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In the Rockies, a Gender Crossroads

Elderly Surgeon Makes a Tiny Hospital Mecca for Sex Change

By Sue Anne Pressley
Washington Post Staff Writer

TRINIDAD, Colo.—It was early morning, before surgery, and Stanley Biber was reading the sports pages, as calm as if he were about to tackle a routine hip replacement. His patient waited drowsily on a stretcher, wondering one final time if he had made the right decision. For him, the next few hours would be profoundly life-altering. He was about to become the woman of his dreams, a legal "F."

In the transgender lexicon, he had taken "the road to Trinidad" -- and to Biber.

Biber, 75, is one of the world's leading gender-reassignment surgeons, and his renown over the past 30 years has given this former mining town of 8,500 the unlikeliest of nicknames. Much to the quiet dismay of its residents, it is known across the country as the "sex-change capital of the world."

This is where men -- and increasingly women -- who feel they were trapped in the wrong anatomy come, as they see it, to correct their bodies. For $10,000 and up, they give up their pasts and their secrets to Biber's matter-of-fact manner and surgical skills. He says he can do in 2 1/2 hours what it takes the handful of other surgeons in this specialty 7 or 8 hours to accomplish. And his work is so realistic, he boasts, that it has fooled at least one gynecologist, husband of a former patient.

Biber's select group of out-of-towners -- he also is general surgeon to the town -- contributes to the local economy and helps keep the private, 82-bed Mt. San Rafael Hospital afloat. Before surgery, patients stroll down the Old West-style streets of Trinidad, 200 miles south of Denver, and climb the steep hill behind the hospital to pray at the blue-and-white shrine to the Virgin Mary. In the hospital, they occupy rooms at the far end of the hall, where the staff treats them sympathetically. After 3,500 of these operations by Biber in the last three decades, no one bats an eye.

"To me, it's just plastic surgery. It's something they want done," said Tina Lankford, an operating room nurse. "These people have put a lot of thought into this. Insurance doesn't cover it; they had to work two or three jobs to afford it. It is not something that is a whim."

A visit to Trinidad, to Biber's office and to his operating room provides a look at a subject that many people probably will never understand. It raises questions about what constitutes a man, when a woman is a woman, whether it is possible to be something in-between or encompassing both. In a society that has already weathered a sexual revolution or two, this remains a taboo.

It is not, of course, as if anyone planned it to work out this way. Trinidad would prefer someday to be known as a tourist town. If Biber's parents years ago back in Iowa had had their choice, he would have become a rabbi.

Instead, a series of circumstances led to the present development. Biber, an Army surgeon in the Korean War, was later assigned to nearby Fort Carson, and decided he wanted to be a rancher as well as a doctor. His entry into transgender surgery came about in 1969 when a friend confided a secret.

"She was sitting right there at the desk, a female social worker. She brought all her kids in to me. In those days, I was doing all the harelips for Social Services. She said, 'Can you do my surgery?' In those days, I had no humility. You know how young surgeons are. 'I can do anything.' "

Biber consulted with a doctor at Johns Hopkins Medical Center in Baltimore, who had done the procedure, and proceeded for the first time to transform a man into a woman. The result, he said, was "horrible-looking but functional, it's just that the cosmetic technique was so bad."

Refinements quickly followed. "Once I got started, the grapevine was so great. There was nobody else to send them to."

At first, Biber was cautious, scheduling the unusual surgeries for after hours, with set crews. While not denying what he was doing, he did not advertise it either. Soon, he met with area ministers and other residents and explained his new specialty. After that, the questions, if not the raised eyebrows, ceased.

Now so many patients have journeyed to Trinidad that they have formed a loose information network, calling themselves, "Biber's girls."

"Originally, I probably accepted it as a surgical challenge," he said. "But after being exposed to these people for a considerable period of time, you develop a lot of empathy for them because they have a horrible life they have to lead.

"And once you begin to understand what they go through, and how they're hiding all the time, how they can't find a good job, how they can't pass a physical examination, how they're not accepted anywhere if they come out, you start thinking, 'I could offer them a service,' and it was a satisfactory service, and it seemed to me I was turning out good products and making good citizens out of them."

The first gender-reassignment patient to gain infamy was Christine Jorgensen in 1952. "Ex-GI Becomes Blonde Bombshell!" screamed the headlines after her surgery in Denmark. But attempts at the procedure had been made as early as the 1800s. The International Foundation for Gender Education estimates that one in 100,000 people experience some feelings of gender confusion and cite evidence throughout history, including Joan of Arc.

There is no medical explanation for this condition. But Biber believes research will prove the size of the hypothalamus, the part of the brain that regulates many body functions, is involved.

Although more surgeons are doing gender-reassignment, the core group for Americans remains a handful of doctors in Oregon, Canada, New Zealand and Britain. The patriarch is Biber, who still performs one or two procedures a week.

That is why a 44-year-old Baltimore man recently came to Trinidad, seeking to solve a lifelong problem "that was not going to go away."

"I've been racking my brains, why did I have to do this. I didn't have to do this, but I had to," said the man, who refused to be identified. "It was just that point in my life where I had to find out. There are choices, I guess. You can either keep this all pent up inside and go crazy, or do this and go into bankruptcy."

In the transgender world, Trinidad has come to represent a mecca. In sight of an impressive series of snow-capped mountains, the town also has its own Fisher's Peak and Simpson's Rest; at night, a white Hollywood-esque "Trinidad" sign illuminates the settlement below. Downtown, a collection of old-fashioned buildings is preserved, including a movie theater and small bars wreathed in neon.

Residents regard strangers politely, asking at most veiled questions such as, "Are you tourists in town?" Trinidad's medical claim to fame, however, is pointedly not advertised by officials or merchants, neither on T-shirts or trinkets.

The Baltimore man had researched the issue for years, deciding finally on Biber. A self-described "mighty big woman," nearly 6 feet tall, he defied any stereotype, coming across more as an earth mother in denim overalls and work boots than a glamorous type.

But he also fit Biber's criteria for acceptance as a patient: He had always felt himself a misplaced female; his favorite secret childhood game was dressing up in his grandmother's clothes. He had sought therapy for his problems, and about 10 years ago, had begun the first steps in becoming a woman -- hormone treatments, electrolysis. Since 1993, he had been living as a female.

Like many transgender people, he did not consider himself gay, although he had had gay experiences in which he pretended to himself that he was a woman. He was even married for five years to a heterosexual woman, to whom he confided his deepest fears on the third date. She said she thought she understood, but the marriage broke up, in part over the gender issue. The man's friends and co-workers were shocked at first to encounter him in what he felt was his true identity.

"I was a believable male," he said, "and when I first went out in drag, it would be around my straight friends who never failed to make a comment, 'You look like a linebacker in a dress.' "

On his last morning as a male, the man woke up early, very calm, and wrote in his journal that he had "had a good life. I was a pretty good boy/man . . . "

Biber's operating room was relaxed but efficient later on that morning. Viewing the procedure was not for the faint-hearted, however.

As Biber sewed, the Baltimore man slept on, snoring slightly, as his body and life were changing forever. In a world where pronouns often are unreliable, "he" was quickly becoming a "she."

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