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Sex Machine

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...
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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."
So Biber stands in the operating room of Trinidad's Mt. San Rafael Hospital on this Saturday morning. His team is ready. His patient is prepped. Biber selects a scalpel and steadies his hand.

Four sex-change operations per week. Nearly two hundred sex-change operations per year. Three thousand eight hundred sex-change operations a career. That was enough to earn him a spot on last week's Guinness World Records Primetime TV show. Enough to bring Geraldo Rivera to southern Colorado for an operating-room exclusive. Enough to transform the former mining town of Trinidad into the "Sex-Change Capital of the World." Dr. Stanley Biber has performed two-thirds of all sex-change operations in the world. Enough, in some circles, for him to be the best.

Pano Ortiz, owner of Pano's Bargain Books: "If anyone knows anatomy, it's him. He's neat and clean."

Charles Martinez, visitor at Pano's Bargain Books: "There are some ugly monsters coming out of there. Gawwd! Big manly types, growing hair and everything, just look like the dickens."

Jon Pompia, Trinidad Chronicle-News city editor: "I think he used to be a world-class power-lifter."

Dominic Verquer, San Rafael Hospital computer-systems director: "The first few times he rode, he had a good cow horse, and the horse went one way and the rider went somewhere else. If you know what I mean."

Marje Marty, former Biber neighbor: "He used to come up to my children, tweak their noses, give them a hug and joke around. It was the love he gave. You don't see that anymore, and that's too bad."

Pompia: "He might have been an Olympic hopeful."
Gene Lujan, former county commissioner and owner of El Rancho Club: "Retiring? I've heard that for years."

The word is out--again. It has floated around the town, made a few laps around the state and settled back on the fourth floor of the First National Bank building in downtown Trinidad, where Dr. Stanley Biber leans back in his chair, frowning.

The rumor, it seems, is premature--again. Although Biber has cut back his medical practice, reduced sex-change surgeries to twice weekly, talked about a replacement, recently celebrated his 75th birthday and spends afternoons on his ranch, the bespectacled, gregarious doctor is still very much "in."

On this muggy August afternoon, his office is buzzing. His phone rings, then rings again. His secretary scurries in with a message. His waiting room of lime-green vinyl-and-chrome chairs fills slowly with patients. His thirteen-year-old daughter, fresh from gymnastics class, fidgets in a nearby examination room, waiting for a ride home.

The rumor is just a rumor, as constant in this town as the wind and barely worth a response from the doctor, who, at the moment, seems more interested in the jar of jellybeans on his desk than in discussing retirement. He shuffles some papers, smiles at his daughter, checks the clock on the wall. "I thought you wanted to talk about transsexuals."

The "Sex-Change Capital of the World" doesn't look like much from the highway, just another old-time town, population now 10,000, that's become a place to gas up, use the rest room and leave. But beyond the Texaco and McDonald's signs, the rusted freight cars and the abandoned brick warehouses, the downtown roads are paved with red bricks bearing the city's name. The hill overlooking the valley holds a local version of the Hollywood sign. A park by the Purgatoire River features the town name again, spelled in white stones.

When something happens here, 200 miles south of Denver, it is often commemorated with a bronze plaque, bust or marker. A memorial to Larry Enlow, a patrolman killed in the line of duty on January 8, 1968. A "City of Champions" sign honoring school football teams that won state championships. An example of the last coal-burning train engine. A bust of JFK. A mining car.

Such symbols offer a sense of identity, of pride, as the coal-mining industry wanes, the shops close downtown and the blood slowly trickles from the historical center, the "Corazón de Trinidad."

Yet nowhere is there mention of the man who has brought more attention to Trinidad than Black Jack Ketchum, Bat Masterson and Mother Jones. Nowhere is there so much as a street sign, mural or key chain commemorating the stocky man with the gold-rimmed glasses, easy laugh and steady hands.

Stanley Biber is just another local, yet he is not. He's a man with mud on his cowboy boots and a million dollars in the bank. A man who curses like a sailor and writes like a poet. A man who builds alliances within the Las Animas County machinery as a commissioner, then splinters them with the attempted recall of another commissioner. A man who heals children and turns men into women.

Stanley Biber was born in Des Moines, the older of two children and the only son of a father who owned a furniture store and a mother interested in social causes.

His parents envisioned him as a concert pianist, and he became quite good. But then they saw him as a rabbi, so he briefly attended sem-inary school. By the time he entered college, he had established a reputation for success, and under his yearbook picture was this caption: "If there is something to be accomplished, he will accomplish it. And the A's will follow."

"But I've always been very humble," Biber says. "As I am now. After many years, you attain humbleness."

During World War II Biber served as a civilian employee with the Office of Strategic Services (the forerunner of the CIA), performing unspecified operations in Alaska and the Northwest Territory. "Let's not make that too specific," he notes. "Just say I was there."

Biber returned to Iowa and enrolled in liberal arts and pre-med courses with the intention of becoming a psychiatrist. Along the way, he almost became a member of the United States Olympic weightlifting team. "I was very good at those things," he says, beaming. "The bench press. The military press. I think I missed it by twenty pounds."

He graduated from the University of Iowa medical school in 1948, and during a residency at an Army hospital in the Panama Canal Zone discovered a talent with a scalpel. "I kind of fell into it by chance," he says. "It was like my second or third choice, but I was very adaptive to it. My hands took to it. Like playing piano. You know how it is--when you're commended for something, you take an interest in it. And it was a constant challenge. At least you had a chance to do innovations."

And innovate he did, seven miles behind enemy lines during the Korean War. As chief surgeon of a MASH unit, Biber supervised such medical advances as vessel transplants and once performed 37 continuous abdominal surgeries before passing out. "I got a tremendous amount of experience there," he says. "Tremendous."

The battlefield seasoning eventually landed him at a Fort Carson hospital, where a colleague asked him to join a five-member United Mine Workers of America clinic in nearby Trinidad. "I thought, 'What the hell. It's close. I'll spend a year there until they get the clinic going and I'll move on,'" Biber recalls. "Hell, all the rest are gone, and I'm still here."

By the mid-Fifties, some 30,000 people lived in Trinidad, and Biber was the town's only general surgeon. He often worked eighteen-hour days, six days a week, performing everything from appendectomies to tonsillectomies to Caesarean-section births, even patching gunshot wounds. "I must have operated on everyone in town five times," he says. "I was young then. When you're young, that's how you work."

Somewhere between surgeries and raising a family (he has nine children), Biber managed to realize a boyhood dream from Iowa. "I used to go to Sargents Feed Store and sit on the bales of alfalfa and just smell the alfalfa," he recalls. "I told myself, 'Someday, I'm going to get me a ranch.'"

He started small, with 25 head of cattle, but he soon needed more land. So he bought more land. Then he needed more cattle. So he bought more cattle. More land. More cattle. On and on. "It's a vicious cycle," says Biber, who eventually built one of the largest ranches in Las Animas County. He even learned to ride, rope and eat dust. "I got bucked off so many times. Broke bones and everything."

But his greatest adventure began when that social worker walked into his office in 1969. "It looked like hell, but it worked," he says of his first sex-change operation. "Just like that, word was out on the grapevine that this was the place to do it. The whole goddamn world came here. All races, all colors, all classes. Movie stars, judges, mayors--everything. Even people from Poland. I don't know how they afforded it, but they came."

Unsure of public reaction, Biber kept his early sex-change medical charts in the hospital administrator's safe. But as more patients arrived, he gathered Trinidad's religious leaders for a series of lectures. "That was one of the smartest things I've ever done," he recalls. "Much to my amazement, there was no opposition. They were very understanding and accepting. All of a sudden, townspeople became very sophisticated and knew everything about transsexuals."

But there was a backlash. Biber was refused insurance. The Colorado Medical Society admonished him for keeping poor records. A Mt. San Rafael Hospital doctor resigned, in part because of the sex-change surgeries.

Biber persevered, squeezing the "Biber Girls" between the general-practice patients who accounted for 80 percent of his work, becoming chief surgeon and helping the hospital stay afloat with the almost-million-dollar annual take from his sex-change clientele. "In my mind, I wanted to improve my technique," he says. "It was a challenge."

Biber performed sex-change operations on twins, three brothers from Georgia and an 84-year-old railroad engineer. "I had everything except a president of the United States," Biber says. "I didn't just decide to do this. They came to me."

She drove straight to Trinidad from Tulsa, alone, and that was scary, because only a few people knew where she was. But that wasn't the worst part. The worst part was writing letters to her two stepchildren and adopted son and telling them the truth in case something bad happened during surgery. Saying goodbye. She never wants to do that again.

Call her Mickey. Everyone else does. She's fifty years old and originally from Little Rock. Say she's a part-time accountant and manager of a fast-food restaurant.

Some people say it's psychological or environmental or physiological, but Mickey thinks it's all three. She's always known she was different. She didn't know why or what to call it, but it was always there. That confusion.

There were three boys in the family--Mickey was the middle one--but Mama always said Mickey was supposed to be a girl. In fact, if Mickey thinks real hard, she remembers Mama dressing her in dresses. Not that Mickey ever did boy things, anyway. When Daddy took his other sons hunting and fishing, Mickey never went along. And that was fine. Mickey went shopping with Mama.

In the beginning, Mickey thought his confusion meant he was homosexual, and at 21 he tried that scene. But it didn't work out. It was uncomfortable. Very uncomfortable.

In 1980 Mickey met a transsexual--a female to a male--who explained everything about gender dysphoria. That was all Mickey needed to hear to change his driver's license, quit his job, leave the state and start living as a woman. Mickey took female hormones, entered therapy. If you passed Mickey on the street, you'd never know. Auburn hair. Green eyes. Big-boned maybe, but completely natural. Mama and Daddy didn't understand, but they accepted it before they died. As for Mickey's brothers, they never even tried.

You know how men say they don't understand women? That's how Mickey felt, except Mickey didn't understand men. And you know how girls get up to go to the restroom together? Mickey did that, too, as long as there were stalls inside.

When Mickey's fourteen-year-old stepdaughter left a condom in her bedroom, they talked about sex, pregnancy and abortion, and Mickey explained things from a woman's perspective. It came from the heart.

Mickey's husband--ex-husband now--had no idea when they met, no clue until their first night together. Mickey pictures it as if it were yesterday. They were lying on the couch in front of the fireplace, and Mickey explained as delicately as possible. Maybe he was gay or bisexual, but Mickey's ex never minded. Even when they had problems and divorced after five years, it wasn't because of the gender thing--Mickey's ex liked to drink and smoke pot.

People say the operation is just about sex, but the act of sex had nothing to do with Mickey's decision to have the final surgery. After years of seeing men and women together, Mickey just watned to be one gender.

As far as the pain, it wasn't bad. Mickey told her ex that she could picture him sitting across from her, crossing his legs and tightening up, but it wasn't that bad. None of it was really difficult.

Except telling the kids. They treat Mickey like a regular stepmom. What they see is what they believe. There was only one time Mickey had to lie. She locked the door so the kids couldn't barge in while she was taking a shower; she told them she was shy. In a way, though, that's true. Most people, when they take a shower and look in the mirror, like what they see. Mickey never did. Mickey never wanted anyone to see her undressed. When Biber conducted an exam before surgery, Mickey cried.

The night before the operation, Mickey looked in the mirror and memorized the image, something to compare her new body with. Five days later, she stood in front of the mirror again. For the first time in her life, she wasn't ashamed.

Phillip Valdez, county commissioner, barber, musician: "I remember Biber around in the early Sixties. I hear he came in with just a little old junker. But you know doctors. With what they charge, it doesn't take long for them to get well-off."

Marge Marty, former owner of Marty Feed: "He was our doctor when one of my boys broke bones in his foot and when my daughter had her tonsils out. He removed my husband's gallbladder, I've had a hysterectomy, and he took care of my husband before he died. He learned Spanish so he can speak to his Spanish patients, and he speaks Italian, too. He's certainly been by far the most outstanding doctor we've had."

Dominic Verquer: "He's into registered Black Angus and Black and Hereford crosses. He took a bull to the Colorado State Fair and placed second in his class."

Gene Lujan: "I've never seen the man drink more than two drinks. We've attended a number of conventions, and we'd socialize. He likes beans, enchiladas, prime rib and smoked salmon--it has a fancy name but I don't know what you call it--and shrimp."

Valdez: "As for transsexuals, I'm basically not for it, but that's his business. But he must be good or else they wouldn't come. And they come from all over the world."

Marty: "Most of them stayed awhile, and you'd see people downtown you didn't know and put two and two together."

Kathleen Donnelly, Trinidad Chamber of Commerce executive director: "We do receive, every month, people calling in who have heard about a doctor in Trinidad. That's the way they start."

Anonymous I: "I don't approve of what he does. I really feel badly when people see our community as the 'Sex-Change Capital of the World.' That really upsets me. There is so much more here."

Anonymous II: "He's on the other side of the tracks from us. I don't appreciate him."

Lujan: "I work in the bar business, and we get quite a few opinions. It's just like your abortions. Same kind of controversy."

Valdez: "At first you heard a lot about it, but it's like a train going by. In the beginning you can't sleep, but eventually you get used to it."

Jon Pompia: "It's a non-issue here. It really is. The only time it's brought up is when people come into town and ask questions. I hang around all over town, and that's maybe 1 percent of our conversation. People have it, they come in, they leave. That's basically it."

Donnelly: "The hotels, restaurants, gift-shop folks and floral people say they've had people from his office coming in. He's quite an astute businessman. From what I've heard, we'd probably not be able to keep this hospital open without his business. Which is important when your town is eighty or ninety miles from a big medical center."

James D'Agostino, administrator of Mt. San Rafael: "It's about 1 or 2 percent of our business. We're a full-service hospital now and we do more. But years ago, it was certainly a higher percent of the bottom line. Transsexual surgery is not covered by insurance, so a lot of it is cash."

Marty: "After my hysterectomy, I went to Denver, and one of my friends said, 'You didn't let that doctor do it.' And I said, 'I certainly did.' They looked at me funny. 'But he does that kind of surgery.' And I said, 'Which proves how good he is. You have to be darn good to do that.' They never thought of it that way."

Valdez: "It took a while to get the respect I wanted from him, but I got it. He was pretty loose of the tongue when I first met him, and I'm the type that doesn't like profanity. He's not a Christian, that's for sure. But we got to the point where he didn't use it around me. I give him a lot of credit. A guy in his position and of his caliber didn't have to do that. But he did."

Verquer: "The first time he cut a calf he was a little confused about how to castrate, and I said, 'Here you are doing all these transsexual operations. It's the same thing. Just cut 'em off.'"

Marty: "About four days before my husband died, almost two weeks before Christmas, everyone was leaving the hospital, and I said, 'Everyone is going home but him.' Dr. Biber took my face in his hands, kissed me on the cheek and said, 'Honey, he will be going home very soon.' He's very special to all of us."

Valdez: "Some of the words he uses you have to look up in a dictionary."
Verquer: "I call him 'Shorty' when I walk up, and he always punches me."
Lujan: "He's a player. If someone needs support for a certain project, I'm sure they inquire with Biber. I'm sure he has influence and always has. He's an intelligent and respected man. His opinion is highly sought after. He's a real fair gentleman. He's worked hard all his life. Everything he's done, he's been good at."

Verquer: "He gets out there in his pickup, gets after cows, cuts hay, bails hay and plants seeds. He's done it from the ground up. He jumps right in there. He has probably the worst pair of blue jeans you've ever seen. And the same for his cowboy boots. They're full of holes and cowshit--excuse the language."

Valdez: "As well-known as he is, he's really down to earth. I've cut his hair in the past. He's not uppity-up. He's a super-duper guy."

Each year several hundred people undergo sex-change operations in this country, Biber says. Many of them walk into his office. But before he agrees to meet them in the operating room, they must fit a set of criteria designed to weed out schizophrenics, sociopaths and those who simply aren't ready.

First, patients must pass at least two psychiatric evaluations ensuring that they're not homosexuals or transvestites or simply people seeking fame and fortune on the talk-show circuit. True transsexuals, Biber says, are not attracted to members of the same sex and do not become aroused by wearing clothes of the opposite sex. True transsexuals consciously and subconsciously believe they are members of the opposite sex, trapped in the wrong body. Scientists think one person in every 30,000 suffers from this gender dysphoria.

"It's not an uncommon thing," Biber says, "when you start to think about all the people in the world."

Next, patients must receive hormone therapy for at least a year and live in the role of the opposite sex for the same period. If the adjustment is successful and another evaluation approved, plastic surgery is recommended. Then, and only then, will they get a consultation with Biber, who makes the final call. If he senses doubt, hesitation or confusion, which he does about 5 percent of the time, he sends patients home. As a consolation, he often performs minor cosmetic surgery first, such as an Adam's-apple reduction or breast augmentation.

"After doing so many of these, you develop a gut feeling," Biber says. "A bell will go off and you'll know something is wrong, even if they came with good evaluations. You certainly don't want to make a mistake. You've got to have a feel for if they're really worried about being a transsexual or if they're just scared of the surgery. It helps me in my own mind to know I'm doing the right thing."

The actual procedure takes Biber about three hours (half the time it takes other surgeons), depending on the extent of the cosmetic surgery. "Sometimes I spend all morning doing a nose job or putting in breasts," he says.

For a male-to-female sex-change operation, the testicles are removed, as well as the spongy tissue inside the penis. The urethra is shortened and placed in a female anatomical position, and an opening about six inches deep is made in the perineum and lined with skin from the penis so that it can act as a vagina. Nerve endings remain undamaged during the procedure, allowing more than 80 percent of patients to achieve orgasm. The empty scrotum is then fashioned into labia, the Adam's apple is reduced by shaving cartilage from the larynx, and breasts are often augmented with implants. The price tag: $12,000 or more.

"I've got one patient married to a gynecologist, and he doesn't know," Biber says. "She won't tell him."

For a female-to-male sex-change operation, the breasts are reduced and the ovaries and uterus removed. A penis is crafted by cutting a flap of skin from the abdomen and shaping it into a tube. Using intricate microsurgical techniques, the clitoris and other nerve endings can be incorporated into the end of the phallus to allow some patients to achieve orgasm. Silicone implants are placed inside the labia skin to simulate a scrotum. This procedure takes several stages to complete and often costs $50,000 or more. "It's still considered experimental," Biber says, "but we're getting better all the time." Biber has performed 300 of these operations.

While plastic surgery techniques have improved, so has science's understanding of gender dysphoria. Biber believes the hypothalamus, a part of the brain that regulates many body functions, including sex, might be responsible. Research has shown a difference in the size and concentration of the gland in transsexual patients.

"No amount of psychological help can change a true transsexual," Biber says. "The longer you work with these people, the more you develop empathy. You realize how hard it really is for them. We definitely think it's a physiological or anatomical change that makes these people different. Papers are written every year. It's now well-accepted."

That wasn't always the case. Critics have argued that sex-change surgery treats the symptom of transsexualism and not the cause. Some still label the procedure as mutilating and potentially dangerous, while others claim it can lead to severe depression and suicide.

Johns Hopkins, the early leader in gender research, phased out transsexual surgery in the Seventies after a study found it did not make patients substantially happier. Biber himself was attacked in a national news magazine by psychologists who claimed he was "committing mayhem" on his transsexual patients.

"They tore me to pieces," he recalls. "They said what I was doing was outrageous, cutting off normal organs and disfiguring people. And the worst part about it was that I wasn't the only one doing it."

Although Biber says he has never been successfully sued by a transsexual patient, he did settle out of court in one case he'd rather not discuss. And with 3,500 male-to-female sex-change operations to his credit, he has performed only three reversals. The first patient, whose original operation was performed by another surgeon, proved not to be a true transsexual and developed psychological problems. The second was a renowned mathematician who succumbed to intense peer pressure. The third patient used the procedure to appear on talk shows, then decided to switch back. "Those patients are harder to spot, because they come to us with good evaluations," he says. "Sometimes they slip through."

How content are the thousands of other patients? Biber doesn't have a complete accounting, he says, because after surgery is performed, patients often disappear. "A lot of them get married and have families and don't want to remember their lives before," Biber explains. "They don't want me to put the finger on them and get lost."

Nevertheless, Biber has tracked more than 500 patients over a ten-year period. "Everything from their salary to how they accept themselves has been very good," he says. "We're changing their bodies to match their gender identities. We're helping them feel good about themselves. I find them to be excellent citizens. I know 3,500 people who would agree."

The earliest memory begins at age three, when John is still Joan. She walks to the bathroom, stands at the toilet and pees all over the floor. Her mom says, "No. No. You can't pee like your brothers." But Joan is just doing what comes naturally. Even at age three, that means being a boy.

But Joan tried. For 31 years she wore lipstick, dresses and high heels and did everything possible to fill the role of a woman and please her family. She even got engaged. Her fiance was flawless, perfect--but Joan knew she could never make him happy. So she broke it off six months before the wedding.

Absolutely no one understood. The pressure became incredible. Another person might have killed herself; Joan poured herself into her job as a vice president for an East Coast advertising agency. But at age 29, exhausted and confused, she quit.

Joan looked in the mirror and saw a clown staring back, a man in a dress. Even her father said she was the only woman he knew who could get dolled up and still look like a fullback. But Joan had no sense of humor about that. How angry would you be if you had to wear pantyhose and lipstick but felt like a man inside?

One night Joan called her mom, a nurse, who sensed something in Joan's voice. "I know what's wrong and I know why," her mother said. "You're not a woman. You've never been a woman. We have to do something. I don't want to lose you."

Joan went to Johns Hopkins. "This is how I feel," she told doctors there. "If I'm sick, then fix me. If it's all in my head, then send me to a doctor, because I can't take this anymore." Doctors found high levels of male chromosomes, a malformed ovary and a tiny malformed penis. Joan was a hermaphrodite.

At least she had an answer, and it felt like a mountain had been lifted from her shoulders. But relief was temporary. A hermaphrodite? What the hell was that? Joan traced the abnormality to her dad's side and decided she would not have children. She wouldn't pass on the condition to her worst enemy.

Joan had a double mastectomy and a hysterectomy and began taking male hormones. Sometime in her mid-thirties, she began her life as John. But that wasn't exactly easy. John worried about getting into car wrecks and paramedics joking, "Okay. Now what have we got here?"

His first wife said he must have been a son of a bitch in a past life to deserve this. Their marriage lasted about a year, but the divorce had little to do with gender. She left John for a life in the Himalayas; John was not a Himalayas kind of guy.

When he met the woman who would become his second wife, John set his stack of medical records on the table. "Go ahead," he told her. "It's all there. Read it and decide for yourself, because I don't want to get hurt anymore." They've been married sixteen years, and it's been great. It's not a sexual relationship, but it's still great.

John has been celibate most of his life, and he didn't decide to have this surgery because of sex. He's not trying to attract women. Why would he go through all this trouble to look the way he does: bald, bearded, ruddy complexion, white chest hair curling over his collar? His doctors are the ones who started it. His primary-care physician and psychologist said he had no choice. The stress was killing him. He developed stress-related arthritis and suffered a breakdown.

When he and his wife made the decision for John to have the sex-change surgery, he drove nonstop to Trinidad from Arizona. His wife was so happy, she could hardly see. And his family said, "It's about time." The surgery cost $50,000 in retirement savings, but at age 56, John felt he deserved it. After all this time, he wants to be whole.

John doesn't know how he'll feel when he returns home. He knows he'll be different, but he doesn't know how. He'll probably take his wife to the best restaurant he can find. How do you say thank you to someone who has been so supportive?

Gene Lujan: "I've served with a number of commissioners in my time, and I can't think of a better one [than Biber]. His main goal was to entice industry into the county. I can't think of a thing he's done that's been underhanded."

Phillip Valdez: "As far as being a commissioner goes, he was straightforward and took interest in what was going on. He was real concerned about the jail [complex]. It took two or three times to get it passed on a referendum, and it finally passed. That was largely through his efforts. I have a lot of respect for him."

Mike Ossola, one of two county commissioners targeted by Biber for recall last January: "I have no respect for him. As a politician, he's not worth a dog. The recall? Ruthless. Low. Totally unnecessary. Just a few old-timers upset because it wasn't business as usual. It gave Trinidad a horrible image. It tore the town apart."

Jon Pompia: "I don't know that it tore the city apart, but it tore the two factions apart. It was intense and intriguing. A lot of people thought it might be kind of a personality thing."

Ossola: "It was a horrible time for me and my family."
Pompia: "Doc Biber's ads in the paper accused them of nepotism and for hiring family members and close associates. Improper firings. Fiscal malfeasance, not paying attention to the budget, that was another one. He started his ads with 'So the People May Know.' He was really good with them linguistically."

Ossola: "If I saw him downtown, I wouldn't talk to him."
Pompia: "The recall failed pretty miserably. Both commissioners retained their seats pretty easily. It's pretty much blown over now."

Biber: "If you do what you think is right, you make a few enemies, and the enemies remain with you for life. We stand by our information. Aw, who cares. It's just one of those things. That's just politics."

After decades at the top of his unexpected specialty, Dr. Biber's star is beginning to fade. Dr. Gordene MacKenzie, a University of New Mexico professor of transgender theory and author of Gender Nation, says: "During the past nine or ten years, the word of mouth has been not to go to Biber. That he has been screwing up more."

Some of Biber's former patients have complained that he's not always open to repairing mistakes, MacKenzie adds. In one case, he reportedly turned away an ailing woman who didn't have up-front money for the surgery.

"I wouldn't send anyone up there for surgery," MacKenzie says. "I know personally of too many cases that have come from Trinidad and have been botched. Basically he told them, 'It's your problem, and you correct it.' I know of at least five cases. There have been other surgeons who have had to pick up his errors."

Dr. Anne Lawrence, who operates a popular Web site, places Biber fifth on her recommendation list. Although he's legendary, performs "pretty nice work" and offers reasonable prices, "his age is starting to show," Lawrence writes. "I can testify to some major dissatisfaction among my informants."

Marsha Botzer, therapist and founder of the Ingersol Center in Seattle, cautions that anecdotal information, particularly on the Internet, should be taken with a grain of salt. While sometimes useful, such information is also subjective. Although Biber's patients may have legitimate reasons to complain, she says, more follow-up surveys must be completed before reliable comparisons can be made.

The Ingersol Center conducted its own survey and found a 97 percent approval rating among 400 of Biber's male-to-female patients. "He's one of those who have done a lot of the research necessary to make the surgeries as good as they can be," Botzer says. "In all those years, he's rendered good service. He has helped people get their lives in order."

Nancy Nangeroni, executive director of the International Foundation for Gender Education in Waltham, Massachusetts, says that while she would not choose Biber personally--"He has one way of doing things, it's too much of a cookie-cutter approach, and he has too much of a paternal approach"--she would not feel uncomfortable recommending him. "There are some things he's done that have been questionable," she adds. "He's made statements like, 'I've made these women.' But there have always been complications. There are very few surgeons who don't make mistakes, especially in something as complicated. I haven't heard of a surgeon yet who hasn't had problems. The kids who have had his surgery are very supportive. Is he turning out satisfied customers? For the most part, he is."

But when Biber retires, she adds, "there won't be a vacuum." Fifteen years ago, very few surgeons performed credible sex-change surgery in the United States; today, between ten and twenty do the operation. "There are, especially in the last five years, many surgeons who have stepped forward," Nangeroni says. "And a number of them were instructed by [Biber's] technique."

Botzer agrees. "We're in a different world," she says. "He has been gracious enough to train a new generation of surgeons. More younger surgeons are willing to make it part of their practice. There are more options. That wasn't the case twenty years ago."

When Biber finally retires, his legacy will probably remain intact. "He was, for many years, the most reliable and trustworthy practitioner in this country, especially at a time when others, like Johns Hopkins, were objecting to this practice," Nangeroni says.

"His legacy will be as one of the absolute outstanding pioneers, both on the technical side and educational side," Botzer says. "We live in a society that has a much different understanding of gender and identity issues. He's firmly in place as one of the stars. I respect him. When he can no longer provide top-quality service, he'll make the call."

Back in Trinidad, Biber addresses his critics this way: "I realize I'm going to retire. Eventually. I'd like to train someone to keep the practice in Trinidad, and I've trained a few, but I'm still looking for the right person. I told my nurses, 'Keep an eye on me. When I lose it up here and my hands start shaking, you tell me.' When that day comes, I'll quit."

That said, Biber shuffles another stack of papers, checks a message and grins. Out in the waiting room, a big-boned blonde woman rises from her chair, smooths her skirt and enters his office.

In the dim, dusty back room of the Trinidad Historical Museum, director Paula Manini frowns slightly and ponders the question.

She has just completed a whirlwind tour of the museum, rattling off the contributions of prominent figures. Kit Carson: "He didn't have a lot to do with Trinidad itself but knew people here." Felipe de Jess Baca: "Some call him the founding father, but there were really five men who started building houses here in the summer of 1861." Uncle Dick Wooton: "He set up a toll road over Raton Pass and charged people to use it." Black Jack Ketchum: "He was robbing a train south of here when he was shot."

Where's Stanley Biber?
"Biber's on the list," she says. "He's certainly one of the things we're known for. People who have heard of Trinidad know it for one of three things: coal mining, the Santa Fe Trail and the 'Sex-Change Capital of the World.' During the years when Trinidad's economy was pretty bad, he's the person that gave the city recognition. I mean, Dr. Biber has been on Geraldo and in GQ and dozens of other publications. Geraldo was actually here."

Manini has been thinking about an exhibit on contemporary figures in Trinidad, sort of a revolving display of modern movers and shakers. She could post various photos of Biber, a stethoscope or two, maybe a few snapshots of his patients. She already has a drawing of him, one done for the First National Bank the year its annual calendar featured twentieth-century figures in Trinidad. "I wrote a little article," she says. "He was just a regular old, pot-bellied, balding guy with glasses."

Still, Biber has made important contributions to Trinidad, and he's earned his spot in the museum. "It would have to be approved, but I personally think it would be interesting," Manini says. "Maybe we could get Geraldo to come for the grand opening."

A few Decembers ago, Biber received a Christmas card from Ann, who'd moved to Washington, D.C., and been hired by the federal government. She passed the interviews, the background checks and the physical exam. She was doing fine and her life was going well. She wanted him to know that.

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