Dr. B and the Women

Its almost summer, but it looks a little bit like Christmas at Dr. Marci Bowerss house. Who has time to take down a stray strand of silver tinsel when youre one of the busiest genital reassignment surgeons in the world, responsible for constructing more vaginas every year in this country than any other doctor? That can mean as many as two per day, three or four days a week, out of a tiny regional hospital in small-town Trinidad, Colo.: a virtual pussy factory smack in the middle of our heartland. Theres that old joke, not entirely undeserved, that doctors -- and surgeons in particular -- believe they do the work of God. But in the case of the 51-year-old Dr. Bowers, one might forgive such grandiosity. When she comes home after a long day in the operating room, Bowers, a willowy, blonde, bombshell-nerd hybrid, sometimes says to her partner of six years, Carol, I changed a man into a woman, a woman into a man, and the dog into a cat today. What did you do? Carol Cometto, 48, loves telling that story, which she does, twice to me and a couple more times to others, punctuating each retelling with a husky smokers laugh. A barrel-chested, sun-flogged, old-school butch who used to work on the railroad and is missing a couple fingers from an unrelated accident, the dark- and curly-haired Cometto is immediately infinitely more accessible than her partner. Where Bowers is at first reserved and impenetrable, visibly sussing me out before deciding how much to offer, Cometto happily shares to the point where I start to wonder, Does Marci know shes telling me all this shit?I dont want to be like [Oprahs beau] Stedman, Cometto insists, as she guzzles a Coke at the kitchen table of the Morning After, the home she maintains and operates in Trinidad as a recovery facility for Bowerss surgical patients. These days theyre mostly male-to-female (MTF) transsexuals who have paid about $22,000 and patiently spent up to a year on the waiting list before making the trek to rural, off-the-grid Trinidad in order to take advantage of Bowerss considerable talents. (She does a small but growing number of female-to-male surgeries -- not phalloplasty, which is a still somewhat imperfect procedure Bowers doesnt care for, but a clitoral-release technique called a metoidioplasty -- but the vast majority of trans patients come to Bowers for her trademark one-stage MTF vaginoplasty.) And let me tell you -- since we cannot show you in these pages -- the vaginas she builds look good. Bowers is a maestro with the scalpel. They didnt really design a womans vulva with efficiency in mind -- or aesthetics for that matter, she tells me, chuckling, when asked to compare Mother Natures handiwork to her own. I get feedback all the time from natal women. They go, Wow, that looks better than mine. Thats better than the real thing! Bowers should know -- because shes seen a hell of a lot of them, even if she doesnt have one of her own. Natal vaginas, that is. Because before she started performing gender reassignment surgeries, Bowers was a conventional OB/GYN, fielding standard-issue lady health concerns like pregnancies, deliveries, C-sections, hysterectomies, ovarian cysts, UTIs, family planning, and so on. Only back then, Dr. Marci Bowers was Dr. Mark Bowers, a married man with three children and a thriving medical career in Seattle. My friends ask me, Did Marci do hers? And I say, Yeah, dumb fuck! Cometto cracks herself up, pouring more Coke and waiting for the caramel head to fizzle before taking a monster sip. A basket of fake grapes, a polar bear coffee mug, and well-thumbed issues of Elle, Redbook, and Marie Claire sit on the kitchen table beside her. Of course Marci didnt do her own surgery. Not that Cometto has always been so blas about changers, the term she uses for transpeople. When she first met Bowers, Cometto nursed a major crush and started flirting right off the bat, but had no inkling that Bowers had not been born female. It was only when a good friend suggested as much that Comettos suspicions were aroused. Bowers and Cometto occasionally played golf together, and it was during an afternoon on the links that Cometto admits to clumsily attempting to peer down Bowerss shirt every time she teed off -- to see if her breasts were real. (No verdict based on the boobs.) Later, that same friends father, who was on the hospital board and thus knew what Bowerss practice involved, showed Cometto a video on the Internet in which Bowers comes out as trans. Cometto says, I was like, This is fucked up. Im out. It just took me a long time to be with Marci, because I was so scared. Id never seen one, Cometto adds sheepishly, referring to a surgically constructed vagina. Cometto, a lifer lesbian who drives around her native Trinidad in a dusty Jeep Cherokee with a huge vaginatarian sticker on the back, was like wha -- what the fuck do I do? Wheres the switch on this bad boy? Its not something Bowers seems to like to talk about much. Thats just ancient history, she insists. Im not a transgender person. Im a woman, and I just have a regular life like anybody else. Which is a little like Brad Pitt insisting hes just a dad. But in the prodigious media coverage of her, much is made of Bowerss MTF status, which is frequently featured front and center. And she will, when pressed, admit that her personal life trajectory might help bring a little more empathy to her practice than that of earlier, non-trans practitioners of vaginoplasty. Most telling, it is her trans status that many of Bowerss patients claim is a deal sealer with regard to choosing a gender reassignment surgery (GRS) doctor. But its clear the instant you meet Bowers that she is first and foremost a surgeon, one who takes her practice seriously and is not satisfied with resting on her laurels. She even drives like a surgeon, rolling through stop signs and cutting a precise, though deliberately circuitous, route through Trinidads back roads in her red Infiniti sedan, almost as though shes being pursued. Only after surgeon on the Bowers hierarchy of identities is she a woman. Then, perhaps, parent, which is probably on par with being a partner to Cometto, followed by decent golfer, good cook, vegetarian, avid reader, and so on -- until maybe, finally, if you press her, a transgender person. Bowers grows perturbed when I inquire about the differences between the surgery she had 11 years ago and those she performs now, whether its difficult to be working her magic daily for others, when she cannot do the same for herself. Its unrelated, doesnt even cross my consciousness, she says. Sure, if I had my druthers, Id have the surgery I do now. Particularly from a visual standpoint. Functionally, they got it, though -- the second generation surgeons, she says of doctors like Pierre Brassard and Toby Meltzer, who used to do the surgery in two stages, while Bowers famously does hers in one. The thing is, there was a lot more scarring than we see now, and it doesnt look as good. But I have a partner whos happy with me the way I am. You know these documentaries? Cometto asks me, referring to the video of a pre-op Marci. Ill leave. I dont want to know about that. I dont know that person, because that person I wouldnt have looked twice at, and that person wouldnt have given two cents about me. But Marci -- Im in love with the soul of that person. So when I see the guy, it just really freaks me out. It was months before we were ever really intimate, Cometto adds, quieter now. I was just nervous. And it takes a lot longer for them to -- you know. But they do. Come, that is. In fact, more than 90% of Bowerss patients report being able to achieve orgasm postsurgery. Which keeps them coming and coming -- to Trinidad, for the form-plus-function that the good doctor is able to deliver (and has delivered more than 600 times, with only 20 patients returning for a second surgery to address minor complications or concerns). Sometimes surgeons reach a level of comfort where its very difficult to make fundamental changes to a procedure. They can be done, but theres always that learning curve, Bowers says. But I really did. Its 180 degrees different from what it was just five years ago. Note to the fellas who were born with penises and would like to keep them: You may want to cross your legs about now, because heres how Dr. Bowers lays down a vagina where a penis was merely hours before. First, the patient is asked to undergo multiple sessions of presurgery laser hair removal or electrolysis to clear follicles from the region (skin from both the penis and the scrotum will end up inside the neo-vagina, so for obvious reasons, you dont want hair growing there). Once in the operating room with the patient under general anesthesia, scrotal skin is harvested and the testicles are amputated and discarded with the rest of the hospitals biomedical waste. The urethra is catheterized and the penile shaft divided in two (think string cheese), with the erectile portions of it removed, again for obvious reasons. Then, retaining constant blood flow, the clitoris is created from the glans of the penis and a bit of skin from the shaft, and securely stitched into place. Bowers herself seems most incredulous about the next stage of the surgery, in which a pretty sizable cavity must be created where there wasnt one before. Essentially, the doctor makes room for the vaginal canal by boring a hole into the area between the anus and the neo-clitoris by cutting and cauterizing. Theres this potential space we open up -- its amazing we can do it. Its very tedious, but we do it day in and day out, so it works, she explains. And the skin that creates the lining of that new pocket? It comes from turning the penis inside out (yes, exactly like a sock)and then grafting it to the harvested scrotal skin, which meanwhile, at a separate work station, has been wrapped around a dildo-like stent and sewn together (with any remaining hair follicles removed). The whole graft -- penile and scrotal skin sewn around the stent -- is then placed inside the cavity to create the neo-vaginal canal, which in Bowerss surgeries generally ends up providing about six inches of depth for her patients (not to mention her patients future sexual partners) to enjoy. Before wrapping up the three- to four-hour procedure, a new urethra is created, the inner labia is sculpted and lined with urinary mucosa (to give it the pinkish, moist attributes of a natal vagina), and a protective hood is sculpted over the clitoris. The labia majora is closed up in a large but tidy V shape, which will be completely concealed when pubic hair grows back. Four days in the hospital plus a few more under Comettos tutelage at the Morning After, and patients are good to go. They are asked to refrain from heavy lifting and activity and instructed to dilate their vaginal canals with increasingly larger dilators over the next weeks and months. Sexual activity is specifically discouraged for at least six weeks (though three months is suggested), but some patients report experiencing what they believe is an orgasm from the dilation process. Remarkably, the vast majority of Bowerss patients do not experience much pain at any time during the process -- just a bit of persistent discomfort from the catheter and vaginal packing, both of which are removed about a week after surgery. Bowers has been performing her revolutionary vaginoplasties solo for six years, having taken over the practice of Dr. Stanley Biber, an early pioneer of sexual reassignment surgery who established his practice in Trinidad in the late 1960s, after his death. Trinidad, population 9,000, is a gritty old mining town along the Santa Fe Trail, halfway between Santa Fe and Denver on Interstate 25. Not a day goes by where I dont wish I was out of here, Bowers says of her adopted hometown -- she spends a good deal of time in Seattle, where her children live with their mother (whom Bowers still calls her spouse even though they are no longer intimate). I mean, you gotta buy your cosmetics at Wal-Mart. But Ive come to realize that LOral mascara is just as good as Chanel. In addition to the lure of the Wal-Mart Supercenter just south of town, Trinidad proudly boasts some pretty righteous New Mexican and Mexican cuisine, a quaint, authentic Western-storefronted downtown vaguely expectant of another showdown at the O.K. Corral, a few dozen churches -- and a down-home friendly atmosphere touted on the official Trinidad Chamber of Commerce website. But whats not mentioned on the towns promotional websites or in any of the myriad tourist brochures proffered at local businesses is what Trinidad -- as evidenced on Oprah, Tyra, CBS Sunday Morning, BBC, NPR, MSNBC, We TV, the Discovery Channel, and so on -- is best known for: being the sex change capital of the world. Well before Bowers arrived to work with Biber in early 2003, Trinidad had earned its unofficial official moniker. According to Wikipedia, as far back as the 60s the saying taking a trip to Trinidad was a euphemism for having an MTF sex-change operation. Bookended by two prominent red-rock peaks, palpably low-key Trinidad is nestled into a small southern Colorado valley that gets its name from the sleepy river that runs through it, the Purgatoire. From there its an easy symbolic leap to that other state of purgatory: a place of limbo between heaven and hell, torturous and unsettling, where youre stuck until somebody back in the real world can cobble together enough cash for your indulgences to spring you into heaven. While not all transpeople opt for surgical transition -- many simply cannot afford the luxury; some prefer solely hormonal transition; and still others are comfortable with no hormones or surgery at all -- a lot of transfolk who do want to alter their genitals will describe feeling stuck in between sexes. Hedwig and that angry inch. So many MTF patients figure its all about the vagina. Build it and they will come, Bowers riffs, laughing. But thats simply not true. Not only will they not come, but they wont even get it up for you. And thats one of the tragedies of transition, she continues, more soberly. There are a lot of people who get left behind. Because the fact is, the rules are different for women, and society judges very harshly if you dont meet a female standard, if youre not beautiful in some way. And some people who transition -- they were the star football player with shoulders you could eat lunch on. Then you transition over and you want to be, you know -- youre not going to be Twiggy. Each year, Bowerss practice pumps hundreds of thousands of dollars into Trinidads somewhat shaky economy and generates millions in revenues for Mount San Rafael Hospital, where she performs her surgeries. And yet, the hospital board recently presented her with new requirements that would have made most of her procedures so expensive that few patients would be able to afford them any longer, essentially pricing her out of town. It was apparently the multipart television documentary Sex Change Hospital that whipped one particularly intolerant member of the hospital administration into a bitter froth, which raised some warning flags for the hospitals board of directors, whom Bowers describes as good old boys who dont have any malice toward what I do and know its been going on here forever. But the boards already tepid and religion-tinged predisposition was buffeted by this very squeaky wheel, and then, according to Bowers, in addition to untenable price hikes, they put what I think are unhealthy restrictions on the media, basically charging them, to keep the sensationalism away. No other hospital in the state charges the media. Biber was no stranger to fights with the town about his practice either. Cometto, who grew up around the doctor and his family, explains, I ate at Dr. Bibers table more often than not. And this man fought, every day, to get where he was. I told Marci, You have to fight. Just because youre this big-shot surgeon, [doesnt mean you dont] have to fight. You cant let this man down and just pack up your bag and leave. In fact, Bowers has been considering two very tempting offers, to take her practice to either Seattle or San Francisco. But when some members of the Trinidad community got wind of the hospitals hostile maneuvering, Bowers recalls, People were like, Oh, shes gonna leave? Oh, wait, Maybe thats not a good idea. And then the towns ready to march with picks and shovels and burning torches like they did in Frankenstein. Its the history. Its the people. But youre also literally supporting a community. There would be a sucking sound as things left here -- it would really change the fabric of the community. And so ultimately, the board backed down and accepted Bowerss pricing proposal, just a slight increase akin to those issued every year to adjust for costs. For now, the rock star of the transgender surgery world has decided to stay in Trinidad. Listen, youre going to fight it no matter where you go. Somebody always pops up whos going to have an issue with what youre doing, Bowers says. Of course, theres a little resentment like, Why couldnt we be known as the mining capital of the West, have everyone from all over the world coming to look at our mining museum? Little towns struggle without a niche, but we have a niche. If Trinidad would really get it, theyd put in T-shirt shops, make it a curiosity. the sex change capital of the world! Theyd have a lingerie shop, tattoos, coffee cups, and souvenirs. Carol said we need blow-up dolls; blow em up and the dick pops out! At Bowerss office, which doubles as the Planned Parenthood outpost in town (a detailed poster by the phone on the wall reads managing a suspicious or offensive call), I meet Amy Chastity West, a painfully shy 23-year-old MTF whos traveled to Trinidad with her parents from rural upstate New York. Her GRS is scheduled for the next afternoon with Bowers. West, sultry, slim-hipped, heavily eyelined, and sporting beat-up combat boots, definitely does not fall into the camp Bowers has described as potential tragedies of transition. Bowers glides into the examination room dressed in a turquoise blouse, pink eyeglasses, and her requisite white doctors coat. She sits on a short stool and threads her long legs around one another, Wests chart resting on her thigh. Bowers is the consummate professional, with an impeccable bedside manner, asking all the right questions to ensure that West is physically and psychologically ready for surgery and that she and her folks know the attendant risks. West tells her visibly anxious parents to leave the room when Bowers asks to examine her genitals as part of the pre-surgical checkup. West says shed like me to stay in the room for the examination -- perhaps because Im trans or maybe because she figures itll all be gone tomorrow anyway. Bowers and her intern, Allison, handle Wests testicles and penis, assessing the raw materials theyll be working with the next day. Youve got a lot of hair. What are you, French? Or Italian? Bowers asks jocularly. Later that day at the Morning After, I meet 69-year-old Erikka Elisabeth deBornac, whos finishing her recovery from surgery the week before. Almost immediately she asks if I want to see her results. She invites me into her bedroom and proceeds to undress completely, lying on the bed and spreading her legs, one hand behind her head. Its a vagina all right. But there are the sizable pink V-shaped incisions, with yellowish-green and reddish-purple bruising spreading across her thighs and up her abdomen. There is a swollen, painful-looking, stitch-encircled clitoris with a dark red and still somewhat bloody inner labia and entrance to the vaginal canal. After pulling up her compression underwear and long skirt, deBornac opens the top dresser drawer and produces her three specially shaped dilators -- pink, powder blue, and aqua-green. DeBornac seems positively giddy about the new plumbing with which Dr. Bowers has equipped her. The first time Id seen a vagina was my own, in the hospital, she marvels. Ive been married twice, but I always had sex in the dark. Later that night theres a small gathering at the Morning After -- nothing fancy, just a barbecue thrown by Cometto for Bowers, some of her patients and staff, and a smattering of friends from Trinidad. MTVs in town too, following another patient: 24-year-old Elle Stice, whos going to be the subject of the show True Life: Im Changing My Gender. Stices mother had died unexpectedly just weeks before, and shes accompanied by her stepfather, Gino. Despite a pall of sadness, there is also relief and elation on both of their parts about the surgery. Bowers is solicitous of the decidedly attractive Stice, and in the kitchen she jokingly suggests she consider going into adult entertainment because her surgery turned out so beautifully. Im getting the Maserati of vaginas, Stice deadpans later, now I just have to learn how to use it." Stice is miked and the MTV producer totes her video camera from room to room, filming people talking and laughing at the party, Cometto guffawing as she pours ketchup on an open-faced veggie burger and hands it to somebody, Gino getting another scoop of Bower's legendary potato salad. One post-surgical MTF patient absconds to her room because she isn't out as trans to friends and family and doesn't want to risk being on camera or included in this story. Cometto fixes a plate and taps on her door to deliver it. "Can you say that again?" the producer asks somebody as she films around the table on the front porch. It was something about the quicksilver nature of gender, and the sun sinks behind a pink cloud. After dinner I ask Bowers if she thinks the media circus around her and her practice is good or bad for trannies? "Oh, totally, it's revolutionized the tolerance and acceptance," she answers without hesitation. "As they say in Hollywood, there's no such thing as bad publicity, and I think that's true of this. Each of these little programs has done a lot to normalize. I'm not sure it's ever going to be quite normalized in some people's minds, but at least there's some empathy for what we're all about." In the meantime, the tranny parade through Trinidad keeps rolling, as Bower's profile continues to rise. And for Cometto, all that "normalization" can't come soon enough: "It don't matter where we go -- New York, Atlanta, Costa Rica -- somebody knows Marci. It's scary, and I'll tell you why," she says dead serious. "I watched a movie the other night about these men, these haters who just want to beat you up. I don't know what I would do if someone did that to Marci, you know, like a plot to get rid of the [GRS] doctor? I would go to prison, because I would take the rest of my life to find that person, and I would kill him." T Cooper is a frequent contributor to Out and the author of Lipshitz Six, or Two Angry Blondes. Send a letter to the editor about this article.