Leading up to the 2024 presidential election, an unprecedented wave of anti-LGBTQ+ bills have been proposed across the country. Gender diverse youth are the most notable target of these proposed laws that seek to prohibit them from accessing gender affirming care, competing on school sports teams, feeling safe to discuss their gender identity at school, and much more.
Mainstream media coverage of anti-LGBTQ+ bills targeting transgender adults and children has, in some ways, been the catalyst for many Americans to be familiarized with transgender identities. For some, this recognition has led to the false belief that transness is “new” or “the latest trend.”
These statements conflating transness with “newness” deepen fearful sentiments among those afraid of what that “change” will bring to a traditional understanding of gender, but they also minimize and dismiss the reality that there are transgender elders among us. Living within the intersection of a marginalized age demographic and gender identity makes the experience of being a transgender older adult unique, yet frequently overlooked. Perhaps this societal disregard reveals a need to bolster the presence of transgender elders in queer spaces so that they can discuss possible solutions to the medical and social challenges they face and hopefully prepare transgender adults and youth to better navigate healthcare and society in more affirming ways.
Below is a brief snapshot of the medical and social issues faced by many transgender elders living in the United States. It is important to remember that every transgender person is a unique individual and may or may not have experience with these concerns or to varying degrees. If you are curious about the individual experiences of a relative,loved one, peer, or colleague, they may likely appreciate if you ask them about their story!
Challenges in Healthcare
Access to Gender Affirming Care
Gender affirming hormones and/or gender affirming surgeries can be extremely difficult to access depending on the health insurance and legal protections available. At the federal level, the Affordable Care Act prohibits discrimination on the basis of a pre-existing condition such as gender dysphoria. Individual states contain their own regulations on what insurance plans must provide coverage for. For instance, the state of Virginia passed a law that prohibits insurance companies from discriminating against transgender patients on the basis of their identity and requires insurance companies to cover the cost of gender affirming care consistent with what cisgender patients are entitled to.
For transgender elders, accessing gender affirming care is often complicated by needing to rely on people, either entirely or somewhat, for their care. Family members and assisted living facilities may not be supportive or competent enough to help administer hormones or provide transportation to and from gender care appointments, let alone to and from gender affirming surgeries. It is imperative for transgender elders to be either independent enough to keep up with gender affirming care on their own or have an ally on their side to help where they can.
Lack of Support from Providers
Despite the importance of endocrinology and primary care specialties in managing hormone care for transgender patients of all ages, there is a shocking lack of transgender-specific training. According to a study published in The Journal of Clinical Endocrinology & Metabolism, 80.6% of 411 surveyed practicing clinicians reported never receiving any formal training on how to treat transgender patients. Outside of prescribing hormones, these clinicians reported feeling ill-prepared to serve transgender patients and requested online modules to learn about gender topics.
Clinicians lacking the proper training on how to build empathetic connections with their transgender patients run the risk of causing harm. Since transgender elders are likely navigating multiple health conditions, they are at a particular disadvantage if their physicians are not trained on age and gender-related issues.
Shared Generational Hardships
LGBTQ+ Americans living through the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic of the 1980s were at an increased risk of contracting HIV via injection drug use and/or unprotected sex. Breaking down the risk of HIV positivity is further complicated by one’s race and socioeconomic status; however, it is currently estimated that transgender women are 66x more likely to be HIV positive while transgender men are 7x more likely, according to a global analysis. Additionally, the Centers for Disease Control and Prevention (CDC) identified that over half of Americans diagnosed with HIV are 50 years old or older.
Considering the overlap between age and gender identity, it is plain to see that transgender elders are at a substantially higher risk of being diagnosed with HIV/AIDS in their lifetime. Physicians should understand this risk assessment and encourage the use of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), as well as multiple methods of protection for safe-sex practices. Building rapport with elderly transgender patients so that they feel safe to discuss how and with whom they have sexual relationships with. This information is crucial for HIV/AIDS prevention.
Challenges in Society
Senior Living Facilities
As populations of older adults living in senior care facilities continue to grow, so does the necessity of ensuring that senior care nurses and staff appreciate the diversity of their residents. After interviewing two transgender older adults who advocate for the rights of transgender elders in Roanoke, Virginia, I discovered how often transgender elders are forced to detransition in facility care. Transgender elders who have not received surgical affirmation are at risk of being told that they must dress as their sex assigned at birth, go by their dead name, and be forced to room/live with cisgender members of their sex assigned at birth, which can be uncomfortable, invalidating, and even dangerous.
Another overlooked issue with senior living facilities as a whole is how they conveniently hide away the elderly from “everyone else.” Living in senior care can be an isolating experience when patients feel that they do not have interaction with younger people. This segregation of society into “age-appropriate” facilities (such as daycare, school, work, etc.) means that systemic issues facing the elderly are not seen by those not living or working there. It is difficult or impossible to ensure that transgender elders are treated humanely if we do not have proof of systemic issues from the inside. We must give elders a platform to speak for themselves, but how can we do that if we do not engage them?
Negative Discourse & Misinformation
Topics regarding gender identity have been crafted into a wedge issue as of late, and this marginalization encourages heavily negative (or downright corrosive) discourse about transgender people. Misinformation about how transgender people live their lives and what they seek when expressing their identity openly is rampant and distorts the reality that transgender people simply want to be recognized for who they are, just like everyone else. Unfortunately, transgender people are rarely given the opportunity to speak for themselves due to a lack of representation in our nation’s most powerful institutions.
Tying a lack of representation for transgender people with an overwhelmingly negative perception of the elderly, it becomes clear that transgender elders are caught in the crosshairs of a double-sided attack targeting their age and gender identity concurrently. These attacks rely on the proliferation of false information, negative stereotypes, and above all else, the continued disenfranchisement of the elderly and transgender people.
Final Thoughts
Transgender elders are particularly vulnerable because they face many of the same issues that younger transgender people and cisgender elders do, with some exceptions. Living within the intersection of two marginalized identities creates a unique, overlapping experience of compounded systemic oppression.
Protecting transgender elders requires recognition of a painful reality: our current institutions do not properly protect the most vulnerable of us. Fortunately, institutions are not autonomous. They are created and maintained by individual people, all within their own power, to decide to promote empathy and empowerment of the people they serve from the cradle to the grave.
Author Bio: Sunny Allison, a recent Hollins University graduate, joins the OutCare team as an LGBTQ+ Health Advocacy Scholar sponsored by the Jack Kent Cooke Foundation. Sunny is a passionate advocate with a dual degree in public health and sociology, graduating Magna Cum Laude. Throughout his time at Hollins, Sunny actively participated in the public health club and dedicated themself as a guide for first-year students, specifically those who identify as first-generation and low-income. Hailing from Bryan, Texas, Sunny has personally encountered discrimination within the healthcare system due to her intersectional identity. These experiences, coupled with a deep fascination with social institutions, fuel Sunny’s unwavering commitment to dismantling oppressive systems and striving for improved health outcomes for all individuals.
