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The transgender surgeon as artist

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

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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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Health

UNAIDS to commemorate Zero Discrimination Day’s 10th anniversary

UN agency urges global action to protect human rights

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A UNAIDS anti-discrimination exhibit at Tocumen International Airport in Panama in 2018. (Washington Blade photo by Michael K. Lavers)

As the world marks the 10th anniversary of Zero Discrimination Day; UNAIDS is sounding the alarm on the increasing threats to human rights, calling for renewed efforts to protect the rights of all individuals as a fundamental step towards ensuring health for everyone.

Established by UNAIDS a decade ago, Zero Discrimination Day aims to promote equality and fairness regardless of gender, age, sexuality, ethnicity or HIV status. The progress achieved over the past years is now in jeopardy, however, due to rising attacks on the rights of women, LGBTQ people and other marginalized communities.

UNAIDS Executive Director Winnie Byanyima emphasized the critical link between protecting human rights and safeguarding public health. 

“The attacks on rights are a threat to freedom and democracy and are harmful to health,” she said in a press release. “Stigma and discrimination obstruct HIV prevention, testing, treatment and care and hold back progress towards ending AIDS by 2030. It is only by protecting everyone’s rights that we can protect everyone’s health.”

Despite challenges, there has been notable progress. 

At the onset of the AIDS pandemic more than 40 years ago, two-thirds of countries criminalized consensual same-sex sexual relations. They are now decriminalized in two-thirds of countries. An additional 38 countries around the world have pledged to end HIV-related stigma and discrimination, contributing to positive changes that include 50 million more girls attending school compared to 2015.

To sustain and enhance these advancements; UNAIDS urges global support for women’s rights movements, LGBTQ rights, racial justice, economic justice, climate justice and peace initiatives. By standing with communities advocating for their rights, the U.N. aims to reinforce the collective effort towards a more inclusive and equitable world.

Zero Discrimination Day is observed on March 1.

Events and activities that will take place around the world throughout the month will serve as reminders of the essential lesson and call to action: Protecting everyone’s health is synonymous with protecting everyone’s rights.

“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals and secure a safer, fairer, kinder and happier world — for everyone,” said Byanyima.

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Health

New CDC report finds transgender women at higher risk for HIV

More than 1,600 people in seven cities surveyed

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The Centers for Disease Control and Prevention in Atlanta (Photo courtesy of the CDC)

The Centers for Disease Control and Prevention issued a new study report this week that revealed that restricted by employment and housing discrimination and lack of access to needed gender-affirming healthcare for transgender women increasing the risk of contracting HIV. 

Researchers reviewed data from a 2019-2020 survey, the National HIV Behavioral Surveillance Among Transgender Women, which found that the demographics of HIV/AIDS have been disproportionally high, especially among Black and Latina trans women, who had experienced employment and housing discrimination coupled with lack of access to gender-affirming healthcare.

The Jan. 25 Morbidity and Mortality Weekly Report was based on data studies of more than 1,600 trans women in seven major urban locales. Participants from Atlanta, Los Angeles, New Orleans, New York, Philadelphia, San Francisco and Seattle were chosen by referrals from people and community-based organizations who knew or were part of the local population of trans women.

The study’s researchers noted: “Employment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity and survival sex work. These issues are interconnected.”

The study stated that trans women’s inability to access quality healthcare, including gender-affirming treatment or access to PrEP, and can expose them to potential incarceration as many turn to “survival sex work” and violence, which increases the risk of contracting HIV. 

The study’s author’s pointed out: “When economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships. This analysis …demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment.”

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Health

A Whole New Perspective on Well-Being

The Mather’s team recognizes that everyone’s wellness journey is completely unique to their life experiences and influences.

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The Mather is incorporating biophilic design—a design approach to facilitate access to nature or things that replicate natural patterns.

It’s easy to spot the distinctive, elegant silhouette of The Mather, a Life Plan Community for those 62+ opening this spring in Tysons, Virginia. What is not apparent to the naked eye is The Mather’s unique wellness philosophy, which is literally built into the community. 

The Mather’s team recognizes that everyone’s wellness journey is completely unique to their life experiences and influences.

Nature is one of the important factors that contribute to well-being. So The Mather is incorporating biophilic design—a design approach to facilitate access to nature or things that replicate natural patterns. This can include interior spaces with sightlines to a garden, choosing natural wood and stone as interior materials, or incorporating fragrant flowers and plants indoors to spark memories and provide tactile opportunities such as gardening. 

Residents of The Mather will be able to select from plentiful amenities, programs, and other offerings to target their personal wellness goals and preferences.

“Providing biophilic design within interior settings connects residents to the natural world,” says Mary Leary, CEO and President of Mather, the organization behind The Mather. “Research shows that a connection to nature provides positive benefits to mental states and overall well-being. At The Mather, biophilic design is the intersection of buildings and programs with nature in an urban setting.”

“The Mather is attracting a diverse group of older adults,” says Mary. “As a result, we aim to incorporate wellness practices from around the world, including Wyda movement theory of the Celtic Druids, which helps people achieve harmony with nature and contentment through mindfulness.” This holistic regenerative approach is similar to Qi Gong and yoga, while born in a different part of the world. Mather Institute has a special focus on mindfulness to support older adults’ practice of present moment awareness, which can lead to increased overall well-being, compassion, and joy.

A very different example of a wellness offering at The Mather is the Gharieni Welnamis spa wave bed, which uses computer-controlled vibrational therapy and audio frequencies to train the brain to relax. “The bed increases mindfulness, concentration, and creativity—all of which support our mission of creating Ways to Age Well,SM” says Mary.

These and other personalized ways to wellness will ensure that residents of The Mather can choose from seemingly countless ways to focus on their well-being. In other words, the sky’s the limit!

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