San Francisco (AP) - Before handcuffing herself to the White House fence, former Petty Officer First Class Autumn Sandeen carefully pinned three rows of Navy ribbons to her chest. Her regulation dress blue skirt, fitted jacket, hat and black pumps were new -- fitting for a woman who spent two decades serving her country as a man.
Sandeen was the only transgender person among the six veterans arrested in April while protesting the military's ban on openly gay troops. But when she watched President Barack Obama last month sign the hard-fought bill allowing for the ban's repeal, melancholy tinged her satisfaction.
"This is another bridesmaid moment for the transgender community," the 51-year-old San Diego resident said.
The "don't ask, don't tell" policy now heading toward history does not apply to transgender recruits, who are automatically disqualified as unfit for service. But the military's long-standing posture on gender-identity has not prevented transgender citizens from signing up before they come out, or from obtaining psychological counseling, hormones and routine health care through the Department of Veterans Affairs once they return to civilian life.
So as the Pentagon prepares to welcome openly gay, lesbian and bisexual service members for the first time, Sandeen is not alone in hoping the United States will one day join the seven other nations -- Canada, the United Kingdom, Spain, Israel, the Czech Republic, Thailand and Australia -- that allow transgender troops.
"There is really no question, it's just a matter of when," said former Army Capt. Allyson Robinson, 40, a 1994 West Point graduate who has spoken to sociology classes at the alma mater she attended as a male cadet. "There are active-duty, as well as reserve and national guard transgender service members, serving today."
No one knows how many transgender people are serving or have served. Neither the Department of Defense nor the VA keep statistics on how many service members have been discharged or treated for transgender conditions or conduct.
The Transgender American Veterans Association, an advocacy group founded in 2003, estimates there could be as many as 300,000 transgender people among the nation's 26 million veterans.
When 50 TAVA members laid a wreath at the Tomb of the Unknown Soldier six years ago, representatives from every U.S. conflict since World War II were there, said former Navy Machinist Mate First Class Monica Helms, the group's co-founder and president.
Most had spent years, if not decades, as veterans before they could acknowledge the mismatches between their brains and their bodies. Helms, 59, spent four years in the engine room of a nuclear submarine during the Vietnam War, but did not start living as Monica until 1997.
Military regulations state that men and women who identify with or present a gender different from their sex at birth have mental conditions that make them ineligible to serve. Those who have undergone genital surgery are listed as having physical abnormalities. Service members caught cross-dressing on base have been court-martialed for interfering with "good order and discipline," according to the National Center for Transgender Equality.
Until the American Psychiatric Association removes Gender Identity Disorder from its Diagnostic and Statistical Manual of Mental Disorders, as it did for homosexuality in 1973, that's likely to remain the case, Sandeen said.
The very diagnosis that keeps transgender Americans out of uniform has enabled some to obtain transition-related medical care and other services when they become veterans.
Federal law prohibits Veterans Health Administration (VA) facilities from performing or paying for sex-change surgeries. But some VA medical centers provide psychological counseling, sex hormones, speech therapy and other medical treatment short of gender reassignment surgery.
Sandeen said the VA hospital in San Diego made it possible for her to start living as a woman once she retired from the Navy a decade ago.
"As soon as I got an appointment with the psychiatry department, the first thing I said to them is, 'I have gender issues. I don't know if I'm a transvestite or a transsexual or if I'm something in between, but I need to work this out with a therapist,'" she recalled.
She eventually received a recommendation to see a VA doctor who could prescribe estrogen to help her grow breasts and hips and diminish body and facial hair. The endocrinologist told her she first would have to try presenting herself as a woman for two-and-half-months.
Sandeen, already classified as a disabled vet with bipolar disorder, had lined up a work-study job at the hospital's patient health library.
"February 6, 2003, my first day of being publicly female, I was working for $10 an hour at the VA helping other vets with health care needs," she said. "The VA is the organization that helped me work this out."
The attention Sandeen received as a veteran is not unusual, but not universal, transgender advocates say. In response to complaints that some transgender veterans have been treated disrespectfully or denied care at VA facilities, Helms' group has lobbied the Veterans Affairs department to issue guidelines on services to which transgender patients are entitled.
San Diego resident Zander Keig, who was a woman during a two-year stint with the Coast Guard, had been on testosterone for a year when he wanted his prescription transferred from a suburban VA clinic. But veterans are not allowed to change their names on discharge papers so he was directed to the women's VA clinic in San Francisco.
Keig, 44, said a senior physician there "grilled me with questions. Why are you taking T? Do you know what it's doing to your body? How are you eligible for these services?"
"I said, 'I established my eligibility for VA services in 1988, I have every reason to be here. Am I going to get my shots or not?'" Keig recalled. He did get his injections.
In 2007, the VA complex in Boston became the first veterans' medical provider to draft a policy designed to assure transgender veterans received consistent and sensitive care.
Department of Veterans Affairs spokeswoman Katie Roberts said the VA is reviewing the Boston policy and others, hoping to create a formal directive in the "near future."
"As all veterans served this nation with the same expectation of honor and excellence, VA strives to provide all veterans equitable treatment respecting their honor by providing medical services with excellence," she said.
Even with the enormous changes in their lives, many transgender veterans maintain connections with their military service. Sandeen still shops at a Navy commissary and grabs her military identification when she goes walking. Robinson considers her four years as a West Point cadet the best of her life, although she feared being caught with women's clothes in her trunk.
"I love this country and I felt a personal calling to express that love of America through my willingness to sacrifice," she said.
But when Robinson made her triumphant return to the academy for her speaking engagement, along with the congratulations, came comments that she was unworthy to be part of the "Long Gray Line."
"It was as though the service I had rendered was suddenly worthless," she said.
Former Air Force Sgt. Nicole Shounder, 52, who underwent sex reassignment surgery in 1999, has spent the last four years wearing a uniform at sea, first with the Coast Guard auxiliary and now, as a civil service mariner nurse aboard the USNS Robert E Perry, which recently supplied deployments in the Mediterranean.
Shounder considers it a privilege to wear Navy-issued collar brass and shoulder boards.
"Given my circumstances, it really is," she said. "Essentially until someone can say otherwise, I am probably the only out and open post-op transsexual in uniform for the Navy, or as close as you can be."