Ever since Cher’s daughter Chastity Bono — now Chaz Bono — announced she was beginning the process of becoming a man – many have wondered what exactly a sex change involves.
In order to get that answer, FOXNews.com talked to Dr. Marci Bowers, an internationally renowned surgeon who performs more than 200 gender-related surgeries a year at her clinic in Trinidad, Colo.
“There’s no one way to transition,” Bowers told FOXNews.com. “But generally a patient receives some type of psychological counseling in the beginning. Once they have therapy, they will then undergo a combination of hormone treatments — usually in conjunction with living in their desired gender role full-time for a year.”
Bono, 40, reportedly began taking hormones and living as a man shortly after his birthday in March, which means he still has a long road filled with many decisions ahead of him.
The fact is – female-to-male transition is not cut and dry. There are many options out there, according to Bowers.
“The one procedure that female-to-males usually do is the chest procedure or mastectomy,” she said. “It’s a surgery where their breasts are removed or modified in a way that gives them a male contour.”
Bowers estimates that the vast majority — around 90 percent — of female-to-male patients opt to get the chest surgery.
“And then some of the other surgeries they may choose may be a hysterectomy, and that might be more along the lines of like 50-to-50,” Bowers said. “And then even less commonly, genital surgery of some form is done.”
One procedure is phalloplasty, which involves the creation of a “sizable but largely non-functional” phallus, Bowers said.
“Some people also choose to have testicles implanted. Some choose to remove a part of the vagina, called a vaginectomy and then close the opening. But we’re seeing some people retain those parts and even use them for sexual gratification.”
The bottom-line, Bowers said, is that it’s all about personal choice.
“Like anything, there’s diversity in choices and in how people choose to express their gender,” she said. “So again, this is a choice. Some people want the vagina gone… they want testicles and they want a penis.”
In addition to phalloplasty, there’s an alternative procedure called a metoidioplasty.
“That’s where the clitoris is released and it grows in response to testosterone,” she said. “In essence, it becomes a small penis.”
Pluses and Minuses of Surgery
“I think the difficulty is in some of the surgical aspects,” Bowers said. “Each surgery has its drawbacks – but the surgery from female to male just isn’t perfect.”
On the other hand, Bowers said, female-to-male candidates are more socially acceptable at an early stage because they blend into society at a much quicker pace.
“Testosterone is enormously powerful,” she said. “Patients get chest hair, they get facial hair, they get male pattern hair recession and even balding in some cases. So socially they fit in immediately as men. Their voice drops… sometimes their feet grow… and they’re very much men in a short amount of time – a shockingly short amount of time.”
One message Bowers wants to get out is that the sex-change process goes far beyond surgery.
“Sometimes what people get hung up on is that it’s all about the surgery. And the fact is it’s really all about their gender role and how society perceives them. In fact, it’s estimated that 80 percent of transgender persons never undergo surgery.”
At her practice in Colorado, Bowers said she only sees the “crème de la crème” of people who can actually afford to go under the knife.
“It’s very expensive surgery that is not generally covered by insurance,” she said. “Some surgeries are very simple and can cost as little as $4,000. But I’ve heard of people spending anywhere from $80,000 to $100,000 for all sorts of surgical procedures. It’s highly variable.”
Bowers said she doesn’t think there is such a thing as a perfect candidate for surgery.
“Who are we to judge who is a perfect candidate?” she said. "I think if you feel it in your heart and soul and you feel it’s something you have to do…. then you have to do it.”
The Story of Dr. Marci Bowers
Bowers is not only a leading expert in the field of genital reassignment surgery -- or gender-confirming surgery, as she likes to call it -- but she was also a patient at one time.
“I had a very typical story,” she said. “I felt differently from a very early age and I largely hid things from my parents. I grew up in a small southern Wisconsin town in a very, very traditional family. My parents weren’t really aware until I was literally on the doorstep of transitioning.”
That was in 1996, when Dr. Mark Bowers was an accomplished obstetrician-gynecologist with a career spanning 20 years. He had been married for 11 years — a union that produced three children.
“Well, it was a bumpy road working through those details because it’s just a very awkward, inherently embarrassing disclosure to make,” she said. “It certainly took a lot of — I guess I’d call it careful negotiation.”
To this day, Bowers is still legally married and spends as much time as possible with her two daughters and son, who live in Seattle, Wash.
“We just have an interesting family and its sort of what I’d call it a 21st century family because it certainly is non-traditional,” she said. “But I think the lesson for any family is if you respect each other, find a way to love each other, you can really transcend things like this.”
Her Life in “The Sex Change Capital of the World”
After an extensive career in Washington, Bowers moved to Trinidad, Colo. — known as the sex change capital of the world — in 2003 to work side-by-side with renowned sexual reassignment surgeon Dr. Stanley Biber. Over a 30-year career, Biber, who died in 2006, performed more than 5,000 sex-change operations.
“I had actually been down there to visit him in 2000 because there were some people in Seattle who had worked for him,” Bowers said. “And they just said they had this amazing practice and I got the chance to meet with him and he said “we’re really looking for a surgeon and we’re hoping to recruit someone or have someone come,” and his idea was that I’d do obstetrics and then gradually take over the surgery division.”
Six months after she started working with Biber, Bowers did her first solo surgery, and she hasn’t looked back since. During her time in Trinidad, Bowers has performed more than 550 male-to-female surgeries and does an average of 220 gender-related surgeries every year.
“It just keeps unfolding and it’s been interesting the entire way,” she said. “I certainly don’t have any complaints. I’ve had an interesting life and it keeps getting more interesting, it seems.”
Although Bowers’ main focus is on gender reassignment surgeries, she is also working on several other projects to improve the health of people from all corners of the globe.
“We are the first center in North America actually that’s going be doing female genital mutilation reversal. We’ve now done two sets of patients from Africa — so that’s kind of the latest and greatest thing we’re up to,” she said.