Bridging the health-care gaps for trans patients

Dr. Anne Koch has done a little of everything.

She helped found the postdoctoral program in endodontics at Harvard University and has developed endodontic techniques. She is an Air Force veteran, a faculty member at the University of Pennsylvania and an activist for LGBT patients, and she’ll publish her first book, “It Never Goes Away: Gender Transition at a Mature Age,” through Rutgers Press early next year. Koch has a fascinating story, with a bit of wisdom for every occasion, and she wants to use that narrative to show the medical community how it’s failing LGBT patients.

Koch is leading a series of lectures at medical schools around the country, including the Philadelphia College of Osteopathic Medicine last month and Harvard this month, telling her story as a medical professional and a transgender woman. PGN sat down with Koch to talk about how doctors can help LGBT patients, her new book and what she’s learned over the years.

PGN: Tell me about starting your dental career in Philadelphia in the 1970s. Was it a comfortable place to be as an LGBT person?

AK: I went to school at Penn and worked there for a while, so I spent about 10 years in West Philadelphia. I had two bikes and a car stolen. I loved Philadelphia, especially in the late ’60s and ’70s. It was so fun! Philadelphia goes out for Halloween like no other city.

I’ll tell you a story I told at my lecture at PCOM: I came out of dental school and I was working that first year in West Philly up on Baltimore. There was this beautiful young woman who came in, looked just like Diana Ross sitting in the waiting room. But my receptionist comes to me and says, “Hey, we have a problem.” The lady’s cards and identifications all had this masculine name. So I asked her if it was a mistake and she said, “Oh no, that’s me.” But I didn’t say anything rude, I treated her exactly as I would the rest of my patients. 

And very quickly after that, I found myself doing cosmetic dentistry for all the queens in West Philadelphia! One patient even brought her mother in to meet me. It’s all about trust and respect. 

PGN: Accessing medical care can be so stressful when you’re queer in any way, and going to the dentist is stressful for everyone. What can medical providers do to make health care less difficult?

AK: If you’re going to be an endodontist, you have to learn how to deal with people in tremendous amounts of pain. I’d make the case that if you’re going to be a surgeon who deals with transgender patients, you need to get used to that too. You need to do some hand-holding. You need to show empathy. Aside from death, gender and surgery are just about as personal as it gets. Doing endodontics — that’s root canals and microsurgery — you see so many people you have tremendous empathy for. They’re sitting in the chair already crying. And I try to use that pain as an analogy for treating the transgender community. The importance of simply letting people know that you really do care, that attitude matters when you’re treating transgender patients. 

PGN: What are some mistakes medical providers commonly make?

AK: I’ve treated a lot of trans patients and one thing you’ll learn is that their level of tolerance with providers is extremely low. So you don’t have a lot of room to screw up. Don’t make any assumptions, that’s a big one providers make. Don’t assume anything and ask them how they’d like to be addressed, which goes right into the pronoun issue. Ask them, because you don’t get to choose their pronoun. They’ll tell you. But it’s just all about basic respect. But I am so optimistic about the next generation of health-care providers. They’re bringing to the table better communication, improved after-care and — oh my God — they’re actually doing follow-ups.

PGN: How are you educating doctors and medical students?

AK: I’ve been doing lectures all over the country for years. I’ve written something like 150 articles and lectures. I’ll answer anything, I’m completely open. I go into the after-effects of the surgeries and I address transgender after-care. I talk a lot about my perspectives and the things I’ve seen along the way. I don’t B.S. it. I talk about what it was like for me to transition, all the way, in 14 months — which is not recommended, by the way! One problem I have with transgender medicine, where we need to improve things, is often that therapy ends when a person has transitioned. Why? That’s the beginning. I’ve had people after lectures thank me for opening their eyes, but I’ve had some people who’ve tried to say, “As a Christian conservative … ” These are people’s lives on the line! No one is disposable here. Doctors take an oath. I can’t believe it’s 2017 and my colleagues are still hesitant to step forward. It’s beyond sad for me, and that’s why I am doing what I’m doing. Someone has to step up. One of the reasons I go around to schools and give lectures is to have transgender medicine become a legitimate part of every curriculum. It needs to be seen as a legitimate part of medicine. I think in four or five years, you’ll see that transgender medical care is very different.

PGN: What can we expect from your book, “It Never Goes Away”?

AK: Well, I talk a bit about myself and how I transitioned at 62. I talk about the medical realities, the emotional realities, all the things that will come up that you don’t expect and no one talks about. I’ve had the opportunity to look at transition from two prisms — as a patient, and as a health-care provider — so I think that’s a unique perspective. I’m really excited for the book to come out because I don’t want to be dramatic here, but this is a book that could save lives! 

One thing I address is the idea of regret. To say there’s never any regrets, I find it disingenuous. It’s really tough to talk about regrets because even if you lose everything, you still have your pride. The far more introspective, interesting question is, Would you do it again? I want people to understand what I’m talking about. I talk about [transitioning] all the time and people tell me, “Annie, you’re too open,” but I have to talk about it. It’s a part of me. If anyone thinks they can intimidate me, they don’t know Anne Koch!