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Q&A with Dr. Marci Bowers, sex reassignment surgeon and gynecologist

Dr. Marci Bowers is a renowned gynecologist and surgeon who is known for performing sex reassignment surgeries. As the first transgender woman in history to perform surgery, Bowers was trained under the late Dr. Stanley Biber, who performed over 4,000 sex reassignment surgeries, and even developed a new way to perform the procedure. This correspondence occurred over email, and was edited for grammatical mistakes only.

Q: How important is your trans identity to your practice? Your practice to your identity?
A: I don’t honestly identify as transgender. I consider the term ‘transgender’ to be a stigmatizing label and an unfair label. Would it be fair to call anyone who has been divorced a ‘divorcee’ as a prefix anytime they are introduced? My identity is as a woman—society sees me as a woman and I live each day as a woman. Society doesn’t see ‘transgender.’ Possibly, in a perfect world, it might be OK to wear each label that is a part of our history but, for me at least, I have many identities that take far more import in my day-to-day life than ‘transgender.’ That said, I work with the transgender community every day. And my history is about as open and ‘out there’ as anyone. And I do take ownership of the term but in its significance as a descriptive term — along the lines of ‘cook’ or ‘gardener’ or ‘tennis player.’
Q: What was a pivotal moment for you when you were working with Dr. Biber?
A: Many surgeons over many years had come to Trinidad to learn the work of Dr. Biber. Dr. Biber famously rejected each of these predecessors as lacking either the ‘hands, the courage or the heart.” He said of me that I had been the first one with all three of those qualities. So on the day in late June of 2003, after two days of howling wind blowing through Trinidad (the Trinidad winds are notorious)–he turned to me and handed me the knife–just as the winds had ceased.  Several in the OR gasped. No one moved. The air was still. I took the knife and haven’t let it down since that day. It was a monumental moment in history.
Q: When he said that you had all three–courage, heart, and hands–how did you feel?
A: I felt the weight of responsibility placed upon my shoulders. I had no idea of how heavy it was but knew from my many years of working in a difficult field (obstetrics and gynecology) that I was up for the challenge. His words were very validating though. I do have those qualities and it does matter that it was me.
Q: Can you explain some of the thoughts you had when you were trying to refine Dr. Biber’s procedure for sex reassignment? What motivated you?
A: I worked through each portion carefully but somewhat haphazardly. There was no one to learn from. I reached out to other colleagues. One, my former personal surgeon, never returned multiple phone calls. Things advanced most once I was able to study with Pierre Brassard, a plastic surgeon working in Montreal. He allowed me to jump Dr. Biber’s technique to something more contemporary. Thereafter, I put my own spin on things and gradually it got better. Lots of things motivated me to get better and better: for one, I held a deep aesthetic sense. I like symmetry and I like things to come together neatly. Secondly, I was and am still the only practicing OGYN worldwide who does these procedures. So I held the advantage of visualizing the result I was after. Third, I hate that scars can be stigmatizing and so much of the recent advances have come in hiding scars of any kind, whether in the primary surgeries we do or in the many re-do’s we are presented with.
Q: How is your technique different from Dr. Biber’s?
A: So different. For one, in Dr. Biber’s day, there was less focus on female sexuality. That women had orgasms was irrelevant to the sexual experience. Feminism and the sexual revolution changed our thinking on that and more modern GRS techniques followed with sensation as a prime concern in addition to the vagina serving solely as a passive receptacle for male pleasure. The aesthetic concerns have come increasingly with what we try to do. Plastic surgeons do amazing work but the stigmatization of scars were not necessarily part of their mindset. I really look to avoid or limit scars whenever possible.
Q: Who were some of your biggest mentors? What made them so significant?
A: See above but Dr. Biber and Dr. Brassard for sure. They both did beautiful, consistent work and raised the bar high. I definitely stand upon their shoulders.
Q: How hard was it for you to open your practice? How has the medical community responded?
A: In Trinidad, it was hard because there was skepticism, Some even did not know my Trans past, so working as a woman succeeding a legacy like Dr. Biber in a small town was not easy. I had to prove myself for a long time in town. Luckily, I was immediately accepted by members of the trans community, despite my relative inexperience. They came in droves and this allowed Trinidad to thrive as my proving ground. Quickly this allowed me to surge past Dr. Biber in quantity and quality and this generated some quiet jealousy on the part of many. On top of proving myself, I had the additional burden of overcoming conservative and religious objections. Most got to know me in town though and most came to like me. I was good and they came to know that. In California, there was far greater acceptance and support, partly because I was already known but also because northern California is a very forward-thinking place.  We look for progress. There is so much innovation here. Although I did have one hospital (Sequoia Hospital in Redwood City) who turned me down for privileges because they viewed my credentials as inadequate despite more than 1000 surgeries behind me.
Q: How have patients supported you? Not supported you?
A: Patients have been great. Even when I have not been up to par, they have been tolerant of my shortcomings and optimistic and patient while answers were sought in the reasonably rare instance of complications.
Q:What makes you joyful?
A: I am most happy when I am able to laugh. I always look for humor. I also look for the best side of people rather than their flaws—this has been a gradual evolution as my own sense of security has grown. I also value diversity as the most important of all societal attributes. I find that I learn the most from people who are most different than I am. I look for that. 
Q: How has the transgender movement changed in the last 10 years? How do you feel about these changes?
A: There is so much support from family and friends. People also now come with lovers or partners. So too, gender expression and a broader notion of gender identity has opened my eyes to the fact that there is really no other measure in science or nature where there are only two choices. Gender is clearly fluid and broader than male and female.
Q: As a mentor of many doctors, what advice do you always give them?
A: Surgically, I remind them that the urethra is our friend. Medically, I try to impart the fact that all of us begin with female anatomy (as embryos and small fetuses). Genitalia grows from the same tissues. So the notion that men are from Mars and women are from Venus is complete fallacy—more like from Milwaukee and Chicago. This understanding of embryology is also key to understanding how to reverse a procedure or go from one sex to the other—nature shows us how it should be done.
Q: For any readers considering this procedure, what do you recommend?
A: Choose wisely. This surgery is not like having a gallbladder out. It is as much art as it is science and this makes choice of surgeon paramount in expecting a good outcome. ‘Do it right and do it once’ is our motto and all surgeons should be loosely held to that standard.
Q: How many surgeries do you perform annually? I read that you perform around 200 a year. Is that correct?
A: Yes, 150 or so MTF primary surgeries plus 30 or so FTM surgeries plus 30-50 FGM surgeries and then many minor outpatient or revisions cases. So something north of 300 seems right.
Q: What made you switch from OB-GYN to reconstructive and sex-reassignment surgeries? Or am I incorrect? I saw you do both gynecology and surgery.
A: I still do both but my practice narrowed to doing mainly trans and FGM surgeries*. I switched in response to need. 
Q: I read that you do not want to retire. Why?
A: I want to retire but fear the standards I have set may not be met for awhile and I fear there may not be enough surgeons necessary to meet the demand. Plus, retirement means checking off the earth, means you are just a consumer, not a contributor. Work keeps you young.
*This answer has been modified as of January 2017 by request of Dr. Bowers.