It Never Goes Away: Gender Transition at a Mature Age

By Anne Lauren Koch

If you are transgendered, the feeling of wanting your body to match the sex you feel you are never goes away. For some, though, especially those who grew up before trans people were widely out and advocating for equality, these feelings were often compartmentalized and rarely acted upon. Now that gender reassignment has become much more commonplace, many of these people may feel increasing pressure to finally undergo the procedures they have always secretly wanted.
 
Ken Koch was one of those people. Married twice, a veteran, and a world traveler, a health scare when he was sixty-three prompted him to acknowledge the feelings that had plagued him since he was a small child. By undergoing a host of procedures, he radically changed his appearance and became Anne Koch. In the process though, Anne lost everything that Ken had accomplished. She had to remake herself from the ground up. Hoping to help other people in her age bracket who may be considering transitioning, Anne describes the step by step procedures that she underwent, and shares the cost to her personal life, in order to show seniors that although it is never too late to become the person you always knew you were, it is better to go into that new life prepared for some serious challenges.  Both a fascinating memoir of a well-educated man growing up trans yet repressed in the mid-twentieth century, and a guidebook to navigating the tricky waters of gender reassignment as a senior, It Never Goes Away shows how what we see in the television world of Transparent translates in real life.   

• Language: English
• Publisher: Rutgers University Press
• Release date: May 10, 2019
• ISBN: 9780813598413

Book preview

Surgery

PREFACE

If you are transgender, the feeling of wanting to embody the sex you feel you are never goes away. It is always there, like the tide. For some, this feeling is overwhelming. Others try to compartmentalize it and move on with their lives. In some instances, the feeling can’t be ignored, and the person transitions. But even when one transitions, it is not the end of the story. Rather, it is only the beginning.

For more than thirty-five years, I was a leading practitioner and educator in my dental medicine specialty. I treated over thirty thousand patients with compassion and concern, presented over one thousand lectures worldwide, founded a Harvard residency program in which I helped train dozens of residents, and created a successful education-technology company. This all came to an end when I changed sex. I underwent gender reassignment surgery at the age of sixty-three! I had no idea how difficult this transition would be.

When I transitioned, I had the unique opportunity to view the process through two separate prisms: that of a patient, and that of an experienced health-care provider. What I witnessed and went through was at times both exhilarating and concerning. Over the past five years, the number of individuals describing themselves as transgender has exploded. As these individuals work their way into the health-care system, chasing their own version of an aligned body and spirit, doctors in many different specialties are being called on to help facilitate these transitions. I found myself wondering whether these patients were being treated properly and with dignity, and whether they were being told the truth about what they could expect. How has the Internet and increased media coverage affected their status as patients? It’s a complicated issue, and I decided to tell my story, as well as provide some information I learned along the way, in an attempt to bring some light to the issue, especially as it relates to mature people who might be considering a surgical transition. As a transsexual woman and as an experienced health-care provider, I feel comfortable sharing my observations, but they are only my opinions, and I completely respect the fact that others may disagree. Furthermore, in the interest of maintaining the privacy of people in my life who do not wish to be named, I have, on occasion, employed the use of pseudonyms throughout the book. The use of such pseudonyms will be noted by an asterisk next to their name on their introduction into the story.

I have no political agenda in writing this book. I do not support the far-right agenda, nor do I support the extreme transgender agenda. Proponents of the far-right agenda deny the physiological basis for gender dysphoria and insist on referring to it as a psychological problem. Supporters of the extreme transgender agenda are the polar opposite, viewing anyone who has an opinion other than the total embrace of everyone’s right to be in the exact body they choose as being transphobic. However, I do not bill for services in this area as a physician, and I am not interested in anyone’s personal agenda. What I am interested in is veracity. The truth.

I believe that transgender medicine has gotten ahead of itself, particularly regarding surgery. Most transgender medical research is consensus based, not evidence based, and this is a challenge, because legitimate medicine depends on actual facts rather than gathered information with implied results. I see problems with trans medicine as it exists today at both ends of the age spectrum—patients over fifty-five years old and those less than eighteen years old. Unfortunately, as the public has gained greater awareness of trans issues, money has entered the equation. Insurance, including Medicare and Medicaid, is now paying for gender reassignment procedures, and the floodgates have opened. We finally have some surgical fellowships in transgender surgery, yet doctors are still taking weekend courses on phalloplasty and vaginoplasty in order to be qualified to perform these procedures. This is not an ideal situation for creating informed and skillful surgeons in this area, and this problem is only going to get worse as more people seek treatment. Buyer beware!

My hope is that transgender medicine will become a legitimate segment of the medical school curriculum. My goal with this book is to offer a cautionary tale to those people over fifty-five years of age who are contemplating a change of gender. Yes, it can be done, but it is difficult to accomplish, and currently there is a preponderance of misinformation and good old-fashioned bullshit out there for anyone trying to find their way. By sharing my story, I hope to encourage mature individuals who are considering a change of gender to re-evaluate their status and to thoroughly investigate other alternatives. There are options available to the mature person other than a complete surgical change of gender. Therapy is critical in these cases and can be enormously helpful.

I am a strong advocate for gender affirmation, and I support the idea of a gender continuum rather than a strictly binary approach. However, I want patients, particularly mature individuals, to be fully informed before they decide to make an irreversible change in their bodies.

IT NEVER GOES AWAY

1   •   THE EARLY YEARS

I WAS BORN on December 20, 1949, a Christmas baby. Everyone was hoping for a baby girl, but following a cesarean section, I arrived on the scene. My life as a very young child was unremarkable other than the fact that I loved the beach and loved being in the water. My parents had a summer house on the end of Long Island, which we would visit on weekends and where we spent the summers every year. It was glorious in July and August. So, Little Kenny Koch spent a lot of time in the sun, occasionally getting very sunburned. I was fair skinned and very blond. I can still smell the Noxzema my mother spread all over my sunburned body after I had been in the sun and gotten really roasted. It’s remarkable, but it actually seems like yesterday. It’s a nice memory.

My earliest recollection of wanting to be a girl was when I was about four or five years old. We were living in an apartment at the time, and my father was a New York City firefighter. My mother’s mother, Grandma Annie, visited us all the time, and she was a wonderful seamstress. I had a cousin, Susan, and I remember my mother wanting to make a dress for Susan. At that age, a lot of little boys and girls are the same size, so they had me model my cousin’s dress. I stood on a chair so they could adjust the fabric. I remember all the fuss that my mother and my grandmother made about me, and I loved it. I loved the fuss. I loved the feel of the dress. I was very much a rough-and-tumble little boy, but I loved being in that dress, being the center of attention. Sometime later, I asked my mother, as she was doing her nails, if I could try some nail polish. So she put some polish on my nails, which I loved seeing flashing at the end of my fingers. That day my father came home early from work, and he saw the nail polish. He got so angry! I had never seen him like that. Normally, he was such a nice man. I remember trying to process his anger, but I didn’t know what to make of it. I do remember my mother getting frightened and removing the polish. That event cured my female feelings, at least temporarily.

FIGURE 1. Fred and Little Kenny Koch, East Setauket, NY, 1951

This picture was taken by my mother in front of our summer house. We would spend the entire summer there as well as many fall weekends. I have many fond memories of this particular home through the years.

The next memorable incident came when I was around six years old. In the mid-1950s, my parents were trying to save for a house. To save money, we lived with my maternal grandmother and grandfather in a place called Whitestone in Queens. Downstairs in the cellar, there were boxes and boxes of dresses made by Grandma Annie, since my mother was one of three sisters. I remember going down into the dusty cellar and playing dress-up and having so much fun. I just loved the feeling of wearing those dresses, and down there, I could hide in the cellar and enjoy myself.

Around the same time, my uncle, who was a merchant marine captain, was dating a German woman who wore fancy underwear. I tried on her underwear a few times and loved the feel of the material on my skin and how pretty it looked. Once, I even got caught wearing the fancy underwear by my relatives when visiting their house, and I was mortified that I’d been caught wearing women’s panties. They made a big joke about it, but it was very embarrassing.

I also became infatuated with fur coats. In fact, anytime my mother would go to a department store, I would be transfixed looking at the fur coats. I specifically remember one salesman saying to my mother, Oh, that little boy is going to make some girl really happy someday by buying her a fur coat. Little did he know that the little boy buying the coat would end up being the girl! I just loved the feel of the coats. I loved the way they looked, and I enjoyed their elegance.

ADOLESCENCE

In 1957, my parents made a huge move. We moved out to Smithtown, Long Island, which was about seventy miles east of Manhattan. Yes, they had finally bought a house. It was such a wonderfully exciting time for my parents as well as for my brother and me. It truly was American dream stuff. The Cape Cod–style house was in a development, and I struck up a friendship with a boy my age. Bobby and I used to play made-up games together. I created a game that included a penalty if you lost. The penalty was that the loser would be changed into a girl. Poof … you’re a girl! As further punishment, you would have to act like a girl. Bobby and I played this game every day for two years. All of a sudden, poof, poof, you’re a girl. The loser would then have to talk and behave like a girl.

At the same time, I was doing incredibly well in athletics, especially baseball. I was also a straight-A student. So, I had this incredible dichotomy in my life at the time, and what is amazing to me now is that a few times during this period, my grandmother asked me if I would like to be a girl. What made this woman think her rough-and-tumble little grandson would want to be a girl? But my Irish grandmother saw something that no one else did. And in those days, in the late 1950s, this sex-change thing was getting a lot of publicity. Christine Jorgensen had made a big splash earlier in the 1950s, and there were also newspaper articles about these exotic creatures from France, like Coccinelle, a performer who had changed sex in Casablanca. I remember focusing on any news pertaining to sex change for many years.

Junior high school is a confusing, crazy time for anyone. I missed the basketball tryouts in eighth grade because I was taking a piano lesson. I really didn’t want to learn the piano, but my mother insisted that I take lessons. Because I missed the basketball tryouts, I didn’t make the team, and so I was stuck at home with time on my hands. Consequently, what I started doing was dressing up in women’s clothes again. At that point, I didn’t connect it to my sexuality; it just felt right. One day, I was home dressing up when my best friend knocked at the front door. He wanted to go to the junior high basketball game. I was wearing women’s clothes at the time, so before I answered the door, I ran upstairs and put my boy’s clothes on top of the women’s clothes. Then we walked to the school to watch the basketball game. There was nothing exotic about it, but I was terrified of someone noticing that I was wearing women’s clothes as I sat there watching the game.

By age thirteen, I realized I was a good athlete. In addition to being an incredible baseball player, I was an excellent football player, who could throw a football fifty yards by ninth grade. I got good grades. I was the perfect son. But every night, I found myself saying a prayer, God, please make me a professional baseball player or a woman. Think about that. As it turned out, I had the option for the former later on, but I was smart enough to not go in that direction; then, the other option came true. It is amazing how sometimes prayers are answered. Truman Capote was correct when he wrote, More tears are shed over answered prayers than unanswered ones.

HIGH SCHOOL

I loved to dance, but it was kind of awkward in high school because I wanted to dance like the girls, not necessarily with a girl. I hid those feelings and suffered tremendous guilt about the way I felt. Thank God I had the intellect and the fortitude to compartmentalize those feelings. But the guilt was always there. It never went away. In high school, all I let myself care about were sports and academics. I had been moved a year ahead in school, so I was only fourteen years old as a sophomore, but I amazingly still made the varsity football team. This was at a big high school—we had more than five hundred kids in my class alone. I made the football team and ended up being the number-two quarterback and a starting cornerback. This was big news! I was the youngest starting varsity football player on Long Island. But at the same time that I was excelling on the football field, upstairs in my house, underneath my bed, I had lots of magazines. Adolescent boys generally have magazines underneath their bed like Penthouse or Playboy, but my magazines were Vogue and Ladies’ Home Journal. I would sit at my desk in my bedroom and trace the dresses and the women’s clothes and then redesign them. I would add a belt or change the color, things like that.

During my sophomore year, I was upstairs in my room, perfectly happy, working on designing women’s clothes, when I heard my mother talking to my father downstairs. My mother had been a professional singer with NBC, so she had a voice that projected. She said to my father, Woody, you have to go upstairs and speak to your son. He said, Why? She continued, He’s upstairs, and he’s drawing dresses. My father’s response was priceless, So? My mother got very agitated with that response and said, You know this is not right. You’ve got to stop this. Go upstairs and speak to him. And she went on in this way for a while. Eventually, I could hear him start to come up the stairs, so I immediately rearranged the papers on my desk, and I closed the bedroom door so that it was open only a little bit. My father came up and knocked on the door, which he never did before or after. He said, Excuse me, Son. He never called me that; he always called me Ken. I said, Yes, Dad? He said, Is everything okay? I said, Yeah, everything’s fine. He continued, What are you doing over there? I said, Well, I’m actually doing my social studies. I’m doing some homework. He responded, Okay, then turned around and walked down the stairs. Of course, as soon as he got down to the living room my mother was on him like bees on honey. Did you speak to him? Yes, I spoke to him. Is everything okay? Everything’s okay. My dad just walked away. I was so grateful for my dad’s response. Indeed, I have often thought about the response of my parents if they had been alive when I transitioned, and I think that my father would have had a much easier time with it than my mother. My father became much more open minded as he aged, and we enjoyed a wonderful relationship.

FIGURE 2. Fourteen years old, varsity football, Smithtown Central High School, 1964

The only sophomore playing varsity football for Smithtown Central High School. I played halfback and quarterback. At fourteen years old, I was the youngest starting varsity football player on Long Island.

I was very successful in high school. Besides playing a varsity sport as a fourteen-year-old, I was only the second student in school history to be elected to the Honor Society as a sophomore. I excelled at everything, but I had no interest in girls. I didn’t want to date girls; I just wanted to be a girl.

During my sophomore year, I suffered a football injury, which would be the first of many. I tore all the ligaments in my right shoulder, so I missed three games and received a lot of sympathy. But the recovery time also gave me time to think about things. As I went through high school, I ended up lettering in seven out of nine possible sports. I won the school’s Most Athletic Award and some local awards on Long Island. But even while I was doing what was expected of me as a young man, I couldn’t stop thinking about being a girl.

Eventually peer pressure made me date. My first date was to the junior prom. It was an absolute nightmare, just a horrible date. My father drove my date and me to the junior prom in our Mustang, and I was so mortified, both because my dad was driving us and because my date, Laura*, didn’t realize that even though I was dressed like a boy, I was secretly thinking, "That dress would be so fun to