The following is a transcript of an interview with Dr. Marci Bowers, president of the World Professional Association for Transgender Health, that aired on “Face the Nation” on July 23, 2023.
MARGARET BRENNAN: We have the pleasure of being joined by Dr. Marci Bowers, a renowned surgeon and leading authority on gender-affirming healthcare. She also serves as the president of the World Professional Association for Transgender Health, an organization that establishes global standards for doctors in this field. Thank you for being here, Dr. Bowers.
DR. MARCI BOWERS: It’s my pleasure, Margaret. Thank you for having me.
MARGARET BRENNAN: During our discussion, our guests touched upon the issue of transgender rights in a political context. We have witnessed the passing of restrictive laws in 21 different states. Let’s delve deeper into what this restricted access actually entails. The Governor of Utah mentioned an explosion of interest in his state. As a doctor, have you observed a similar trend?
DR. BOWERS: Yes, there has indeed been an increase in demand for services. However, it is crucial to recognize that transgender identities have existed throughout history, even dating back to biblical times and documented in literature and art. Experts believe that the incidence of transgender individuals has not actually changed. What has changed is that more people now feel comfortable coming out, which explains the rise in numbers.
MARGARET BRENNAN: So there is a spectrum from gender identity to surgical procedures. How common is it for individuals under 18 to undergo surgery?
DR. BOWERS: Surgery is rarely performed on individuals under 18, with the exception of severe cases, primarily involving top surgery for trans masculine individuals. Even then, the number of surgeries conducted for transgender individuals under 18 is low. It is important to note that the majority of transgender diverse individuals neither seek medical interventions nor undergo surgery. Gender identity encompasses more than just hormones and chromosomes; it is influenced by various factors. This is reflected in the low numbers, which will likely remain so. Current estimates suggest that approximately 0.6% to 3% of the population identifies as transgender, amounting to around 1.6 million people. However, the majority of individuals are comfortable with their assigned gender, underscoring the importance of providing healthcare to this vulnerable population.
MARGARET BRENNAN: Apart from surgery, there are other treatment options such as hormone therapies. Many of the recent laws focus on the young population. How much research has been conducted on the effects of puberty blockers and hormone treatments for this age group?
DR. BOWERS: We have decades of experience in providing transgender treatment, which has unequivocally demonstrated its benefits. Regarding the specific age group you mentioned, we have only been utilizing hormone blockers since the late 2000s, which has sparked controversy. However, research, particularly from groups in the Netherlands and increasingly in the United States, has yielded similar outcomes. These include high levels of satisfaction, improved self-esteem, and a reduction in suicidality. The results align with what we have observed in adult populations. The narrative that suggests these treatments will spread like a contagion and engulf children is simply false.
MARGARET BRENNAN: Your organization, which sets guidelines for transgender healthcare, has faced controversy for removing age guidelines from surgery recommendations. Could you explain the reasoning behind this decision?
DR. BOWERS: It’s important to clarify that the leaked draft guidelines, which reportedly omitted age considerations, were not final. The purpose of our guidelines is to individualize care, with adulthood generally being the threshold except in severe cases. The WPATH standards of care are based on consensus and scientific evidence. It is worth noting that science and medicine are constantly evolving, and we are continually seeking new data and insights. However, the consensus is clear that this small subset of the population deserves and benefits from healthcare.
MARGARET BRENNAN: Some critics suggest that organizations like the American Academy of Pediatrics have become too political in their stance on transgender issues. Which scientific evidence do you rely on, and how do you respond to these claims?
DR. BOWERS: Critics often demand level I evidence, which requires a systematic review of all randomized controlled studies in a particular area. It is important to recognize that in medicine, about half of the treatments considered routine lack level I evidence. For instance, cancer treatment, cleft palate surgery, and diabetes care do not meet this standard because it would be unethical to withhold treatment from a control group. Therefore, while we strive for evidence-based practices, the absence of level I evidence does not undermine the effectiveness or importance of transgender healthcare.
MARGARET BRENNAN: Different benchmarks and considerations are applied in this field. Thank you, Dr. Bowers, for shedding light on these issues. We appreciate your insights. We’ll be right back.
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