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The transgender surgeon as artist

Calif.-based doctor to appear at Saturday’s Trans Pride event



Marci Bowers

Dr. Marci Bowers. (Photo courtesy of Bowers)

Dr. Marci Bowers is a rarity — she’s one of only two doctors who specializes in gender reassignment surgery who’s also transgender herself. The other (Dr. Christine McGinn) is a protégé of Bowers.

Bowers, who transitioned in the mid-1990s, is the only gynecologist who does gender reassignment surgery. She’ll be at Trans Pride on Saturday (10 a.m. to 5 p.m. at Metropolitan Community Church of Washington) to give the keynote address and took nearly an hour on the phone last week from her practice in San Mateo, Calif., to talk about her life, her work, the practicalities of trans surgical procedures and where trans issues are going. Bowers’ comments have been edited for length and clarity.

Washington Blade: How does a surgeon trained in one area move to another? What kind of training is involved?

Dr. Marci Bowers: Well sometimes people think when you’re a gynecologist all you do is look at female vulvas all day but it’s quite a surgical specialty. There’s extensive surgery experience required before learning the gender reassignment stuff. And after I’d been doing surgery in practice for 13 years or so, once you have a basic framework about handling tissue and bleeding, learning a new skill isn’t as hard as it might seem.

Blade: So if someone does, say, gall bladder surgeries and wants to start doing heart transplants, what’s the process like to move to a whole other part of the body?

Bowers: Traditionally you have to do a fellowship of some kind to do that. You have to go back, reapply as if you’re just out of medical school, do a residency all over again in the new field and go from there. They might give you a little credit on a few things, but you pretty much have to start back at the beginning. It was different for me because there’s no residency or fellowship for doing gender reassignment surgeries and I had a lot of experience surgically so doing an entire residency for me would have been ridiculous and superfluous. It’s really a mentoring process and I learned from Dr. (Stanley) Biber.

Dr. Marci Bowers

Dr. Marci Bowers says gender reassignment surgery isn’t as traumatic as many fear. Complications, she says, are extremely rare, patients are in the hospital an average of only three nights and most are off pain medication within 48 hours. (Photo courtesy of Bowers)

Blade: Does it give you added credibility to be doing these surgeries but also be transgender yourself?

Bowers: Well, I think that’s really for the consumer to decide that, but I think so. It’s sort of like the hair club for men. Not only am I president, I’m also a customer. Someone who understands what it’s like to be bald. Or like if you’re selling sports cars but you drive a minivan. I know what the consumer is looking for but I think being a gynecologist is the most important. Because it’s a very visual surgery and very artistically based. If someone has a gall bladder out and there are no complications, nobody cares what it looked like but this surgery has such an artistic component, the surgeon’s interpretation is so critical.

Blade: Many trans people say the world is too obsessed with who’s had what done surgically. Do you agree?

Bowers: That’s a crucial point and one that I keep bringing up proactively because obviously people still don’t understand the difference between gender and genitalia. Gender, we know, gets established at a very early age, like by age 4, 5 or 6 and it doesn’t really change very much. This is what transgender people have been saying for years, “This is how I felt since I was 5 years old.” So the question about surgery is really the dumbest question. … I was a woman since I transitioned. Nobody tells you whether you’re male or female. And it isn’t about the surgery, it’s what society says when they meet you at the grocery store or the food counter.

Blade: Trans acceptance seems to be making progress but still seems significantly behind gay and lesbian acceptance. Do you agree with that? Do you think it will continue to improve?

Bowers: Well, yes, I do think we are behind where the lesbian and gay community is in terms of acceptance. Some of that is just the sheer numbers, some of it is it’s still a little bit of a minority sort of thing and somehow it does sort of push people’s buttons in a different way. That’s too bad because if the gay and lesbian community saw the trans community as more supportive, we could make much more progress but sometimes the discrimination we get within the gay and lesbian community is worse than it is with the straight community. It’s like they just don’t get it and it’s very hurtful. There are common threads that run through all kinds of discrimination. We’re fighting the same forces that want to simplify the world and turn back the clock so everything is black and white and keep dragging at the heels of progress.

Blade: What kinds of procedures do you do? All “bottom” stuff or more?

Bowers: Kind of bottom plus. I do a procedure on the females, Chondrolaryngoplasty, which is a shaving of the thyroid cartilage. For some women, it’s a telltale sign in the throat and it was first done by Dr. Biber in the 1970s. It’s also a very delicate procedure that’s not taught anywhere, no ear, nose or throat doctors do it. It’s a very specialized thing.

Blade: And you do both male-to-female and female-to-male gender reassignment procedures?

Bowers: Yes.

Blade: Which are more common? How many do you average in a year?

Bowers: I do about 120 male-to-female surgeries a year. It’s about four-to-one female to male versus male to female.

Blade: Are most people able to orgasm after surgery?

Bowers: It’s different. For female to male, there’s really no impact. With a Metoidioplasty, guys can use it for penetration so that’s the good part there. If anything, it’s enhanced. Plus the fact that they’re testosterone-driven men, the libido tends to accelerate with transition. With male to female, it’s very complicated and about 30 percent of biologically born women aren’t able to orgasm at all anyway. Our patients for the most part are able to. It’s a very high percentile. About 90 percent but the thing you have to realize is that going from male to female for one thing, just hormonally, you tend to go to a lower level of interest just based on reduced testosterone levels. When you’re a woman, you wonder why we leave men in charge of so much. It’s so dominated by sexual thoughts. Sometimes I think, “Wow, what was I thinking about all those years? There’s so much more to do.” I say that sort of tongue in check. And the feelings are a big different. Maybe like going from the oboe to the banjo.

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Biden names White House National Monkeypox Response Coordinators

Governors of New York, Illinois, California declare ‘States of Emergency’



President Joe Biden meets with his national security team on July 1. (Official White House Photo)

The White House announced Tuesday that President Biden has named FEMA’s Robert Fenton as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis as the White House National Monkeypox Response Deputy Coordinator.

The president’s actions come as the governors of New York, Illinois and California have declared ‘States of Emergency’ as the case numbers of global cases of infection also caused World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus to declare the escalating global monkeypox outbreak a Public Health Emergency of International Concern.

The White House notes that Fenton and Daskalakis will lead the Administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.

Both men have extensive experience in infection disease outbreaks and response. The White House statement laid out their qualifications:

Fenton and Daskalakis combined have over four decades of experience in Federal emergency response and public health leadership, including overseeing the operations and implementation of key components of the Biden Administration’s response to the COVID-19 pandemic, and leading local and Federal public health emergency efforts such as infectious disease control and HIV prevention.

Both played critical roles in making COVID vaccines more accessible for underserved communities and closing the equity gap in adult vaccination rates, through the implementation and execution of FEMA mass vaccination sites in some of the country’s most underserved communities, and working with trusted members of local communities to build vaccine confidence.

Robert Fenton currently serves as Regional Administrator for FEMA Region 9 in the American West, with nearly 50 million people in his area of responsibility. One of the Nation’s most experienced and effective emergency management leaders, Robert Fenton has twice served as Acting Administrator of FEMA and led multiple challenging prevention, response and recovery operations throughout his long and distinguished career, including for natural disasters, disease outbreaks, and complex humanitarian operations. 

Demetre Daskalakis, a leading public health expert, is currently Director of the CDC Division of HIV Prevention. Widely known as a national expert on health issues affecting the LGBGQIA+ communities, his clinical practice has focused on providing care for the underserved LGBTQIA+ communities. He previously oversaw management of infectious diseases for the New York City Department of Health and Mental Hygiene, one of the largest departments in the nation – including in serving as incident commander for the City’s COVID-19 response.

Both the U.S. Secretary of Health and Human Services and the President’s chief medical advisor issued statements applauding Biden’s actions.

“We look forward to partnering with Bob Fenton and Demetre Dasklalakis as we work to end the monkeypox outbreak in America,” said HHS Secretary Xavier Becerra. “Bob’s experience in federal and regional response coordination, and Demetre’s vast knowledge of our public health systems’ strengths and limits will be instrumental as we work to stay ahead of the virus and advance a whole-of-government response.”

“Bob Fenton and Dr. Daskalakis are proven, effective leaders that will lead a whole of government effort to implement President Biden’s comprehensive monkeypox response strategy with the urgency that this outbreak warrants,” said Dr. Anthony Fauci, Chief Medical Advisor to the President. “From Bob’s work at FEMA leading COVID-19 mass vaccination efforts and getting vaccines to underserved communities to Demetre’s extensive experience and leadership on health equity and STD and HIV prevention, this team will allow the Biden Administration to further accelerate and strengthen its monkeypox response.”

The Centers for Disease Control and Prevention as of Monday reported that there were 5,811 confirmed cases of the monkeypox virus in the United States.

Statement from GLAAD President and CEO Sarah Kate Ellis:

“The White House appointments today reflect the seriousness of the monkeypox (MPV) outbreak and should be a call for all appropriate federal and state officials to urgently commit necessary resources to educate the public and counter MPV. We must get more vaccines to vulnerable people, especially sexually active gay and bi men, and accelerate all efforts to inform the public to track, test, treat and contain this virus as quickly as possible. Bob Fenton’s experience shows this can be done. Dr. Demetre Daskalakis is a longtime LGBTQ and HIV health advocate whose work will be critical to ensure the federal government responds to the needs of the medical community and the LGBTQ community in equitable ways.”

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With time, the Monkeypox vaccine provides good protection

In clinical trials, recipients who were HIV negative had an 83 percent immune response 28 days after one dose compared to 98 percent with two doses at 42 days.



A review of academic literature published in the Journal of Internet Medical Research last year determined, when it comes to information about health topics, social media is not the place to turn. (Unless you follow me, of course!) One study found 87 percent of health-related posts contain misinformation. More than 40 percent of posts about vaccines contain incorrect information.   

These findings are, perhaps, not surprising. But they are important to keep in mind as we doom-scroll for information about monkeypox. 

I’ve already seen a number of posts on Twitter claiming to have monkeypox breakthrough infections after vaccination. One author said they developed a monkeypox rash two weeks after vaccination. While this person’s experience was not likely a breakthrough case, the post brings up important questions. How much protection does a person have after being vaccinated and when? And, as some cities move to a one-dose regimen due to vaccine supply, what does research say about the number of doses needed to protect a person?

Monkeypox rashes and lesions can take up to three weeks to develop after exposure to the virus, which means it is possible the Twitter user mentioned above was exposed before vaccination or shortly after. The time following vaccination and when you are exposed to the virus matters in terms of the amount of protection you have. 

Simply put: vaccines do not offer protection immediately after being administered. Remember what we learned when getting our COVID-19 vaccines: no matter which vaccine you received, you were not fully protected until two weeks after the final dose. For the monkeypox vaccine the time to protection is actually longer. Clinical trials indicated it takes up to four weeks for patients to develop strong protection. In fact, two weeks after the first dose, the immune response was just 29 percent! Take extra care during this period to prevent spread.  

Now, what about one dose versus two? With limited monkeypox vaccine supply, cities and states should consider limiting doses to one per person to protect more people.

The U.S. Food and Drug Administration (FDA) approved a vaccine, Jynneos, developed by the U.S. government and Bavarian Nordic in 2019 to protect against both monkeypox and smallpox. The FDA recommended a two dose regimen, four weeks apart. This regimen outperformed an older smallpox vaccine (ACAM2000) for producing an immunological response. The Jynneos vaccine also has fewer side effects and is much safer.

Unfortunately, the Jynneos vaccine is in very short supply. Bavarian Nordic, the only manufacturer of the vaccine worldwide, says it can produce 30 million doses of Jynneos annually, meaning with a full regimen less than 15 million patients worldwide will have full protection. That’s why cities like Washington, D.C. and New York have chosen to move to a single-dose regimen. The United Kingdom and some countries in Europe have done the same.  

This approach is the right one. 

In clinical trials, recipients who were HIV negative had an 83 percent immune response 28 days after one dose compared to 98 percent with two doses at 42 days. HIV positive recipients had a 67 percent immune response 28 days after one dose. It was 96 percent 42 days after two doses. 

While that data indicates a two-dose regimen is best, with supplies limited, a one-dose regimen for most people is a reasonable approach. That strategy allows double the group of individuals to be immunized — even though there is slightly lower efficacy. A recent article in Science highlighted this important point. Jynneos’ CEO, an immunologist, said one dose of the vaccine conferred a “robust immune response.” 

There is one caveat, however. Based on the clinical trial data, we might need to stick with the original two-dose regimen for people who are immunocompromised or live with HIV (irrespective of immune status).

In the face of what appears to be a public health system in disarray, Americans need to be partners in fighting the virus’ spread. Get vaccinated when available. Individuals who are most at risk should sign up now to receive a vaccine. Second, understand it takes time after receiving the vaccine to develop immunity whether you are HIV positive or not. Understand monkeypox symptoms, the timing of symptoms and how to reduce your risk. And, of course, take care when it comes to social media. Spread truth.

Dr. N. Adam Brown is a practicing emergency medicine physician, founder of a healthcare strategy advisory group ABIG Health, and a professor of practice at the University of North Carolina’s Kenan-Flagler Business School. Previously he served as President of Emergency Medicine and Chief Impact Officer for a leading national medical group. Follow him on Twitter @ERDocBrown.

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World’s first heart transplant between HIV-positive donors performed at NYC hospital

The heart transplant recipient, a woman in her sixties, also received a new kidney during the surgery at a Bronx, New York, hospital.



World’s first heart transplant between HIV-Positive donor and recipient was successfully performed at Montefiore Health System in New York City. 

According to the Montefiore press release, the organ recipient, who suffered from advanced heart failure, went through a four-hour transplant surgery in early spring. She received a kidney transplant at the same time. After recovering at hospital for five weeks, she is seeing her transplant physicians at Montefiore for monitoring.

“Thanks to significant medical advances, people living with HIV are able to control the disease so well that they can now save the lives of other people living with this condition. This surgery is a milestone in the history of organ donation and offers new hope to people who once had nowhere to turn,” said Ulrich P. Jorde, MD, a cardiologist affiliated with Montefiore and also Professor of Medicine at Einstein.

In 2013, the HIV Organ Policy Equity Act was approved, allowing people living with HIV to donate their organs to other HIV-positive members. However, it took 10 years for heart transplants among the HIV-positive community to become a reality. 

According to the data from Montefiore, there are between 60,000 and 100,000 people who could benefit from a new heart across the United States. Studies point out that most HIV-positive people die from end-stage organ diseases or organ failures instead of infections. However, only about 3,800 transplants were performed in 2021.

“This was a complicated case and a true multidisciplinary effort by cardiology, surgery, nephrology, infectious disease, critical care and immunology,” said the patient’s cardiologist, Omar Saeed, also an Assistant Professor of Medicine at Einstein. 

“Making this option available to people living with HIV expands the pool of donors and means more people, with or without HIV, will have quicker access to a lifesaving organ. To say we are proud of what this means for our patients and the medical community at large, is an understatement,” Saeed continued.

HIV-positive patients have not been considered good candidates for organ transplants, due to their short life expectancies. While the federal act went into effect and the United Network for Organ Sharing (UNOS) doesn’t consider HIV a problem for organ transplants, the individual transplant center has the final say in the transplant decision. 

There are only 25 centers nationwide eligible to offer the procedure after it met surgical benchmarks and outcomes set by the Organ Procurement and Transplantation Network.

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