Transcript: Dr. Marci Bowers on

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’re joined now by Dr. Marci Bowers. She is a surgeon and one of the nation’s leading experts on gender affirming health care. Also the president of the World Professional Association for Transgender Health, which sets global standards for care for doctors in the field. Thank you for being here. 

DR. MARCI BOWERS: Thank you, Margaret, for having me.

MARGARET BRENNAN: We’ve- you’ve heard our guests talk about transgender issues in the political sense. We’ve now seen 21 different states pass laws restricting access. And so I want to understand a little bit more about what that access actually looks like. You know, the Governor of Utah was here and said there’s an explosion in his state of interest. Are you seeing that as a doctor?

DR. BOWERS: Yes, there. I mean, there has been an increase in demand for services. But keep in mind, trans identities have been with us since the antiquities, I mean, the time of the Bible and in literature and art history. I mean, there’s examples of people throughout. So experts feel that the incidence has actually never changed. And- but what we are seeing is more people feeling comfortable coming out. And so that explains the rise.

MARGARET BRENNAN: So there’s a spectrum here, though, from identity all the way to surgery. So how common is it with surgery for someone under the age of 18, to be able to access it.

DR. BOWERS: Surgery really is not done under the age of 18, except in severe cases, usually top surgery for trans masculine persons. And even that is rare, I think the estimates are something like 57 surgeries under the age of 18 were done for trans individuals. So the majority of people though, that are- that do identify as TGD or transgender diverse, don’t access even medicine or surgery. It’s just a feeling of maleness and femaleness that- that differs from their birth assigned gender, and gender identity being diverse has lots of inputs, not just hormones, not just chromosomes, not assigned gender, but- but a variety of inputs. And that reflects the numbers, but they are, they’re low, and they’ll always be low. The current estimates are about 0.6% of the population, which is about 1.6 million people might be as high as two or 3%. But it’ll never be much more than that. The majority of people still identify and are very comfortable with their binary assignments. And- but this is a vulnerable population that deserves health care.

MARGARET BRENNAN: So deserves health care, there are other treatments as well, hormone therapies, and the like. A lot of these laws that are recently becoming or taking hold are aimed at this young segment of the population. How much research is there into the effects of puberty blockers and hormone treatments of people in this age group?

DR. BOWERS: Right, well, we have decades of experience with trans treatment overall. And- and that shows unequivocally that treatment is beneficial. But in this age group, really we’ve only been treating with hormone blockers, which is the point of real controversy that- that people are after, since the late 2000s. But in that time, there has been research, especially from groups in, in the Netherlands, but increasingly here as well and experienced with this in this the results are similar, we’re seeing certainly very high levels of satisfaction, improved self esteem, reduce suicidality. So- so they seem similar to what we’ve- we’ve already witnessed in adult populations. But the controversy is that I think people feel like this number is increasing, and it’s going to like, envelop their children and- and spread like a contagion, which is just really a false narrative.

MARGARET BRENNAN: You know, there has been controversy regarding your particular group, which set some of these parameters, because they removed age guidelines from the surgery recommendations. Why did you take the age guidelines out?

DR. BOWERS: Well, the point of that is that, first of all, the- what was leaked apparently, was the- the draft guidelines, which we were going to consider younger age groupings. But- But the important point is that care is individualized. And so age isn’t really the issue. Generally, it’s adulthood and- except in severe cases. And, you know, again, a draft guideline means it gets input from around the world, with available science that provides input and consensus, so this is what the WPATH standards of care are all about. They’re consensus and science based guidelines. And- and I want to add, though, that- you know, some people say the science is settled, I never say the science is settled. I really feel like science is always evolving. Medicine is always looking for new input and new data. But what we see is- is promising. And again, this very small subset of the population is- is worthy of that care, and it seems to be beneficial.

MARGARET BRENNAN: So one of the things that we heard on this program from the governor of Utah was that he felt that some of the organizations like even the American Academy of Pediatrics, were too political on this issue. What science are you looking at where you think the politics aren’t interfering?

DR. BOWERS: Well, I mean, you know, what- what the critics are looking for is what they call level I evidence. Now, level I evidence would require a systematic review of all randomized controlled studies in this area, and if you look anywhere else in medicine, about half of what we now accept as routine treatment, in- in any field, is not guided by level I evidence. Level I- let’s take for example, cancer treatment or cleft palate surgery, diabetes care, none of those have Level I evidence, because to do so, you would have to induce- introduce a placebo. In other words, a non-treatment of that group. But can you imagine offering someone who has cancer non-treatment? 

MARGARET BRENNAN: You’re saying–

[CROSSTALK]

DR. BOWERS: It would be unethical–

MARGARET BRENNAN: There’s a different benchmark, you’re saying, is being applied here. Doctor, thank you for your explanations. I appreciate it. We’ll be right back.