A polite round of applause, and she takes the stage. Adjusting her glasses, and buttoning the microphone to her blouse, she begins to speak. Doctors, med students, and activists alike lean forward in anticipation.
“Never dreamed I’d walk back in here in a dress,” she mused.
And then she was off. Coyly, letting her audience idle, and then full force. Smiling, she started in.
The Denver Post calls her the “Rockstar” of gender-confirming surgeries. Dr. Marci Bowers is that and much more. She is one of the premier sexual reassignment surgery (SRS) surgeons worldwide, performing more than 350 alignment procedures every year. Trained under the direction of Dr. Stanley Biber, she has followed in his footsteps, perfecting the techniques that he pioneered.
I had a chance to speak with Bowers just before her recent keynote address at the Minnesota Trans Health & Wellness Fair on May 10.
Dr. Bowers, what is your background in the medical field? Sexual reassignment surgery, in addition to being highly controversial, is a challenging and specialized field. How did you come to call it your own?
I am trained formally as an Ob/Gyn. I attended the University of Minnesota, where I graduated in 1986, where I was Medical School Class President and President of the Medical Student Council. I then went to Seattle, where I did my residency in Ob/Gyn at the University of Washington.
I settled into private practice at a large multispecialty clinic in Downtown Seattle called the Polyclinic. I practiced there for 12 years.
About my 10th year, I actually met Dr. Biber. He indicated that Trinidad was in need of an Ob/Gyn, and that, if I came here, I could learn the SRS procedure from him, while performing obstetrics and gynecology for the community. In January 2003, I finally did just that, leaving the relative security of an established practice in Seattle, and facing the specter of the many hours and hassles that go with practicing in a large urban area.
I decided to roll the dice, so to speak, noting that there were very few reassignment surgeons in the United States, and that two of the most prominent, Dr. Biber and Dr. [Eugene] Schrang, were already well into their 70s at the time. I worked with Dr. Biber, side by side, for six months, and then, with his inability to obtain malpractice insurance, took over his duties in July 2003, surviving with a combination of good luck, good skills, intuition, and faith that I was doing the right thing.
You are the surgery end. What needs to happen before a patient meets with you? Do you believe these practices are fair, or should they be changed? How have they evolved since their inception?
We follow the World Professional Association for Transgender Health (WPATH) standards of care (SOC), a set of guidelines that, although written to be fluid and flexible, is made by most to be rigid and encumbering.
There do need to be standards, though, because this population is diverse, and, without standards, the utilization is subject to criticism even more than it already is by naysayers and conservative critics. That said, I am critical of some aspects of the SOC. As a result, and because I am looked to for leadership in this field, based upon my experience, I do not feel that a second letter [of approval] for someone living many years is prudent. So, we’ve dropped that.
Secondly, children are increasingly recognized and treated, yet the SOC states that kids need to wait until they are “of age” . That, in my opinion, is the worst and most egregious error currently written into the SOC, and needs to change. There is nothing worse, in my opinion, to take a kid, often socially isolated because of their genitalia, make them wait until they are 18, then unleash a surgery on the kids, and send them off to college or working world with all of the challenges of adulthood coinciding with this critical surgery.
I believe the surgery should be responsibly performed for the proper, carefully screened candidates, not at age 18, but at age 16 or 17, while still under the caring environment of home, allowing some social transition still in high school. It is the only morally responsible approach to this problem. We have already made that change in our standards here, and I will live to see that change be made globally as well.
Medically speaking, what are the procedures you perform, and which do you consider your specialty? Do you feel that your mastery of all of them sets you apart?
Vaginoplasty, or genital reassignment for MTFs [males transitioning to females], is the bread-and-butter procedure that we perform week in, week out, generally five times per week. This is the mother of all surgeries, so to speak, because the results are so very dramatic, and the effects so life-changing.
I still perform many of the local Gyn surgeries here, and am regarded for that expertise as well. We also perform cosmetic procedures, such as breast augmentation and tracheal shaving, but have lately been increasingly working with the FTM [female-transitioning-to-male] population, performing metoidioplasites and scrotoplasties.
I think my favorite surgery is still the vaginoplasty, in that so much of the procedure is now my own, altered by observation, feedback, and an intent towards perfecting a very detailed, incredibly difficult procedure.
What other procedures are you working on, and why are they worth your devotion?
Two things, actually.
Besides continuing to tweak the vaginoplasty procedure, which is ongoing, I spent time last year in Paris working with a French urologist who does female circumcision reversals. I feel this to be hugely important, and we have many, many women—from Africa, mainly—who now seek this procedure. It has been largely ignored by American physicians. I was recruited, because of my reconstructive experience, to involve myself in that cause. I have donated [money] for a hospital being constructed in Burkina Faso, but will also eventually offer this service here in Colorado.
Secondly, I like the metoidioplasty we’ve developed, but would like to add a urinary hookup for FTMs, many of whom find that standing to pee—a function most men take for granted—is an important aspect of their male gender role. We have a Japanese plastic surgeon coming to visit with us this summer, and I hope that I am able to garner enough information to make this a reliable addition to my work with the FTM community.
I have heard of people seeking treatment overseas because of the cheaper cost. Where is this happening, and would you discourage people from this practice?
Surgeries overseas vary greatly in their outcomes and their standards for a success. Thailand is the current “sex change capital of the world,” although the results, again, are variable. The surgeons are unregulated, and are not under the threat of litigation as we are here in the United States.
The cost structure is also very different, allowing for relatively cheap surgeries by US standards—as little as $5,000 for vaginoplasty and $2,000 for breast augmentation. As variable as the results are, and as important as the message “do it right and do it once” goes, this low-cost alternative is important globally, because it allows persons who might otherwise go without surgery to have that option always. So, it is good there is competition.
I do feel our product is worth the cost differential, and is also a relative bargain at $18,500. There is also the issue of the long flight over, and the long time needed during the recovery process. There are some important technical differences with US surgeons, but that is another long story.
Where do you find that the trans community has the most acceptance—within the straight community, or the GLB one? Neither, or both?
That is an interesting question, one that I’d not been asked before. Acceptance is found anywhere, I feel, so long as a person is open and educated about gender versus genitalia, and what the implications are of each. That is a principal reason why I have become so visible media-wise, trying to reach people in the relative comfort of their living rooms with stories about real people.
GLB people probably are more open to some of that media stuff, but I am constantly getting e-mailed by persons who, watching one show or another, suddenly get it. That is gratifying. I will say that sometimes, assuming a person who is GLB has got it, often, in fact, they do not. Persons we assume to be allies have little empathy for the issues we face, and leave us hanging, disappointed by our so-called GLB brethren.
What should the gay community know about the Ts among us? Does the T even belong with the rest of us?
I think the biggest thing is that, while overt discrimination against GLB persons seems so much more rare and unlikely these days, trans persons face huge discrimination in nearly every aspect of their lives, particularly when passing is an issue. Unfortunately, because a person stands out as being “different,” regardless of their abilities or what they have to say, they are discriminated against in a way few GLB people have known or experienced. That still happens, and it is a huge problem.
That is the very reason why noninclusion with the recent ENDA bill is so disappointing—that a person, so long as they aren’t trans, is protected against workplace discrimination. Yes, the T needs inclusion with the GLB, if only for lack of other allies. There are common issues.
One thing that still burns brighter than any other issue within the GLB community is marriage equality. What is important is that the trans phenomenon undoes any and all objections to marriage equality, no matter how the issue is argued. Once GLB leaders recognize the utility of having passable trans persons recognized in marriage, marriage equality for same-gendered persons will follow.
Of the GLBTQIA, the T (trans) and I (intersex) are often the most misunderstood. Also, they seem to be the most uncommon among our community. Is this the case, or am I missing something?
I feel the true incidence of trans and intersex individuals is approximately the same—between 1:2000 and 1:3000—much higher than previous estimates. Intersex represents diversity along the lines of genitalia formation, and trans is represented by diversity with respect to gender.
One of the great myths, I feel, is the underrepresentation of the FTM community in incidence and awareness figures. I feel this incidence is reasonably close to 1:1 or at worst 2:3, compared to the MTF population, at least in the United States.
The reasons for many thinking “trans” is mainly about MTFs is the fact that drastically fewer MTFs “pass” as their preferred gender, integrating less successfully back into society, and thus presenting at organized functions in greater numbers, etc. I think if you ask most trans persons, the ideal of transition is to do exactly that—blend back in, and go forward with life.
Then again, I am one to speak, having blended back in, but coming out, and being about as visible as one can be.
Anyway, my point is that FTMs are in larger number than society perceives. If it were easier admitting a trans history, more transmen would be out about their pasts, and the recognition might be better. That is beginning to happen.
The interesting thing about society is that perceptions about gender roles can influence the incidence of persons coming out in their respective gender. For example, in parts of Eastern Europe and Japan, the ratio of FTM:MTF is as high as 5:1, a figure that most in the United States find shocking, but are unaware of.
It seems that a trans person’s prerogative is to pass in straight culture. Yet a gay person’s prerogative is not to pass, but to stand apart from it. One of the largest points of argument is the inclusion or exclusion of the T in GLBT. Is it fair to ask a community to support members who ideally want to be apart from it? Granted, this ignores gay-identified trans individuals, but doesn’t this seem a bit selfish?
This is an interesting question that gets at the heart of what it is to be trans.
I feel fully female, and don’t tap my trans history, except when asked. Then again, there are those “who know,” because of my prominence, and so, I face it on a small scale every day. Trinidad is very accepting of all persons, and I have become somewhat of a hero to many here locally, whether people treat me fully as any other woman or not. I blend into society, but I stand up and out, because there are issues to discuss and defend. If there weren’t issues, I’d disappear, and that might be nicer, actually.
Again, the qualities that are unique to the trans population can be utilized in the arguments for marriage equality. That needs recognition from within the GLB leadership, and heretofore, I feel, has not. Similarly, there are issues that trans persons face that are daunting, and the GLB community needs to recognize those, and stand behind their T brethren perhaps more fully.
Discrimination is subtler today than it has ever been, and it makes it even more important that we stand up when affronted, and accumulate persons who are there to watch our backs. The community has changed. Much of that has to do with the emergence of friends and allies, both GLB and straight, who now partner with us, are out with us, and look out for us.