In 2010, the WikiLeaks source Bradley Manning confided to Adrian Lamo, a former hacker who eventually turned Manning in to the government, that “I wouldn’t mind going to prison for the rest of my life, or being executed so much, if it wasn’t for the possibility of having pictures of me plastered all over the world press as a boy.”

On Thursday, a day after he was sentenced to thirty-five years in prison, Manning released a statement in which he said, “I am Chelsea Manning. I am a female. Given the way that I feel, and have felt since childhood, I want to begin hormone therapy as soon as possible.” He continued, “I hope that you will support me in this transition.”

Today, the United States is friendlier to lesbians, gays, and bisexuals than at any point in its history. But there is often still a discomfort toward and about the population represented by the final letter in the acronym L.G.B.T. Western society long ago decided that gender is immutable, that men are men and women women in perpetuity—that, somehow, nature or God or whomever is responsible for determining the formation of genitalia and chromosomes in utero is incapable of error. We may know today that this is not true, but we have not figured out how to deal with that fact.

There is already discussion and debate about how we should refer to Manning now: do we stick to the name we know him by, or accede to her wish and acknowledge the identity she knows to be the correct one? Is it about the choice, or is there a line that must be crossed before we begin using the female pronoun: when Manning begins hormone therapy, say, or undergoes an operation—or maybe just schedules one? What about the moment the discharged soldier starts to cross-dress, or pad bras, and looks, by some mysterious objective standard of gender-bearing, like a lady? Then what? Would it make any difference to the court or to the country, or to us, if we just did as she asked and started calling her Chelsea?

It will, at the very least, make a difference to Manning. Gender dysphoria is a classified medical disorder, and the Fourth U.S. Circuit Court of Appeals, which has jurisdiction over the military court in Maryland, where Manning was sentenced, has recognized that. In a unanimous decision in January, a three-judge panel concluded that denying a transgender prisoner a sex-change operation amounts to cruel and unusual punishment.

But Fort Leavenworth, the military prison where Manning’s attorney, David Coombs, says she is likely to be incarcerated, does not guarantee this right. The spokeswoman there, Kimberly Lewis, has made it clear that the facility does not provide hormone therapy or sex-reassignment surgery, or any treatment beyond psychiatric care. Manning has asked for hope from her supporters. Hope is one thing. There is not much they can do.

No federal law exists to protect transgender people from discrimination in the workplace; a full ninety per cent have reported harassment, mistreatment, or discrimination at work. The rate of unemployment in the trans community is double that of the population at large. Most states do not guarantee access to public services, like hospitals, for transgender people. In New York State, where the modern gay-rights movement really began, gay and lesbian activists dropped their transgender allies for a non-discrimination bill, and still there is no guarantee of equality of gender expression.

Discrimination and violence, especially sexual violence, against transgender women is disproportionately bad. And in prison, according to a 2009 study of inmates in California, some sixty per cent of male-to-female transgender individuals locked up with cisgendered men suffered sexual assault. Not one of the transgender inmates in the study trusted guards to protect them against rape and harm.

On Thursday morning, Coombs said on the “Today” show that, for Manning, “the ultimate goal is to be comfortable in her skin and to be the person that she’s never had an opportunity to be.”

That will be difficult. Manning, a twenty-five-year-old who suffered neglect as a child, and who was subject to solitary confinement after her arrest, will be in prison for at least the next eight years. And during that time, she will have to live with the knowledge that the world outside has seen those pictures of her as a boy, that others feel a right to determine her identity—who she feels she is inside her body—on her behalf.

Photograph: U.S. Army/AP