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.

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.