obstacles in completing the stated desire to become a woman, he just may have what might be called an advantage. He has nothing left to lose.

"If you're gender dysphoric living on the outside, you may lose family, friends, and your job if you undergo sex reassignment," says Lawrence.

Manning has lost much of that.

35 comments
Sean Hao
Sean Hao

that's great, i mean, that must be a supreme experience in one's life. it's like to start a new life from what you already have. if you have nothing to loose, you should probably try it. 

Gwendolyn Mugliston
Gwendolyn Mugliston

No, he was not a traitor.  Our government was and is out of our, the civilian population's control.  He has helped us see how our government has abrogated the Constitution and Bill of rights.

Concerning his sex change operation.  I am assuming you chose to be "male"? And when, exactly, did you do that? Pre birth as in utero, post birth as a neonate, or as a child or just when exactly? Or perhaps your disenchantment is a function of envy?


Philip McCleary
Philip McCleary

Mr. Manning is a traitor to his country and should have been shot. I for one am very happy that he will not be able to spend tax money to become a woman. I have no problem with people that want to to be reassigned and feel they have the right to have it done if they wish and if they pay for it but I refuse to pay the bill for a traitor to be reassigned.

Bethany Maloney
Bethany Maloney

Ms. Chelsea has decided who she is. The problem is she informed the public of certain discrepancies within the Government. In my opinion Ms Manning is a hero. She should not spend a day in jail, and she should be allowed to live her life as the person she believes herself to be.

Kristel Sitz
Kristel Sitz

How the HRT is so expensive ($ 200 per month) in USA? My HRT in Europe is less than € 20 per month.

John C.
John C.

Who let this screw ball near highly sensitive top secret documents? He obviously has a number of "issues" that should have flagged him early in the process as being psychologically unfit to handle such data, as his later behavior proved. Way to go Army.

Rita Santos
Rita Santos

This is complete nonsense. Manning's not female and he's not a woman. Maybe he wishes he were a woman; maybe he "feels like" he's a woman; but he's still a man. At best, he can distort and mutilate his body and pretend to be a woman. Doctors who assist him in enacting this fantasy are simply going along with and validating someone's psychosis.

The "female-appearing genitalia" that Manning desires require lifelong, very intensive after-care. It's not some simple operation. It is a massive and complicated operation, with much associated long-term morbidity and mortality. He won't get it in prison, but unfortunately by generating news stories like this a lot of other confused persons will have the operation.

It is shocking and disgusting that it is now considered acceptable and almost normal for people to "come out" and tell the world of their "transgender" delusion. It is becoming so normalized that parents are now pushing "transgender" status on their small children. If little Johnny wants to play with dolls or likes the color pink, some foolish parents now begin to raise this little boy "as a girl" and force the issue on the other impressionable children at school. Nothing but insanity and pain can come from this.

Bradley Manning is hoping to mentally "check out" of this tough spot he's in by taking on a new "female" persona. However, he's always going to be a man, 100% male, no matter what he says.

Diana Marie
Diana Marie

I find it disappointing that you've reported on Manning without respecting what she has asked for - to be referred to by the name Chelsea Manning, and to be referred to using female pronouns.

I think this article tries to take a compassionate slant on Manning and the "enormous obstacles" she has ahead of her - however, by continuing to refer to her as a man and by her old name, media articles such as this are actively contributing to her challenges.

Here is a GLAAD article for members of the media you may find useful should you publish stories about transgender people in future - http://www.glaad.org/reference/transgender - there is a section on names, pronouns and descriptions of transgender people that is particularly relevant.

Brandon Speer
Brandon Speer

@Gwendolyn Mugliston CHoice isn't a thing in life sometimes. If you are born a man then you are a man and vice versa. This whole changing genders thing is one of the weirdest things I have ever heard of. I can't believe it's called science.

John C.
John C.

Tell that to Barack.

Richard Koppinger
Richard Koppinger

@Kristel Sitz - Everything health related in the USA is extremely expensive because the insurance companies want it that way. They maximize profits because they know people will pay whatever they can to get treatment to take away pain or stay alive.  That's why the Republicans have tried 40 times (so far) to repeal the Affordable Care Act.

Bethany Maloney
Bethany Maloney

@Rita Santos I mourn for you. You have no heart. Some people are born in the wrong body. My cousin was, and HE died long before sexual reassignment was available.

Aaron Jager
Aaron Jager

Psychotic or delusional people (your words), hold beliefs that conflict with reality. Transgendered people do not. They beleive that they very uncomfortable with their bodies. That is true. They also believe that by presenting themselves as the gender they identify with, rather than the one implied by the genitals they were born with, they can live a more fulfilling life. That's also true. They are not delusional. They are failing to follow your idea that a person's gender, a complex cultural role, is immutable and determined entirely by their sex organs at birth.

In short, you are the biggest reason why their lives are difficult.
So stop it. Why are you responsible for telling people what social identities they can and cannot assume?

Also, can you find any study that says children are being forced to change genders (on a societal level)? I have trouble believing that that happened even once.

John C.
John C.

@Diana Marie

Well, she'll have plenty of time to think it all over in Leavenworth once President Obama gets done with her. What's next? Convert to Islam and demand a burka? 

Harry McMerkin
Harry McMerkin

@Diana Marie and I would like to be referred to as the 'Almighty Merkster of the Harry McMerkins' otherwise people are disrespecting me.  How effing ridiculous.

Christina Eneroth
Christina Eneroth

@Brandon Speer @Gwendolyn Mugliston

Being transsexual is probably caused by the hormone levels during pregnancy changing between the development of genitalia and the brain. So she probably was born with a female brain, not a male brain. I can't see what' weird with that.

Transphobia on the other hand is weird.

John C.
John C.

You're a HE if you have a male genome, which an operation and hormone therapy doesn't change.

John C.
John C.

@Leonardo Alenizi @John C. 

Well, you can lump President Obama into that group of conservative crazies as well, he's the one vigorously prosecuting Manning. 

Diana Marie
Diana Marie

@Harry McMerkin @Diana Marie Well, I think it's effing ridiculous to analogise a person's gender identity with an internet nickname.

Aside from that, I also think it's effing ridiculous to think it's ok to speak about someone using a name and terminology that that makes them feel profoundly uncomfortable.

Brandon Speer
Brandon Speer

@Zoe Brain A person with a 46 XY does not have an average male genome. There is a mistake which causes it to be female, therefore it is a female genome. If you would actually read before spouting your mouth you would realize that 46XY is a female genome.


Zoe Brain
Zoe Brain

@John C.
A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis. -- The Journal of Clinical Endocrinology & Metabolism January 1, 2008 vol. 93 no. 1 182-189

You were saying about a "male genome"?

Brandon Speer
Brandon Speer

@Diana Marie @Harry McMerkin Actually it is completely analogous. What if someone was extremely anti-social and was more comfortable online than he was in the real world and wanted to be called by his screen name? If that made him more comfortable would you call him by his screen name that he prefers or by the name he was given when he was born?

Zoe Brain
Zoe Brain

@John C.@Aaron Jager@Diana Marie@Harry McMerkin

A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.

Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones


It turns out that rather than being delusional, transsexuals merely reported what autopsies, MRI and PET scans have since confirmed.

We've known that for nearly 20 years.

Unfortunately, the word hasn't got out beyond the medical profession, so we still have ill-informed people calling them "delusional", if only to justify past mistreatment and salve their own consciences.

Aaron Jager
Aaron Jager

@John C. @Aaron Jager @Diana Marie @Harry McMerkin 

First, transgendered people are real, and their gender dysphoria is real. There are not millions of people in the world suffering because they want to live as vampires.

Second, if there were transdraculas, why shouldn't they wear fangs and capes? If I wear a cape, does it harm you in any way? 

John C.
John C.

@Aaron Jager @John C. @Diana Marie @Harry McMerkin 

Who cares what somebody does to transform or disfigure their body to make themselves feel better - plastic surgery addicts, extreme tattoos or piercings, bleaching your skin and filing your teeth to look like Dracula. But after somebody does that, collectively pretending with them that they really are Dracula or another gender is just ridiculous.

Aaron Jager
Aaron Jager

@John C.@Diana Marie@Harry McMerkin

>
Transgender people have a rare psychological condition who feel more comfortable living in a skin suit of the opposite sex, but they definitely are not suddenly another sex after an operation.

Yes, it is deathly important that we respect the genitals a person was born with, rather than the identity that makes them feel comfortable.

John C.
John C.

@Diana Marie @Harry McMerkin 

Medically, Manning (or should we be using  Womyning now?) will still be a genetic male after any sex change operation, so "he" is appropriate. Hormones and genital reconstruction will create a "women suit" but not change his underlying genetic gender.

It's no different from Lizard Man in the circus who filed his teeth, had skull horn implants, forked his tongue, etc. Knock yourself out and we'll even call you Godzilla if you want but it doesn't change a human into an actual lizard. 

Transgender people have a rare psychological condition who feel more comfortable living in a skin suit of the opposite sex, but they definitely are not suddenly another sex after an operation.

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