Gender-Affirming Care and Colorado History as Sex Change Capital

Dr. Stanley Biber, right, with one of his patients, Marsha Botzer, as seen in a 2020 Legacy Project interview.
Dr. Stanley Biber, right, with one of his patients, Marsha Botzer, as seen in a 2020 Legacy Project interview.
On October 12, Governor Jared Polis announced that the administration of President Joe Biden had approved a Colorado health-care plan that will include gender-affirming care services, described by the Colorado Division of Insurance as "mental and physical health services that help align a transgender person's body into alignment with their gender identity." Examples include facial modifications, breast or chest construction, and more.

Colorado is the first state in the nation to make these moves, but that shouldn't be a surprise. During decades past, at a time when the language applied to transgender individuals was much less refined than it is now, the unlikely town of Trinidad was known as the sex-change capital of the United States — an unusual piece of Colorado history documented in many Westword stories.

A case in point is "Sex Machine," an August 27, 1998 feature article by Harrison Fletcher, which profiled Dr. Stanley Biber, the man who put Trinidad on the transgender surgery map. The introductory passages from the article make it clear how much times have changed:
The surgical team gathers early one Saturday morning, not exactly hiding what they're doing, but not advertising it, either. The procedure is still in its experimental stages, and who knows how people will react.

Dr. Stanley Biber stands beside the operating table, white light shining down, the patient's chest rising and falling with each breath of anesthetic.

A few weeks before, Ann had come to him, sitting in the same chair as thousands of other patients and putting the question to him directly. She is a friend, a social worker who has brought him harelip and cleft palate cases from around Las Animas County. Ann is impressed with his work.

"Can you do my surgery?"

"Sure," Biber says. "There's not a surgery I can't do."

He has no humility. He's 46 years old and still a rising star.

"What kind of surgery is it?"

"I'm a transsexual," Ann says.

"A transsexual? What in hell's name is that?"

It's 1969. Most people don't know a transsexual from a transvestite, and Biber himself is a little sketchy. To him, this person sitting across his desk is a woman. Reddish hair. Medium build. Not bad-looking.

As it turns out, Ann is one of the first patients to receive hormone therapy from Dr. Harry Benjamin, the father of transsexual research. Ann has passed Benjamin's psychological criteria, lived as a woman for a year and is ready for the final step.

That afternoon, Biber calls New York and asks Benjamin's advice. He then contacts surgeons at Johns Hopkins Hospital in Baltimore, where the early sex-change operations have been performed, and arranges for the hospital to send hand-drawn diagrams that detail transforming a man's genitals into a woman's. The technique is basic — crude, even — but similar to the procedure for prostate cancer.

"Okay," he says. "We can do it."

By 1998, Biber was performing four gender-reassignment surgeries every week and nearly 200 a year. Five years later, as Fletcher pointed out in a 2003 followup, the doctor's total number of such surgeries had exceeded 6,000. But it ended there, because Biber, then eighty, had reluctantly hung up his scalpel. "I didn't retire — I was forced to retire," he said at the time. "I'm in great shape. I work out every day; I out-lift the kids." But owing to his age, his insurance company would no longer cover him.

Biber died in 2006, as documented by an obituary in the New York Times, but as Patricia Calhoun wrote in a 2015 piece, he left Trinidad a successor: Dr. Marci Bowers, described as "an OB/GYN surgeon in Seattle who’d had sex-reassignment surgery herself in 1997, had met Biber in 2000, on the advice of a psychologist who’d had Biber do her own sex-change surgery.... A few years later, when Bowers was ready to move on from the Seattle clinic where she worked, she thought about Biber’s offer to have her take over his practice. That’s how she wound up in Trinidad, coming right around the time the town held Stanley Biber Day, and staying until October 2010."

Bowers left Trinidad partly because of friction with the facility where she performed procedures; the administrators weren't thrilled by the publicity generated by Sex Change Hospital, a reality show in which she starred back in 2008. She eventually relocated to California, prompting a local newspaper to headline a piece about her departure "Trinidad Slays the Golden Goose."

Today, of course, gender-affirming care is much more mainstream than it was even a decade ago, as Colorado's new health-care plan demonstrates. And while Biber didn't live to see the change, he helped make it happen one surgery at a time.