By Isabella Ventura, RN, MSN, AGPCNP-BC, and Katie Willingham
The International Workshop on HIV and Transgender People strives to reduce gaps in knowledge related to people of transgender experience by encouraging information exchange among professionals across disciplines, from medicine to community work and beyond, to improve quality of life for transgender people living with or vulnerable to acquiring HIV. The Well Project medical editor Isabella Ventura, RN, MSN, AGPCNP-BC, and community advisory board member Katie Willingham, attended the virtual gathering in December 2021 and reported on compelling takeaways.
Katie Willingham
I was so surprised and excited to see that Marci Bowers, MD, of the World Professional Association for Transgender Health (WPATH) and the Trevor Project, was presenting at the International Workshop on HIV and Transgender People. I've known about Bowers for a long time now. She's been performing gender-affirming surgeries for over 30 years and has done thousands of surgeries. She's considered one of the best in the world, and certainly the United States. She is who I wish could perform my surgeries if I ever get them done.
Hearing Bowers speak about gender-affirming surgeries was fascinating. She explained WPATH's Standards of Care and the requirements one must complete before being approved for such surgeries, including psychological evaluation and one year of taking hormones and living in one's desired gender. In many states, a client must be 18 years of age to be considered for surgery.
She then talked about the various surgeries one can have – like facial feminization, which could include:
- Rhinoplasty (nose reshaping)
- Forehead contouring
- Jaw restructuring
- Cheek and chin augmentation
- Tracheal shaving (to reduce the Adam's apple)
- Fat injection
- Dental feminization
She also covered body modifications like breast augmentation and, of course, gender reassignment surgery. She walked us through the entire process of a vaginoplasty (plastic surgery to create a vagina) procedure, and it was amazing. The overall results showed that the constructed vagina was capable of orgasm in 90 percent of patients, produced lubrication, and could reach depths of 15-20 cm, thus forming a fully functional vagina. Possible complications of a vaginoplasty could include wound separation, bleeding, poor cosmetic results, infection, urinary difficulties, and others – but Bowers reported that the likelihood of such complications was minimal.
Bowers also talked about affirmative procedures for men of transgender experience, which was riveting as well. However, results from a phalloplasty (formation of a penis) was generally not as satisfactory. The procedure is extremely expensive, leaves a large scar from skin harvesting, has a high complication rate, can affect sexual satisfaction – and more procedures are necessary.
Bowers learned her skills from Stanley Biber, MD – a man who had performed more gender-affirming surgeries than anyone in the world, so much so that the small Colorado city where he worked was once considered to be the gender reassignment capital of the world. She spoke fondly about her mentor; I could hear it in her voice. Biber died in 2006.
I learned so much from Bowers about the process and everything one can expect from gender reassignment surgery. I also learned that the sexes are more alike than we realize. As Bowers said in her presentation: "We all come from the same primordial soup."
**
Isabella Ventura, RN, MSN, AGPCNP-BC
In the same session, D'hana Perry of the queer and trans health care service Folx Health, Inc., discussed community perspectives in providing gender-affirming care. Perry encouraged gender-affirming surgery sites to:
- Spend more time with trans and gender-diverse (TGD) clients providing education on treatment and care around these surgical procedures, including risks and benefits and care planning
- Deliver trauma-informed care
- Provide community resources and understand local TGD communities' needs, which could include housing, employment, access to health insurance, and insurance coverage of surgeries and other transition-related treatment.
More from The Well Project on the International Workshop on HIV and Transgender People 2021
- A Research Conference All About Transgender Communities by Katie Willingham on A Girl Like Me
- Parenting Intentions of Trans and Gender-Diverse Young People: Recaps from the International Workshop on HIV and Transgender People by Katie Willingham, with additional reporting by Isabella Ventura, RN, MSN, AGPCNP-BC
- Access to HIV and Sexual Health Care (and Who's Doing it Right): Recaps from the International Workshop on HIV and Transgender People by Isabella Ventura, RN, MSN, AGPCNP-BC
