The current state of transgender reproductive care in the United States

[Transcript edited for clarity]

Marci Bowers, MD:

I'm Marci Bowers, MD, and I am an obstetrician gynecologist practicing gynecologic surgery and reconstructive surgery. I practice in the Bay area of San Francisco at a community hospital called Mills Peninsula. But I also have a joint faculty appointment at Mount Sinai in New York and also at Denver Health.

Contemporary OB/GYN:

Can you give a recap of your presentation at the 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting?

Bowers:

Well, I think even though this is a group of hospital-based obstetric specialists, the theme of the conference was diversity, equity, and inclusion. And so care for trans and gender diverse people fit under that umbrella. It was surprising [to find out that] 3 quarters of the audience have taken care of someone who is trans or nonbinary during a pregnancy, which was really shocking, considering I trained 36 years ago, and, you know, we didn't even know we barely knew the word gay and lesbian, let alone trans and gender diverse or gender fluid. So, obviously, there has been a lot more recognition that gender is diverse. And the notion that there are just 2 genders is really an outdated concept. And it's really not even supported by biology. So, my point today during the topic was mainly to raise people's awareness of the fact that that 1 in 50 persons are born intersex. In fact, that's 2% of the population, a fact that very few people are aware of, and this has served to enforce this idea of a gender binary, because they think that genitalia are biologically evident. And so therefore, that corresponds with gender. And it's simply not true. So in other words, there can be babies born with a penis and have 2 X chromosomes, there's babies that are born with vulvas and you can have Y chromosomes, and everything in between. So this is a concept I think we need to evolve. We are really very primitive, if you actually look evolutionarily. I mean, it wasn't long ago that we were stoning these people to death or, putting them on a cross, or putting them in a circus. And so my point is that, you know, where are we? Where are we today? You know, last century, we were also doing nonconsensual surgery on people that were were that had gender diverse genitals. So, we need to evolve. I mean, this is what progress is. And if we look at things ethically, we have to go back to the fact that people do have rights. Human rights and ethics would suggest that people make their own decisions about surgery that includes intersex surgery, that includes trans surgery, that includes FGM, another another topic that I work actively in, why are we genitally, altering children at an early age? So, this has to come as a decision from within. So this is about true, consensual surgery.

Contemporary OB/GYN:

Can you discuss the current state of transgender care in this political climate?

Bowers:

Well, it's very disturbing that we're seeing legislators decide that they know more about medicine than doctors and patients and families. And that is a real troubling sign. We have to turn that train around. That just simply cannot be the future. I think federal judges are increasingly understanding even even conservative judges. But what it also takes is education of people. People aren't inherently mean, we're not trying to deprive people of health care, but providers need to give them the information so that they can realize that their choices that they're making are wrong. And we have to turn those decisions back to doctors and evidence-based treatment protocols. It's fascinating that I was in training in the CIA started in 1986, amazingly enough, and I never thought that during my career that obstetrician gynecologists would be turned into pregnancy police, for example. And I was just stunned by the talk that preceded mine that now states or states are using just the medical record that a doctor is objectively providing to to turn against women making reproductive choices. I mean that is just really disappointing. But I'm not I won't take up the abortion debate, that's for other people to decide. But we do share this disturbing trend where we're legislators are thinking they know more than than doctors or patients and their families. So you know, weconsider ourselves an evolved country, but sometimes really not so and I think we need to get back to that, and be the leader in the world that we can be.