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The Tiny Colorado Town That Became the ‘Sex Change Capital of the World’

Three hours south of Denver and located in the mountains along the Santa Fe trail, the small, semi-conservative town was home to a forward-thinking local doctor whose pioneering surgeries would change trans health care forever

2022 marks the 25th anniversary of the year that everything happened — 1997. It was an ear-biting, Pierce Brosnan-loving, comet-obsessed world, and we’re here to relive every minute of it. Twice a week over the next 12 months, we will take you back to the winter of sheep cloning and the summer of Con Air. Come for the Chumbawamba, and stay for the return of the Mack. See all of the stories here.

In 1969, a trans woman known only as Ann stepped into the Trinidad, Colorado office of Dr. Stanley Biber. They weren’t exactly close friends, but Biber — who, at that point, was the town doctor — knew pretty much everyone, and everyone knew him. More importantly, they trusted him. The woman was a social worker, so over the years she’d brought many local kids to see him. But that day, she wasn’t there for the children; she had a request of her own. “She asked if I’d do her operation; she said she was a transsexual,” recalled Biber in a 1985 interview with the Los Angeles Times. “I didn’t even know what a transsexual was. She looked completely female to me.”

Prior to that point, Biber had zero experience with the trans community. A dedicated weightlifter who almost qualified for the Olympics, he was unpretentious, friendly and unflinchingly confident in his work. Biber was Jewish, and initially toyed with the idea of becoming a rabbi. Instead, he decided to become a doctor, spending the earliest years of his career on the frontlines of the Korean War, sewing up the battle wounds of soldiers. When the war ended in 1954, he moved to Trinidad, a remote, somewhat conservative mining town situated along the Santa Fe trail amidst pine-forested mountains and buildings bearing the historic touch of Old West architecture. 

Here, Biber shifted his medical focus toward coal-miners and their families. Plenty of these families were immigrants who had come to work in the mines; others had moved to Trinidad due to its proximity to the Mexican border — although it doesn’t actually border Mexico, as Trump believed when he pledged to build a “border wall.” Biber’s lack of flashiness and down-to-earth attitude went down well with the working-class locals. They let him into their lives, and in return, he helped deliver their babies, set their broken bones and guided them carefully through even the most complex medical procedures.

But despite his expertise, Ann was the first person who’d ever asked Biber to perform a vaginoplasty, also known as transfeminine “bottom surgery.” Unfazed, he reached out to the doctors who’d prescribed her feminizing hormones. Next, he sought the guidance of surgeons at Baltimore’s John Hopkins Hospital, known as a hub of gender confirmation surgery knowledge. Doctors there sent over a handful of how-to drawings, and Biber quickly set to work.

At this point in the 1960s, gender confirmation surgeries were extremely rare. When they were conducted, they were seen as novel fascinations — the famous transition of Christine Jorgensen, who famously flew to Denmark for surgeries in the 1950s and returned to the U.S. as a bona-fide celebrity, is exemplary. But despite this lack of established knowledge to fall back on, Ann’s operation was a success. Understanding the rarity of his achievement, Biber decided to make these surgeries his focus, and he established his private practice for gender confirmation surgeries then and there.

By 1997, Trinidad had developed a reputation as the “Sex Change Capital of the U.S.” At that point, Biber had performed thousands of vaginoplasty procedures, and he’d even started trying to teach himself phalloplasty — the complicated art of constructing a functioning penis. Estimates vary, but it’s thought that his practice performed around 6,000 gender confirmation surgeries over the course of four decades. When Biber eventually sought to retire in 2003, he had been training Dr. Marci Bowers as an apprentice. Bowers became the world’s first trans doctor to specialize in gender confirmation surgeries, taking over Biber’s small-town practice after his retirement.

The fact this was all happening in Trinidad, of all places, makes Biber’s story all the more bizarre. Dig deeper into the area’s eccentric history though, and it starts to make sense. “What’s interesting about Trinidad is that it’s always been this little crucible for American experimentation,” says Noel Black, host of the Lost Highways podcast, which has an episode on Biber. Black has used the podcast as a vehicle to explore Trinidad’s attempts to “figure out its identity” — such as its embrace of Drop City, America’s first artist commune — but also to look at more difficult aspects of Colorado history, like the brutal Ludlow Massacre of the 1914 Miners’ Strike

Also the first town to have a female sports editor of a newspaper and one of the most important seeds of the modern labor movement, Trinidad is now lined with dispensaries and is often jokingly referred to as the “weed mall.” In other words, Trinidad wasn’t just any small town — it was a small town used to making big waves. 

The first time Black came across Biber’s work was in 2002, when he interviewed a trans woman named Conni at a local trans support group. Conni’s transition landed her in the midst of brutal divorce proceedings, which drained her savings and opened her up to legal discrimination. Yet like many trans locals, Conni spoke fondly of Biber. “I got really curious about him, and I had read the news that he was about to retire,” explains Black. “It was forcible retirement; I think he could no longer get insured because he was 80 years old, so I drove to his office, which is on the fourth floor of the bank building here in Trinidad. I got to sit down with him for an hour-long interview, and he’s a fascinating guy.”

According to Black, Biber was “like a hobbit.” “He was really short, and I was also shocked by how sort of vain he was,” he says, laughing. “He was totally bald, but he had this combover. He had a picture of himself from his time as a bodybuilder, right behind this very Soviet-looking metal desk. In the photo, he had his shirt off with these dark glasses on, and he’s flexing his bicep. The first thing you see is this projection not just of machismo, but of this curious sort of vanity.”

Biber was clearly proud of his weightlifting glory days, and he’d rarely slowed down — on top of his medical practice, he also owned a ranch. “I’ve talked to people that worked with him, and they all said how busy he was all the time,” says Al Melton, Director of the Trinidad History Museum. “I don’t know how he slept. People talked about how much of a great boss he was and how supportive he was of his staff, which is always nice to hear because you want important figures in your history to be good people.”

Black echoes this description of Biber as “friendly and generous with his time,” but his main fascination was that Biber’s dichotomous personality: He was committed to his own aesthetic, but his office looked like “he hadn’t spent a dime on anything — the floor was so worn, and there were holes in his chair.” Trinidad locals recognized his “shitty old Toyota pickup truck,” which, despite Biber’s success, he drove more or less until his death in January 2006.

This “folksy, unobtrusive” side of Biber went down well with the locals, but on the flip side, he had a “professional arrogance.” “In the podcast episode, [trans historian] Susan Stryker talks about the surgeons who pioneered gender confirmation surgery at that time being very macho,” Black says. “They had to have this kind of arrogance about them: Not only did you need to think you could do those surgeries, you needed to have this professional air.” Biber was relentlessly pragmatic and versatile too, probably due to his war background. Melton tells me about a patient who came to Biber with a hemorrhoid. “Biber just said, ‘Bend over now, we’ll take care of it!’”

It was likely, then, that Biber’s down-to-earth attitude played a key role in establishing the town’s role as a hub of trans health care. It’s not necessarily that the Trinidad locals were particularly progressive or ahead of their time, either — they just understood that Biber’s work would bring money into the town, which was suffering economically as demand for coal began to wane. Any lingering transphobia could largely be quelled by the cold, hard cash of trans patients, and this argument for the town’s economy overrode any kind of moral panic. For example, Biber was Jewish, but he practiced at Mt. San Rafael Hospital, named after a “generous benefactor of the Catholic church.” 

“There were some internal discussions as to whether this was okay, because it didn’t really fall in line with the Catholic church at the time,” Melton recalls. “Apparently, one of the nuns wrote to the Diocese, basically pointing out that these gender confirmation surgeries were happening. The response was: ‘Well, it’s bringing the hospital money, so let’s just go with it.’”

This wasn’t always the case, of course. Trans health care was a mixed bag throughout the 1990s, and the care that patients received was dependent on factors including a patient’s zip code and their doctor’s attitude. And although there were official medical standards for trans health care — created by a then-cisgender-led organization known now as the World Professional Association for Transgender Health (WPATH) — they weren’t always useful or affirming. Speaking to Wired about WPATH’s 1997 British Columbia conference, Jamison Green, a trans man and health activist, described being one of the few actual trans people present. “It wasn’t a welcoming environment, [and] they weren’t happy to see you,” he recalled.

Despite this, Biber was able to work with little backlash for decades. Trinidad became a safe haven for trans people nationwide, although the locals had their own clunky ways to refer to the people who came to town for surgeries. “I heard stories that, back in the day that if you went to a bar and wanted to pick someone up, you had to ask what brought them there,” explains Melton. “There was some coded language to figure out whether they had come for Biber, and a lot of it wasn’t politically correct — this was the 1970s, so they were a lot more blunt!” 

Meanwhile, the term “going to Trinidad” became shorthand for surgical transition. It’s a phrase so famous there’s even a book named after it, Going To Trinidad, written by Martin J. Smith and released last year. 

By contrast, when Bowers took over Biber’s practice in 2003, her experiences were colored by transphobia. “Biber was able to successfully do the work he did because he was everyone’s doctor,” says Melton. “Marci had a completely different experience, and there was definitely some transphobia and misogyny there.” Both Black and Melton touch on class, too. Whereas Biber drove his shitty Toyota, Bowers drove a Porsche. “I’ve talked to locals who were upset that she was driving this sports car,” continues Melton. “Film crews would make reality TV shows about her surgeries, which I think would probably do well in a major city, but it rubbed the local community the wrong way.”

The mainstream media picked up on this, and in 2005, South Park aired an episode called “Mr. Garrison’s Fancy New Vagina,” which was set in Trinidad. “That was actually my first introduction to Biber’s work,” says Melton, who was “maybe 14 or 15” when they first came across South Park. The episode is basically one huge shit-post, which features a “caricature of Dr. Biber.” As the episode progresses, “it does get really alarming,” says Melton. “It goes from ‘I’m transgender and I want my confirmation surgery’ to ‘I want to be a different race, a different species.’ That’s where they lose me, watching that as a trans adult now.” According to Melton, “Biber wasn’t pleased with his portrayal, but his grandkids thought it was hilarious.” Nevertheless, it cemented national interest in Trinidad, and locals weren’t happy.

By 2010, Bowers had relocated to San Francisco. Since then, she’s pioneered gender confirmation surgeries practices worldwide, including pro bono clitoral restoration surgeries for survivors of female genital mutilation. Bowers’ expertise has improved trans health care worldwide, but her departure meant that, almost overnight, Trinidad had gone from a world-renowned center for gender confirmation surgeries to — at least in the eyes of trans communities — just another mountain town.

It’s interesting to look back at Biber’s legacy and compare it to trans health care today. In some ways, there have been vast improvements. Biber’s surgeries used to set patients back around $3,000 — which, in 1970, would have been the equivalent of around $22,000. Considering the average annual salary at the time was just shy of $10,000, it was a hell of a lot of money. Today, some states cover trans health care with insurance, but new anti-trans bills are being pushed daily across the U.S., threatening this hard-earned progress.

For some trans demographics — usually those with racial, class and economic privilege — access comes easier than ever, yet there’s still an “uncountable number of barriers,” according to 33-year-old teaching assistant AJ, who decided to start microdosing testosterone around three months after “coming out socially as non-binary. “Geography is a huge one,” they say. “I have friends who had to drive over two hours to get to the closest clinic for hormones.” This was, of course, the case in the 1990s, too — patients came to Trinidad from all over the world due to the sheer lack of trans-friendly or trans-educated health-care practitioners.

Now that Trinidad has no trans health care, Melton has to travel anywhere from one to three hours for appointments, too. That said, the vast majority of staff they’ve seen have been “visibly queer,” and their insurance has so far covered consultations and drastically reduced the price of testosterone. So while trans health care is no longer local, for them, it’s at least improved. 

Within this context, where does Biber’s legacy sit? “I’d not heard the story of Trinidad before, but it doesn’t surprise me,” says 26-year-old Violet Valentine, a trans adult model and tattoo artist. “Gender confirmation surgery has been practiced for a very long time at this point, and rudimentary forms of it are ancient. I think it’s great that he was able to help so many people, but I do think it’s off to focus on the aspect of how much business it brought in for the town. It just feels like a weird way to say your town is running off the profits made from trans people trying to access health care, although I’m not necessarily surprised.”

For Melton, learning about Biber — albeit initially through South Park — was eye-opening. “It’s kind of sad that, as a trans, queer person, I didn’t know anything about trans history,” they say. Today, their biggest takeaway from Biber’s story is that “there are so many ways you can be an ally. Biber could have said to that first trans patient: ‘That sucks, good luck with your confirmation surgeries!’ Yet he was a genuinely kind dude, and wanted to help people. Not everyone has to become a surgeon obviously, but there are ways to just be a good person.”

“I’m sort of surprised and not surprised by this story,” says AJ of Biber’s legacy. “I feel like so much of my experience being trans has just been relying on teaching myself things or learning from other trans people who have taught themselves things. In that sense, hearing about a doctor basically just figuring out how to do a vaginoplasty and using that to build this kind of locus for gender-affirming surgeries feels very trans.”