The Visionary Surgeon Who Put Trinidad on the Map

On December 12, 1990, a law office secretary and part-time English graduate student in Rancho Cucamonga, California, sat down to write a letter that had been nearly four decades in the making. Her name was Claudine Toni Griggs.

The diminutive Griggs had lived as a woman for 16 years, since the summer of 1974, though she’d been born and spent the first 21 years of her life as Claude Anthony Griggs. So complete had been her outward transformation from male to female that few of her friends and professional colleagues knew. At five-feet-five and 120 pounds, she says, “All I had to do to look sexually ambiguous was shave what little facial hair I had.” Plus, for 17 years she’d been taking hormone treatments that eased her even further toward the female end of the gender spectrum. Her transition had stalled short of the next logical step, though: surgery that would transform her male genitalia into that of a female. But by early December 1990, Griggs had made peace with that decision.

During a routine appointment with her endocrinologist less than two weeks earlier, though, her doctor had asked a direct, provocative question: “When are you planning to have surgery?”

“Never,” she replied. “I’ve learned to live without it.”

The doctor pressed. “Why don’t you want to have the surgery?”

When she’d explored the possibility in the 1970s, Griggs told him, she’d found the attitudes of the doctors she approached off-putting. Her half-dozen encounters with various surgeons, medical centers, psychiatrists, and others left her feeling they were “less than knowledgeable, sometimes less than competent and less than ethical.” In her journal, she later allowed herself to remember those difficult encounters: “If you do everything we tell you, when we tell you, and convince us you will be successful as a woman (their definition of ‘success’), then we will consider, after keeping you under our scrutiny for several years, whether to authorize final sex reassignment; and bear in mind, we rarely approve surgery (no alternative was ever mentioned). On one occasion, I met with a slightly more dangerous attitude: ‘If you’ve got the money, I’ll do surgery—immediately.’ ”

Once, in 1977, she’d gotten as far as scheduling the operation—only to find out the chosen surgeon had lost his medical license just weeks before he was set to do her surgery. “I was told by another physician that ‘he had butchered a couple of people,’ ” Griggs later recalled. “To this day, I do not believe I have completely recovered from the experience.”

The endocrinologist shook his head, assuring Griggs that things had improved. Still anxious about revisiting the idea, she couldn’t escape that thought as she left his office that morning. A “familiar and terrible emotional storm” began to swell, and she found herself crying during the drive home.

Five days later, during a phone call, she asked the doctor to help her identify and locate one of the specialists he’d suggested might help. The doctor referred her to a nun in nearby Orange County, who he said had experience in connecting transgender people with a doctor who could do the type of surgery she was seeking. Although they never met in person, Griggs today believes the nun was herself a transgender woman and was prepared to make a referral based on her own experience.

Griggs made the call. After a phone consultation in which Griggs answered questions about how long she’d lived as a woman, whether she was taking hormones, and if she was in counseling, the nun simply said: “Most patients go to Dr. Biber.”

Who?

Griggs was given the contact information for an office in a place that sounded as if it were the middle of nowhere, a small town 200 miles south of Denver near the New Mexico border that the New York Times many years later would describe as “the sex-change capital of the world”: Trinidad, Colorado. “I had never heard of Dr. Biber or Trinidad until I was referred to his office, and I really didn’t want to travel so far for the surgery,” Griggs says today. “But I wanted the procedure badly enough to do it nonetheless.”

Griggs’ improbable adviser, the Orange County nun, was correct. Since 1969, Dr. Stanley H. Biber had been specializing in something that few surgeons dared attempt, and he had been doing so in perhaps the unlikeliest place on the planet.

Trinidad, a small town along the southern Colorado–northern New Mexico border, once was a coal mining and ranching outpost that today is home to only about 8,000 people. While it has a colorful history and maintains a charming downtown, Trinidad has always been the kind of place where road-numbed motorists traveling Interstate 25 between Denver and Santa Fe exit just long enough to top off their gas tanks, refill their go-cups, and use the bathroom.

Trinidad’s only hospital, which serves a population that’s more than 50 percent Latino, still has only 25 beds. Biber had performed the first of more than 6,000 gender confirmation surgeries there in 1969 during a career that would last until he was in his 80s.

The self-assured doctor—himself a bantam at five-five, but who once was a bodybuilder—had honed his surgical skills as chief surgeon of a Mobile Army Surgical Hospital, or MASH unit, during the Korean War and spent the early years of his career focused on appendectomies, tonsillectomies, and C-section births. But one day a social worker and personal friend asked a question at the end of an otherwise routine appointment: Would Biber consider performing a delicate surgery?

“Of course I can do your surgery. What do you want done?”

His visitor explained that she was a transgender woman.

“What’s that?” he replied.

At the time, few U.S. surgeons had ever performed a gender confirmation surgery. About 18 years had passed since the phrase “sex change” first entered the American lexicon, when an American soldier who was assigned male at birth traveled to Denmark to become Christine Jorgensen. But Biber never lacked for confidence and began researching the idea. He consulted a doctor in New York who’d performed the male-to-female surgery, obtained some hand-drawn diagrams from Johns Hopkins University, and without informing his bosses at then-Catholic Mt. San Rafael Hospital, agreed to give the experimental operation a try.

It was the beginning of a medical specialty he never could have imagined. As he began to refine his techniques, word got around. By the time Griggs first heard Biber’s name in late 1990, the phrase “going to Trinidad” had become a familiar euphemism for undergoing that type of surgery among transgender men and women around the world.

Griggs thanked the nun for the information, hung up the phone, and stared for several minutes at her notepad. Don’t get too excited, she remembers thinking. Don’t get your hopes up until you have actually heard from this person. She knew the screening process to qualify for the surgery could be rigorous, based on guidelines recommended for treating those with gender dysphoria. She also knew that only a handful of doctors in the world were capable of doing what she wanted done. It was a long shot, and she was afraid to imagine. For people like her, she later wrote, “the distance from faintish optimism to the brink of suicide can be very short.”

Six days later, according to her journal, Griggs sat down at her keyboard and began to type. “Dear Dr. Biber,” she began, trying to sound businesslike and restrained. “I was referred to your office by Dr. Herbert Roberts, M.D. [a pseudonym Griggs created for UCLA’s Dr. Gerald Leve to mask his identity, among others, in her published journal]. Dr. Roberts indicates that many of his transsexual patients have had surgery through your office. I have been under Dr. Roberts’ care for 17 years. Would you please send me information regarding your requirements for my having surgery through your office? If you need more information or have any questions, do not hesitate to call. Thank you. I am looking forward to hearing from you. Very truly yours, Claudine Griggs.”

She recorded her feelings about sending the letter in her journal. Reflecting on the letter’s tone, she wrote: “I don’t want to sound as if I’m begging, because I have determined that I will not plead my case from my knees.” Of the quiet desperation that took hold once it was in the mail, she added: “I am afraid that the surgeon will respond too soon; I worry that he will not respond at all; I fear that he will die or retire before I can have the operation; I dread the surgery; I dread more a life without it.”

But the holidays were fast approaching, as were her exams for a master’s degree in English. During holiday meals of turkey, dressing, pie, and wine with family and friends, she wondered, Will I be alive next Christmas? Will I be female?

Some say that the story of Stanley Biber in Trinidad began during a childhood train trip from his native Des Moines, Iowa, to visit an uncle who lived on a Texas ranch. That’s where, according to his widow, Mary Lee, the dream of owning a ranch and running cattle may have caught fire in the young man, a dream stoked and nurtured by Biber’s fondness for John Wayne movies and the Hollywood version of Old West mythology.

Others suggest the story began more directly in Korea, during Biber’s time as a battlefield surgeon in a MASH unit. That’s where he honed his skills as a surgeon while trying to save soldiers who’d been shot or who had stepped on a land mine, leaving their bodies devastated by wounds to reproductive organs, bowels, and urinary tracts. That’s where he developed a reputation as tireless and determined, where he supposedly cemented his legend by performing 37 consecutive surgeries before passing out, and earned a commendation for completing an operation even after shrapnel from an explosion outside the surgical unit lodged in his butt, sending a stream of his own blood down his leg as he worked.

Of course, there was a bit of serendipity involved as well. Biber was born May 4, 1923, in Des Moines, where his father owned a furniture store and his mother stayed busy with local social causes. After briefly considering a career as a concert pianist, he graduated from high school early and enrolled in a yeshiva in Chicago, intending to become a rabbi. As happened with so many of his generation, World War II interrupted his studies.

The basic origin story of Biber’s life in Trinidad holds that he arrived in 1954 after serving as a civilian employee with the Office of Strategic Services (OSS, the forerunner of the Central Intelligence Agency) in Alaska and Canada’s Northwest Territories during World War II. Biber, who was not yet 20 at the time, didn’t talk much about his work during that period. “Just say I was there,” he told an interviewer in 1998. But Kelly Tucker, who in 1983 became Biber’s financial adviser, says Biber once alluded vaguely to “blowing up Japanese radar bases.”

The specific details of Biber’s OSS service may be lost to history. At best, they’re buried in inaccessible government records that even a Freedom of Information Act request could not excavate. But it’s worth noting that in June 1942, six months after the attack on Pearl Harbor, Japanese troops invaded two remote, sparsely inhabited Aleutian Islands named Attu and Kiska in what was then the American territory of Alaska. What followed is a nearly forgotten chapter of the war called the Aleutian Islands campaign. The Japanese military quickly established bases there, about 1,200 miles west of the Alaska Peninsula, possibly to monitor any American attempts to strike Japan from the Aleutians, or possibly to dilute U.S. forces before the planned Japanese strike on the more strategic Midway Island in the central Pacific. Either way, the islands represented the only U.S. soil captured by an enemy during the war, and because of that their recapture had great symbolic value.

After setting up a naval blockade of the islands, the U.S. military landed 11,000 troops on Attu in May 1943 to take it back. After a bloody two-day battle, more than 2,000 Japanese soldiers were dead, as were about 1,000 Americans. The Japanese occupiers soon abandoned Kiska, where 35,000 American soldiers landed unopposed in August 1943. Was Biber part of that mostly uncelebrated effort? It’s difficult to say, though his cryptic comments to Tucker raise that intriguing possibility.

Biber excelled at a number of things during his postwar life, including his premedical studies to become a psychiatrist and his quest to become a member of the U.S. Olympic weightlifting team. He once claimed to have missed that honor “by 20 pounds,” and even into his 80s was prone to rolling his sleeves up over his biceps to show off his guns. After graduating from medical school at the University of Iowa in 1948, he discovered a talent and passion for surgery during his residency at an Army hospital in the Panama Canal Zone. He was also a gifted pianist, and he found that his dexterous hands quickly adapted to the fine motor skills needed during surgery. He liked the challenge of it and the opportunity to innovate as circumstances with the patient changed. He excelled, and people noticed.

Biber eventually found himself in Korea. “He was encouraged by the government to either volunteer for two years or be drafted for three,” Mary Lee Biber, his fifth and final wife, says. “So he volunteered and went to the DMZ as a MASH doctor.” As the unit’s chief surgeon, Biber once told an interviewer, he supervised such medical advances as vessel transplants and “got a tremendous amount of experience.” He also became an inadvertent hero, according to two family members, after accompanying a helicopter pilot behind enemy lines to rescue wounded soldiers. “He didn’t know he had crossed enemy lines!” says stepdaughter Kelly Mestas, whose mother, Ella Mae, was Biber’s fourth wife. “He went and he picked them up. They were shooting at him and everything. And he brought them back. But he said, ‘Do you think I’m dumb? I wouldn’t have crossed enemy lines. I didn’t know!’”

After the war, Biber was working at the Army’s Fort Carson near Colorado Springs when a colleague asked him to join a five-member clinic planned by the United Mine Workers in Trinidad. He figured he’d help get the clinic up and running, then move on. But he didn’t. While Las Animas County’s population peaked at nearly 39,000 people during the coal boom in the 1920s, it still had a post-boom population of about 26,000 residents by the 1950s. At that point, Biber was the only general surgeon in town.

His focus was caring for the workers doing the dangerous underground work at the Allen Mine, which opened in 1951 and was among the most productive in the state. He once told Ella Mae, to whom he was married for 23 years, that he knew he could practice medicine anywhere in the world. But he also told her he never wanted to leave Trinidad. “He was so dedicated there,” she says. “He delivered so many babies, did everybody’s surgery, and everybody trusted him tremendously. He loved everyone in Trinidad. You don’t see doctors commit to their patients anymore. He took care of them from birth to death, in most cases.” Mary Lee Biber, who worked as a nurse with Biber for 42 years before becoming his fifth wife, says she ended up marrying the man who’d been her doctor since she was 15 years old.

Biber once described working 18-hour days, six days a week, during his early years in Trinidad. By many accounts, he did a bit of everything, from setting broken bones, to repairing gunshot wounds, to resolving more run-of-the-mill problems such as hernias, hemorrhoids, and infected or burst appendixes. “He told me he made $3,500 his first year in Trinidad,” Mary Lee says. “He charged $3 for a house call and $2 for an office visit.”

He also began what ultimately would become a very complicated family life—five wives and nine children and stepchildren—during those years. He and his first wife, Shirley, had four children: Joann (who now goes by the name Prabhu Nam Kaur Khalsa), Robert, Debbie, and Patricia. After the marriage ended in divorce, Shirley decided to relocate with their kids to the Denver area, nearly 200 miles north of Trinidad. The children sometimes visited their father, and Biber apparently used his pilot’s license to visit them on weekends, but for much of their lives there remained a distance between Biber and those four children.

Biber’s second marriage, to Sharon, was short-lived but produced a son, David, who now lives in a rural area near Pueblo. The surgeon’s third marriage, to a nurse named Debbie, was brief as well, and produced no children. The 23-year marriage to Ella Mae produced two children, John and Terri, who shared Biber’s ranch home with Ella Mae’s daughters from her previous marriage, Pam and Kelly. Biber spent his final years with longtime nurse Mary Lee Vigil, eventually marrying her in 2005, less than a year before his death in January 2006, at age 82.

Biber’s professional success carried on through it all. The more he worked, the more he got to know the people in the community, and the more useful Biber felt. He touched many lives, in many ways, every day. It’s hard to find a local who’s not eager to share a personal story of the time Biber set their broken bone, did minor surgery during an office visit, or delivered them squalling into the world.

Lifelong Trinidad resident Dick Hamman recalls a day in 1960 when Biber saved his father’s life. The elder Hamman, a tough-it-out clerk on the Colorado and Southern Railway for nearly 50 years, experienced severe abdominal pain at work and was sent home to recuperate after four days of suffering. The family doctor requested a urine sample, which Hamman’s mother collected in a sterilized jar. Young Dick, then perhaps eight or nine years old, rode the sample to the doctor’s Main Street office on his bicycle. The doctor tested the sample and then ordered Hamman’s father to the hospital, immediately.

When they arrived by car, Stanley Biber was waiting and took the father into the operating room, where Biber discovered that his appendix had ruptured four days earlier. Infection of the abdominal wall had already set in. “That’s a death sentence,” Hamman’s son says. “He took my dad in, cut him open, and literally took his guts out, put them on the table, washed them all out, repaired everything, put him back together, and sewed him up. And since then dad swore he was the best ever. Before that, he didn’t like Dr. Biber, but after that….” Hamman shakes his head as he recounts the story. “Everybody will tell you he was a brilliant, brilliant surgeon. And he was. He was very good at it.”

The moment that would change Biber’s life, the reputation of his adopted hometown, and the lives of thousands of transgender patients “came to him by accident,” says stepdaughter Kelly. “It just kind of walked into his office one day.”

His visitor was a friend, a social worker with whom Biber had consulted in the past on harelip and cleft palate cases from around Las Animas County. As Biber recounted in a 1998 interview, the red-haired woman lingered a moment after the business of the day was finished. Eventually, she summoned the nerve to ask her important question. Biber knew about the widely reported case in which Christine Jorgensen had been surgically transformed. But at the time, the term transsexual or transgender was hardly part of the cultural vocabulary.

After his visitor explained that she was among the first patients to be treated with female hormones by pioneering gender researcher Dr. Harry Benjamin, Biber began educating himself the same afternoon—apparently after he’d tentatively agreed to do the operation. He learned that Benjamin was a German-born protégé of Magnus Hirschfeld, who Susan Stryker, author of the 2008 book Transgender History, says first advanced the theory of “sexual intermediaries”—the notion that each person represents a unique combination of sex characteristics, secondary sex-linked traits, erotic preferences, psychological inclinations, and culturally acquired habits and practices.

Benjamin moved to the United States in 1913, and by the 1950s had established himself as the leading American authority on transgender issues. It would be another decade before Benjamin’s “standards of care” would become the accepted protocol for treating transgender patients, but Biber’s visitor apparently already was adhering to basic tenets of those standards. She was taking hormones, had passed Benjamin’s psychological criteria for the surgery, and already had lived for a full year as a woman.

At the time, the Johns Hopkins Hospital in Baltimore was the American center of what then was called sex change surgery. Biber called Dr. John Hoopes, a plastic surgeon at Johns Hopkins who at the time had done about 13 such operations, seven of which were what Biber described as “simple penectomies,” similar to the operation done on Jorgensen. Hoopes eventually sent Biber a set of rudimentary hand-drawn diagrams showing the basic technique for deconstructing a man’s genitalia and reconstructing it into a sort of artisanal vagina.

Biber looked over the drawings and called the social worker back. “Well, I’ve never done one, but if you want to do it, I think we can do it.” She agreed, and Biber for the first time performed a procedure known as the penile-scrotal flap, a technique he later described as “horrible looking.” But he also said it seemed to work reasonably well.

In the early 1970s, transgender people seeking surgical relief didn’t have many options. Things were changing, for sure. Thanks to the social and sexual upheavals of the 1960s, women wearing pants in public no longer caused a fuss, and men whose hair spilled over their collars were more the norm than the exception. Gender-bending entertainers such as the New York Dolls and David Bowie were finding their ways into the American mainstream. Historian Susan Stryker describes the dawning of a momentarily cool “transgender aesthetic” back then that signaled a changing relationship between appearance and biological sex, even if the more entrenched forms of gender discrimination and sexism remained firmly in place.

For transgender men and women, Stanley Biber’s nascent practice in Trinidad was a revelation. Here was a skilled surgeon at a real hospital who offered them help, dignity, and hope—all with a dose of extreme confidence, and without judgment. At the time, that combination was enough to coax reluctant and sometimes desperate people to Trinidad from thousands of miles away.

Just three weeks after she’d first reached out to the renowned surgeon, Griggs found a letter in her mailbox postmarked Trinidad, Colorado, from the offices of Dr. Stanley Biber. She braced herself.

Biber’s response was, she says, “a pleasant shock.” His letter simply described the available services—genital surgery, breast implants, a tracheal shave to reduce the Adam’s apple, rhinoplasty—and their corresponding costs. It described the need for two psychiatric evaluations recommending her for surgery, and the need to write and forward to Biber a social history of herself. Also, Griggs was told that she must have been living full-time as a woman for at least one year before she would be considered. She’d already been living openly as a woman for 17.

The cost breakdown, payable in full at the time of the surgery, would be as follows: Biber’s surgical fee, $4,850; hospital cost, $5,435; anesthesiologist fee, $925. Breast implants were not included, but were available for an extra cost. Insurance would not cover the surgery, the letter noted, but Biber promised to refund appropriate fees if she made a successful claim against her medical insurer. It ended: “We will be glad to help if you can meet our requirements.”

Again, Griggs began to cry.

By January 21, 1991, less than two months after she first wrote to Biber, Griggs was ready to send another letter that included the requested “brief social history.” It was 10 pages long, single-spaced, beginning with her birth in Millington, Tennessee, 37 years earlier; her youth as the child of an Air Force and California National Guard “lifer”; her primary and secondary education in Southern California; her own year and a half as an information specialist in the Air Force; her honorable discharge from the military after revealing her gender-identity situation; her education and work history; and her generally unsatisfying sexual history with both male and female lovers. At the time, she wrote, she was involved in a four-year relationship with a woman named Carolyn, “the first relationship I have ever dared hope will be permanent.”

“I have asked myself why, if I am so happy, do I seek out a surgeon as I approach middle age; I can come up with only partial answers,” she explained to Biber. “I know that if surgery were impossible to attain, I could survive without it, bearing the discomfort of my present physical condition in much the same way (I think) I might bear up if I were paralyzed from the waist down and had to spend my life in a wheelchair. It would be a distressing situation, it would present some grave obstacles, it would be depressing, but it would not stop me from reaching out to work, study, learn, and just keep moving through life.”

She also enclosed a photograph and noted in closing that the cost would be manageable. “I may flinch when I withdraw the funds from my savings, but I can afford your fees.” About three months later, on April 27, Griggs got the answer that both thrilled and frightened her. Biber accepted her as a “surgical candidate” and enclosed a four-page information packet called “The Trinidad Experience: Information About Your Hospital Stay (Male to Female Procedure).” But the decision was not yet final, Biber explained: “Though you have been accepted as a candidate, please bear in mind that I will make the final decision in my office the day prior to your scheduled surgery.”

Still, Griggs allowed herself some hope. Fifteen years after her first attempts to find a surgeon, she found herself reassured by this voice from the Colorado wilderness, by Biber’s professionalism and confidence, by the fact that, as she wrote, “medical care is being offered almost routinely to a subdued transsexual who had given up looking for a remedy, resolving instead to accept the pain of existence—physically, legally, psychologically—in a kind of sexual limbo.”

For the first time in what seemed like forever, Claudine Griggs imagined the life she felt born to live.

This article is adapted from Going to Trinidad: A Doctor, a Colorado Town, and Stories from an Unlikely Gender Crossroads, which will be published by Bower House Books on April 15; Tantor Media will release Going to Trinidad as an audio book on that same day.

Martin J. Smith is the author of five novels and five nonfiction books, and is a frequent 5280 contributor. Email him at letters@5280.com.