In the suit, Manning’s attorneys argue that, despite her repeated requests, the military has failed to provide hormone therapy or permit her to live outwardly as a woman, which amounts to a violation of the Constitution’s prohibition against cruel and unusual punishment.

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“Every day that goes by without appropriate treatment, Plaintiff experiences escalating anxiety, distress, and depression. She feels as though her body is being poisoned by testosterone,” wrote the attorneys, including lawyers from the American Civil Liberties Union. “Plaintiff fears that without appropriate treatment, her anguish will only escalate and she will not be able to survive the 35 years of her sentence, let alone the next few years.”

Multiple military doctors have diagnosed Manning with gender dysphoria over the years, but the Army has struggled with how to deal with her and respond to her repeated requests for treatment and accommodations while serving her sentence at the military prison in Fort Leavenworth, Kansas.

While federal prisons have systems in place to deal with transgender inmates, military prisons do not, because transgender people are technically barred from serving. The Army has changed its records to reflect Manning’s name change, from Bradley to Chelsea, but it still considers Manning a male and has housed her with male inmates.

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The Army has said in the past that Manning was approved to receive some treatment, and according to the suit, Manning was recently given access to women’s undergarments. But Manning has asked to be allowed grow out her hair and use women’s cosmetics and grooming products. She has also asked for hormone therapy, including estrogens and anti-androgens. In the suit, she has not asked for surgery.

According to the suit, Manning has contemplated suicide and self-mutilation. An outside expert retained by Manning concluded that she “is experiencing significant distress and is at high risk for serious medical consequences, including self-castration and suicide, if such medically necessary treatment is not promptly provided.”