Rancher, competitive weightlifter, pianist, Army doctor, pioneer of transsexual surgery.
For Dr. Stanley Biber, the man who made the quiet historic town of Trinidad, Colo., the sex change capital of the world, it was all in a day's work.
Since he did his first transsexual surgery in 1969 until his retirement 35 years later, Biber performed an average of three to four per week, operating on men and women who were willing to go to great lengths to have their bodies surgically altered to match their own internal gender identity.
Over the course of his career, Biber has performed about 5,000 male-to-female operations and between 800 and 1,000 female-to-male operations to help people with what is known as "gender dysphoria" or "gender identity disorder" transform their bodies to match the gender they believe they were born to be.
Earlier this year, Biber was abruptly forced to retire at the age of 80 because, he said, he couldn't get insurance.
"It's terrible. I guess they think I'm too old," he said. "They don't say it's because of your age, but they say, 'You do not meet our criteria.' What are you gonna do?"
His inability to practice most directly affects the 10,000 people of Trinidad, 130 miles south of Colorado Springs, where the majority of his practice was as a family doctor and surgeon for the community.
At Reflections Salon, just half a block from Biber's office on the fourth floor of the First National Bank building downtown, locals expressed respect and admiration for the local doctor.
"He was a friend to the community," said Paul, who asked his last name not be used, as he sat for his haircut. "He kept my dad alive -- he's 94 and still going."
When asked how he felt about Biber's specialty -- transforming transsexuals -- Paul said: "Everybody's gotta make a buck. How they do it is their business."
Corrine Guara, a lifelong resident of Trinidad, remembered the many transsexual patients who came into her salon.
"They'd come in and get haircuts, color. ... They were very comfortable here," Guara said. "You wouldn't expect something like that in Trinidad, but it's a really accepting town of transients."
Despite the impact of Biber's retirement, the town will likely retain its status as "sex change capital." Dr. Marci Bowers, a gynecologist from Seattle, recently relocated to Trinidad to take over Biber's transsexual surgery practice.
"I started teaching Dr. Bowers and now she's here and now she's doing the procedure," said Biber. "They took away my insurance before I could teach her a lot of things, but the basic procedure she knows. I'm just sorry I can't help her any more now."
Bowers, a transsexual herself (though not a patient of Biber's), also regretted that Biber's career came to such an abrupt end.
"That was disappointing for both us for lots of reasons," she said. "One is, obviously, just his commitment to the community. But for me, he was my mentor and my inspiration. ... Even though he's here in town, it's just not the same."
Bowers was particularly disappointed that she wasn't able to learn some of Biber's techniques for female-to-male surgery, but noted that she has already been able to make some improvements to the male-to-female surgery.
Bowers also hopes to change some peoples' perception that transsexuals are sick people that have to be cured with surgery in order to live full lives.
"What I hope people will realize is that this is not some kind of pathology or diseased brain, but that it's far more important for the world. As societies in the past have done, they've embraced this two-gendered spirit. ... Men and women see the world in very different ways, and when you see it from both genders, it's incredible."
Bowers added that she thinks even those who work with the transsexual and transgender communities often still see the reality of gender as very "binary."
"But I think what is changing is that gender expression can be much more fluid on a scale of 1 to 10 rather than a 1 or a 10," she said
Though Biber's career may have come to a sudden end, his legacy as a pioneer in the field of transsexual surgery has earned him a place in the history books (including the Guinness Book of World Records), in the annals of medicine and in the hearts of those patients whose lives and bodies he changed.
"We're lucky to have surgeons who care," said Leslie Feinberg, a transgender activist and author of Transgender Warriors, of Biber's impact on the transgender community. "We need doctors who treat us with respect."
Biber recently spoke with the Independent about his career, the future of transsexual surgery, and what it was that drove him to redefine the boundaries of gender in one of the most unlikely places in the world.
Indy: How is it that you were able to create such a welcoming environment for transsexuals in Trinidad?
SB: I started doing [transsexual surgeries] here in a Catholic hospital, you know. Mount San Rafael Hospital is run by Sisters of Charity from Cincinnati, Ohio, an excellent Catholic hospital. We did the first couple cases and they looked at the records and said we couldn't do that even though it was accepted by the administrator. They said we'd have to tell the townspeople and everybody else. So, the smartest thing I ever did was to call a meeting of the ministerial alliance here [in Trinidad] and let everybody in on it -- all the rabbis and the priests and the fathers and everybody together. And I gave them a very serious lecture.
Indy: This was in 1972?
SB: I think it was earlier than that, about '70-something. I had only done about 10 cases, maybe. And they understood so well and they accepted so well that they became the ombudsmen of those patients that I was [operating on] in our hospital. And I had a nun through Sisters of Charity -- who just left me about three or four years ago -- who'd always been my social worker.
Indy: How do you explain that kind of acceptance in a small town here in the West?
SB: Well, the town itself was really no problem. They still accept it very well because they're so used to it, you know. They're more sophisticated than in some of the bigger cities where you have all the religious groups that would be against it. But you see, they [the transsexual patients] come here with their families, they live downtown in hotels and their families are with them, and finally they realize they're just plain people like everybody else. Besides that, they bring business to the community. I used to operate on three or four a week, and hell, they stay over two weeks and that means we have eight to 12 families staying in town and shopping here. And so we have a very sophisticated group of people living here now. They're the experts in transsexualism. So that worked out pretty well.
Indy: You performed your first sex change surgery in 1969. That was a huge year in American history in terms of changes in sexual mores, the civil rights movement, the Stonewall riots in New York, gays coming out, the pill. Yet transsexual surgery was still something incredibly unusual to be doing at that time. What was it that made you so open to doing this kind of surgery, and did you feel you were doing something radical?
SB: It was a tremendous challenge, and I accepted it as a tremendous challenge. I remember articles in the New York Times and Newsweek and some psychiatrist in New York, and they tore me apart. I was "committing mayhem on these patients" and Time magazine said that "within two years all these patients will commit suicide." I was getting the brunt of it pretty good. Pretty good publicity. This was about 1972. And the medical profession was not very pleased with what I was doing either.
But little by little, year after year, these [patients] looked better and better and, with education and so forth, finally we developed the Harry Benjamin Gender Dysphoria Association [Benjamin was one of the first doctors to do transsexual research]. That was probably 1976 -- and I was the charter member. I got together just with a few doctors who were in the business plus some psychiatrists and social workers. We developed our organization and the criteria so there wouldn't be surgery on demand. We told patients what they had to do before they were operated on. And things got better and better. Pretty soon, [we were] accepted.
Then we got a DSM [Diagnostic and Statistical Manual of Mental Disorders] number in the psychiatric literature. Then we're accepted pretty well. Pretty soon articles are being written all over. Now, 40 or 50 articles a month are being written on the subject.
Indy: What was it about you that made you so open-minded about it?
SB: You've gotta realize that surgeons aren't very humble. They take a challenge. Surgery is like an artist playing the piano. You develop your depth of technique and things like that. And that's what makes it a challenge. How can I do it better? And that's what we did.
Indy: So you weren't even thinking about what the actual surgery was?
SB: Nah, we didn't care about that. [Laughs]
Indy: How many transsexual patients did you turn away in all these years?
SB: We open a file on [the patients] maybe a year in advance and we make sure they follow the [specified] criteria. You know, taking hormones and living as the opposite sex for a year, et cetera. So by the time they come here, they've been referred to me for surgery. Then I have to make the final decision. Well, there are still some things when you walk through the door -- I can get a feeling almost -- that something's wrong. So I sit down and question them for a while. And I see there's hesitancy and they don't know about the surgery or something in their past that disturbs me somewhat. Because once I do it, it's not so easy to turn them back the other way. So I'll sit down and I'll talk with them and sometimes I even use hypnosis [to regress them] back to when they were children, just to see what they were and how they felt even when they were a child. And then some people aren't ready and I know that. I have to be careful with the ones who are real hesitant because sometimes they're afraid of the surgery itself. They have to go under the knife, you know. So if there's some hesitation, I won't do them.
Indy: Did you have any early cases of recidivism [patients who want the surgery reversed] that came back to bite you?
SB: No. Of all these cases I've done, I've only changed about three back [to their original anatomies]. One of those I didn't even do in the first place. It was a poor choice. One of those was a sociopath -- a severe sociopath. He went on TV before the surgery and went on all the programs. And I got taken by that one, I have to admit. But that's not bad out of 5,000 cases.
Indy: What does changing someone back involve?
SB: It's the same procedure that I do for the female-to-male. So we changed [the patient referred to above] back. Then he went on TV again. That's the kind of people you have to be careful of.
Indy: Do you do follow-ups with any of your transgender patients?
SB: We've followed up with close to 1,000 patients over a period of years. It's probably the best study there is now because it's so far reaching and has so many numbers.
Indy: What have you learned from that study?
SB: That we turn out a pretty good product. That we make changes that people may fit into society -- into the social milieu very excellently: 28 percent adopt children and lead a normal life and they're very happy. Our rate of recidivism, because we choose so carefully, has been very low. And, actually, we do them quite a service. In the follow-up questionnaire, we go through some of the physiological things, like how well they're having sex and if they have orgasms and things like that. And we go on to their social status: "Are you accepted now in society?" "What's your wage scale?" et cetera. They're accepted so well nobody even knows what they were before. In fact, they themselves don't even know what they were before; they block it out in their mind completely. So we have quite excellent results.
Indy: Is this just one of nature's mysteries that has to be dealt with because it causes tremendous grief for people who can't be the gender they want to be?
SB: If you want to get spiritual with it, I guess you could say that God made it that way. But it's one of those things where you don't sit back and say, "God made it that way, so it has to be that way." If there's something you can do to help these people, then of course. They have tremendous problems. These people are withdrawn and depressed. They're hiding. All their lives they have to hide their differences. They cross-dress in private, and they can't get a job. So there's tremendous stress and tremendous problems. If they choose right and we can work on them, then it's just like a ton has been lifted from their psyche. ... But we have to live with them and accept them as they are and do what we can to correct them. At least in the transsexual population we can correct them. If they're really female we can make them female and if they're really male we can make them male. Then they live in the opposite role and don't bounce back and forth from one to the other and one to the other.
Indy: What about transgender people like author Leslie Feinberg who speak out against constraints of male/female, either/or views of gender.
SB: OK, to each his own. But if they're really a true transsexual and they have what we can offer them now, it sure makes a big difference in their lives. You show me a true transsexual and I'll show you one that will change heaven and earth just to get the surgery. They go to any means to get the money for it.
Indy: Has the process of perfecting these surgeries led you to any philosophical or spiritual conclusions of your own?
SB: No. It's been a technical challenge for me over the years. But it's not always because of the technical challenge. It's because you begin to know these people. You begin to develop a lot of empathy for them. They have terrible histories, terrible pasts. Pretty soon you get to feeling, well, if I can do something for these people, I think it's worthwhile.
And that's why I think they come here, too, because all my people who work in the hospital know them so well and the hospital staff accepts them. They don't treat them like outsiders. They're patients just like anybody else. That's part of the reason of our success, why they come.
Indy: What are you going to do now that you've been forced to retire?
SB: Oh, I'll still take care of my business and then I'll go ranching. It's a shame because I feel I could still be doing the work. If I could get some insurance, I'd probably go back and do it. Other than that I'm enjoying my retirement and you can see that. Right now I'm going to go down and lift weights.
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