Issues in Transgender Aging

It was more than 70 years ago when Christine Jorgensen, the most famous of the transsexual pioneers of the 20th Century, stepped off her plane at Idlewild Airport into a media storm of flashbulbs and shouted questions. For a short while she was a star, with public appearances and support. But after that media firestorm introduced the concept of gender transition to the world, transgender persons have faced continuous battles to claim our rights and our rightful place in society. And given the timing of the “transsexual phenomenon,” each year increasingly greater numbers of transgender adults will reach their golden years of retirement.

Much has been researched and written on the plight of transkids and other transgender persons, but very little information is available on the aging and elderly of the transgender population. This article is an overview of the potential challenges faced by transgender individuals who either are “late bloomers” to transition, or who have been in transition for some time and are arriving in their later years.

How Many Elderly Transgender People Are There?

Throughout my research for this article, one item which was somewhat troubling to me was the dearth of information on elderly transsexuals. Not only are there so few transsexuals among the general population to begin with, but many of those who have transitioned have gone “stealth,” and as a result will not show up in polls, studies, or surveys. (Witten 2006) In fact, it was very common to find studies which prefaced with words to the effect of “elderly transgender persons have not been the focus of extensive research…” And almost no published research exists on transgender persons over age 85. (IOM)

It is difficult enough to estimate how many transgender and transsexual persons there are in the United States, let alone how many of them are elderly. We can however make some rough estimates. In 2010 57,085,908 persons were age 60 or older, 40,267,984 were age 65 or older, and 27,832,721 were age 70 or older. (ACL) Given estimates of about 0.0023 of the United States being transgender and 0.0002 being transsexual, we have the following high and low bounds for the number of elderly transgender Americans.

Age Range	Low Bound	High Bound
60+	11,417	131,298
65+	8,054	92,616
70+	5,567	64,015

These estimates of course assume that the differential mortality rate between cisgender and transgender persons is close to 1, which we know prima facie is not true.

In terms of estimates of elderly transgender density, we can look to one example from San Francisco, which estimated that there were from 18,000 to 20,000 LGBT adults aged 60 or older living in the city. In a subset survey of LGBT adults aged 60 to 92 years, transgender persons comprised 4% of the respondents. Taking the low end of the overall LGBT estimates, we could conclude that as many as 720 elderly transgender persons inhabit San Francisco alone. (Fredriksen-Goldsen 2013²) And however small that number is, though, it is expected to more than double by 2030. (Fredriksen-Goldsen 2014)

This upper bound for elderly transgender density in an urban area indicates that the number of transgender persons who might be encountered by the elderly care system in a specific region of the United States may be quite small. Thus, this raises significant concerns as to whether their rarity will complicate receiving proper treatment by health care providers.

Examples of Discrimination Against Transgender Elders

Transgender persons comprise all possible ages, and while uncommon some do not fully realize or manifest their transgender status towards transition until a very late age. One transsexual person from the literature realized they were transgender from age 8, but didn’t start hormone therapy until age 72. Their first time dressing in public was going to be at age 90, at the wedding of her grandson, but she passed away just prior to realizing her dream. (Ong et al.)

Witten gives some case examples of elderly persons who have suffered discrimination in health care. From her examples:

UK: Linda is a 63 year old male to female trans woman. She had genital reconstructive surgery to create a vagina over 20 years ago. After vaginal bleeding she is found to have pre-cancerous cells within the neo-vagina. Her Health Authority is insisting that they do not have any speciality in this area and that she must be referred back to the national Gender Identity Clinic (GIC). Linda is extremely concerned because the GIC has no experience of cancer treatment (it is a psychiatric unit), and it has a waiting list of over 18 months. (Witten 2004) In the end the UK NHS eventually backed down and admitted that yes, pre-cancerous cells are something which should actually be treated even if the patient is transgender. However, they still refused to refer her to a gynecologist until one was found who had specific experience in the type of vagina creation which Linda had undergone (they used colo-rectal tissue). (Witten 2004)

UK: James, a trans man of 71 who had undergone chest reconstruction but not genital surgery, was in the stages of early Alzheimer’s. He was placed within a local authority care home where every other client was female. The staff at the care home was very uncomfortable with meeting his bodily needs and were very unhappy with his constant removal of his incontinence pads. They had also taken to not passing on his post which included a support group magazine, deciding that he was not able to read and understand it. A local volunteer visitor contacted a support group after discovering James very distressed. (Witten 2004)

James was hindered in that his family rejected him outright, and he lived alone with no loved ones or friends to keep him company or assist in his care. He was upset with using the incontinence pads because they reminded him of sanitary towels he used to require. The NHS fought tooth and nail against allowing James into a men’s nursing facility, by threat of lawsuit under the Disability Discrimination Act he was eventually transferred to a gay men’s residential home which agreed to take him in. (Witten 2004)

Of a group of San Franciscan elderly who were surveyed, the number reporting discrimination or harassment in the prior 12 months included:

• Sexual Orientation: 81%
• Gender Identity: 69%
• Race: 38%
• Age: 46%
• Disability: 38%
• Poverty: 27%

In addition to this, 12% of transgender persons reported they were abused by someone they knew or an institutionalized provider, and 32% reported victimization by a stranger in the prior 12 months. (Fredriksen-Goldsen 2013²)

Death or injury from medical maltreatment is a frequent fear of transgender persons. A study of 646 transgender adults living in California (80 persons being over 55) found that 30% of the group avoided medical treatment out of fear of maltreatment by the medical staff. (IOM) One large study found that nearly 40% of elderly transgender persons were afraid of seeking health care, compared to just 13% of the LGB community. On average each transgender person in the study reported 11 different severe incidents of discrimination and victimization, including verbal insults, threats, denial of employment, and police harassment. (Fredriksen-Goldsen 2013¹)

One survey of transgender adults and their thoughts on medical care included the following opinion, which unfortunately is quite common.

I am already scared of death. I don’t want to die. Being transsexual, I worry I will die thanks to some bigoted doctor, or something bad will happen to me and they will let me die because I’m transsexual. (Witten 2014)

Starting Transition While Elderly

It’s not unusual for transgender persons to begin seeking treatment at age 60 or older. Often this is due to an overwhelming fear of losing their career and livelihood, but sometimes it’s just simply the right time for them to transition.

It’s true that sex reassignment surgery (SRS) at advanced ages is both uncommon and advised against, but a transperson in good health may be able to have SRS at a very late age. As early as 1985 a report was published of a transgender woman who had SRS at age 74. (Ettner 2013) In another case an 84-year-old transwoman underwent orchiectomy and labiaplasty, without creating a vagina. (Ettner 2013)

Transition during old age is often more mentally challenging than physically challenging, as it is fraught with a sense of urgency. Frequently the elderly transgender person will be consumed with remorse over not having transitioned earlier, and this can lead them to attempt transition on an accelerated and potentially unsafe schedule. “I have so little time left, I need to do it all now!” or “do I want to die, having never lived life authentically?” are common feelings which are evinced. (Ettner 2013) As a result, psychological care may be much more important, both in depth and duration, than for a younger transgender person.

Health Insurance Problems

Transsexuals may discover that because of the way in which they are coded by their insurer, certain procedures may be rejected out of accident or by policy. Examples which are frequently cited include prostate exams for transsexual women, and pap smears and mammograms for transsexual men. It may be a good idea to contact your health insurer directly prior to seeking such treatment. At a minimum, it will provide you with an understanding of what your financial liability may be, so you are not unpleasantly surprised upon reaching the clinic.

A study of 646 transgender adults living in California (80 persons being over 55) found that even when health care was available, it often was not sought due to financial pressures, and 30 percent of the group avoided medical treatment out of fear of maltreatment by the medical staff. (IOM)

Aging – Accentuating the Positive

There are some positive aspects to the aging process for transgender persons, namely in how the process impacts the cisgender population who are not on hormone therapy. Women and men have greater physical similarity as they age due to reductions in their respective estrogen and testosterone levels. Wrinkles tend to dis-gender facial features, muscle loss occurs in men, fat deposits tend to be similar between the sexes, and women can see facial hair growth. (Witten 2002) Men sometimes lose leg hair. Women’s voices typically become rougher, lower, and scratchier with age. The need or desire for sexual relations decreases as people age, which can assist pre-operative transsexuals who wish to have a romantic but non-sexual relationship.

Because many transgender women do not have significant breast growth until later in life, their breasts may appear firmer and younger through much of their elderly years. The same could also occur with genitals. Hormones to some extent can act as a temporary “fountain of youth” with respect to skin tone and firmness, muscle development, and fat distribution. (Witten 2002) Aggressive removal of body hair may greatly reduce hirsuteness in later life for women. Transgender men who have had prosthetic devices implanted in their bottom surgery may find sex easier than cisgender men as they age. (Witten 2002)

Negative Health Behaviors During Aging

Before we discuss the physical challenges faced by the transgender elderly, we should also focus on some (mostly) preventable problems which can best be grouped into the category of health behaviors. Unfortunately, transgender persons have been found to suffer from a higher frequency of poor health behaviors than the rest of the LGBT community. One large study found that 15% of elderly transgender persons currently smoked, which was almost double the rate of the LGB elderly community. Almost 23% had little to no physical activity, and 40% were obese. (Fredriksen-Goldsen 2013¹) A survey of LGBT persons in San Francisco found that 28% of elderly transgender persons were HIV positive, a number close to the 24.6% of LGB adults. Furthermore, this transgender population had three times the need for alcohol or substance abuse programs than the LGB elderly population. (Fredriksen-Goldsen 2013²)

Physical Health During Aging

Most transgender persons unfortunately not only have no clear idea of what some common health risks are as they age, neither do their physicians. The following data has been collected from a variety of sources, but please note that we are not attempting to make any specific prediction with respect to how any individual’s aging process will proceed.

Little is known about the effects of using transsexual hormone regimes for decades or well into old age. Based on other hormone replacement studies one can expect elevated risks of cancer, cardiovascular disease, stroke (Witten 2006) – but little data supports a worsening of health from hormone therapy among elderly transgender persons.

Transsexual Women: Those who have had SRS are at risk of developing fistulas later in life, as well as urinary tract infections. Other potential concerns include breast cancer, deep vein thrombosis, pulmonary embolisms, and osteoporosis. (Persson) As the prostate is often left in the body, there is a potential risk of undetected prostate cancer unless regular prostate exams are done. (Persson, Witten 2006) As transsexual women age the skin of their vaginas can lose flexibility and resilience, and they can also find their vaginas losing depth. (Witten 2002)

Known impacts of long-term hormone use among transgender women include lower total and regional muscle mass, less strength and endurance, and lower bone density than those of cisgender men*. A comparison of 23 transwomen with 46 cisgender men found this to be the case. The transwomen, who had an average age of 41 years and an average time on hormone therapy of 8 years, saw a reduction in grip strength of 22%, a bicep strength reduction of 33%, and a quadriceps strength reduction of 25%. Bone mineral density decreased by an average of 11.8%, with the greatest reduction seen in the hips, which lost 15.7% of their bone minerals. (Lapauw 2008)

That being said, there is also intriguing evidence (but not proof) that transgender women tend to suffer from lower bone density and muscle strength than cisgender men before the initiation of hormone therapy (possibly due to avoidance of physical activity and impact sports). (Caenegem 2013) If true, this may mean that a bone density scan prior to starting hormone treatment is advisable for elderly transgender women.

* In this case, we compare transgender women to cisgender men because the vast majority of transgender women have XY chromosomes and some male musculoskeletal development.

Transsexual Men: High-dose testosterone treatment is arguably less kind to the body than high-dose estrogen treatment. As a result transsexual men see their risks of cardiovascular disease, liver disease, and diabetes increase. (Witten 2006) Those who have not had a hysterectomy are at risk of ovarian and endometrial cancer. (Persson) Transgender men may still be at risk for breast cancer, even if they have had top surgery, as it is difficult to remove all breast tissue which may be sensitive to hormone therapy. (IOM)

Beyond specific individual case studies, there has been little research on cancer rates and risk for transgender elders.

Emergency Care

Do you remember the old adage, often taught by moms, which goes “make sure you always wear clean underwear, in case you have an accident and go to the hospital?” Well, my mother used to say it to me at least, and the overarching advice is sound. Some transsexual persons are able to remain in “stealth” in public until a health crisis or accident occurs – for example, when brought in to the emergency room after a heart attack or automobile accident. For those who have not had full surgical transition, it is helpful to carry a letter on your person which can be examined by health care providers so they are informed of your transgender status. This letter should also have a lifeline in the form of contact information to someone close to you, or a community advocate, who can come to the hospital to field intrusive questions.

Disability

As if aging wasn’t difficult enough, aging while transsexual can be especially challenging. One large study found that nearly 62% of transgender persons over age 66 were disabled in some way, were highly likely to be depressed and stressed, and to have generally much poorer overall health than LGB elderly persons. (Fredriksen-Goldsen 2013¹) A study of elderly transgender San Franciscans found that 76% over age 60 were physically disabled in some way, and 52% of the total transgender group reported they were in poor health. In that same study, however, 54% of transgender adults reported that they had taken advantage of community health services in the prior 12 months. While this was a much higher rate than other LGB persons, it is also indicative of the high level of poverty in which transgender adults live. It was also notable that no transgender persons over the age of 69 were encountered in the survey, whereas more than 30% of LGB persons in the survey were age 70 or older. (Fredriksen-Goldsen 2013²) In that same study, compared to cisgender elderly LGB persons, transgender persons had more than four times the need for caregiver support, and more than three times the need for mental health services. More than twice as many of the transgender elderly needed a case worker or social manager.

A significant number of us will require either home living assistance, an assisted living facility, or a traditional nursing home as we get older. This places a transgender person in the role of being dependent upon strangers, who may not necessarily be friendly to transgender patients. Unlike lesbian, gay, or bisexual persons, a transgender person sometimes immediately stands out from other patients if they cannot “pass” well enough, especially if they are pre- or non-operative. (Witten 2006) Even if a pre-operative transgender person is trying hard to present as their birth gender, signs such as laser-treated legs or an orchiectomy may raise uncomfortable questions. (Witten 2006)

Mental Health During Aging

It’s a given that all transgender persons who are pursuing transition need psychological help during their journey, but when you combine this need with the aging process and its effects upon the brain, the need grows even greater. The aforementioned sense of urgency among elderly transgender persons can manifest itself as regret, self-recrimination, anger and lashing out at others, and fear of change and mortality.

Depression strikes the transgender elderly more than LGB elderly, with one researcher reporting 48% of transgender elderly adults were depressed, compared to 30% of LGB and 5% of heterosexual cisgender adults. (Fredriksen-Goldsen 2013¹) Another study of elderly San Franciscans by the same researcher found shockingly that more than 80% of transgender elderly needed mental health services. (Fredriksen-Goldsen 2013²) Within that same study it was reported that 26% of the transgender elderly limited their activities due to poor mental health, and 32% had seriously contemplated suicide in the prior 12 months.

Dementia is a fear of most people, and unfortunately the prevalence of dementia and Alzheimer’s disease appears to be increasing, with a potential that one in three people will die with some sort of dementia. (Witten 2014) For transgender elderly adults, this can bring on a whole new realm of fears. Such as the following, expressed during a large health survey.

I am worried that I will development[sic] dementia and will not remember that I have transitioned. I am worried that I will not be able to support myself and that there will be no one to take care of me. I am already becoming so forgetful and unable to concentrate at 55yo that I worry I will not be able to hold or keep a job at some point within the next five years or longer. I worry that I will not have the resolve to kill myself when I cannot support myself any longer. (Witten 2014)

Social Function

Transgender elders are sometimes referred to as “twice hidden,” meaning that they are marginalized and compartmentalized away from society as a whole due to their gender identity and age.

Elderly persons often find significant comfort in churches and church activities, but transgender persons may have lost their faith or been too intimidated to participate in church due to fear of discrimination. An example from Witten, although not dealing directly with an elderly transgender person, is nonetheless applicable across all ages.

US: Cynthia is a 38 year old male to female trans woman. Upon returning to her Baptist church after she had had genital surgery, she was told that the only way that she could be a member of the parish was to realize that she had sinned by altering her body. Moreover, the church insisted that she promise to remain celibate. (Witten 2004)

Elder abuse is unfortunately more common than it should be, and can be perpetrated by medical staff, nursing home staff, other nursing home residents, and even other family members. Take this case from Witten.

Frank’s 90 year-old father Bob lives alone in his own home and has COPD. He requires Frank’s daily visitation. Frank is a 68 year-old transman who has lived, with full surgical realignment, in his target identity for over 30 years. Bob’s unresolved anger at Frank’s transition leads him to abusive behaviors against Frank. Frank finds he is increasingly unable to control his own anger and has had numerous shouting matches with his father; recently having to restrain himself from hitting Bob. (Witten 2004)

It’s speculated that transsexual women enjoy touch from a partner more than cisgender women, as the touch helps to validate their sense of body correctness and wholeness. But the natural tendency of society to avoid elderly persons through agism or, combined with the potential for being without close friends or a partner of any kind, may lead to severe psychological stress. (Witten 2002) A study of 272 transgender persons and their partners, aged 50-79 years, found that about 25% were not in a sexual relationship or were celibate. (IOM)

Financial Concerns

On top of the expenses of assisted health care as we age, transgender persons may find themselves entering retirement with additional financial barriers. Sex reassignment surgery (SRS) is still only rarely covered by insurance plans, and some plans do not even cover daily hormone regimens. Other cosmetic procedures (hair removal, mastectomy, liposuction, etc.) as well as the necessity of purchasing a new wardrobe create additional financial stresses. Some transgender women find themselves borrowing or closing out their retirement or 401k plans in order to pay for treatments, and unfortunately this is sometimes never built back up. A survey of the transgender elderly found that only 59.5% had any sort of pension or retirement plan. (Witten 2014)

A study of 2,560 people in the LGBT community over age 50 (average age 66.5 years) found that among the 174 members of the study who were transgender, 22% had serious financial barriers to obtaining healthcare (compared to 6.4% for LGB persons). (Fredriksen-Goldsen 2013¹) Since divorce rates are very high among the transgender community, many transgender persons will enter retirement alone and without a partner to help meet household expenses. Let alone the fact that due to workplace discrimination many transgender persons will find themselves potentially either underemployed or unemployed.

A study of elderly LGBT persons in San Francisco found that only 16% of them lived in a house, and only half of that group had no mortgage remaining. An incredible 77% were living in an apartment, and 8% were either homeless, living in a shelter, or staying temporarily with friends or family. (numbers add to 101% due to rounding) What’s worse, 54% of elderly transgender persons were at or below 200% of the poverty level, and 44% had an annual household income of $20,000 or less. And half of transgender persons reported needing housing assistance. (Fredriksen-Goldsen 2013²) The same study of elderly transgender persons in San Francisco found that when compared to cisgender elderly LGB persons, transgender persons had three times the need for meal assistance, and more than twice the need for in-home care and day programs. (Fredriksen-Goldsen 2013²)

Most retirees rely on Social Security for a significant portion of their income, as well as pensions and other managed benefit plans. It was only recently that Social Security allowed same-sex couples to claim survivor benefits when the primary Social Security recipient dies. Veteran’s benefits have thus far followed the same track for acceptance of transgender persons and their spouses. However, many pension plans do not allow designating anyone else as a beneficiary save for the spouse and children. What’s more, should one partner of a same-sex couple attempt to stay in the marital home while the other is under care elsewhere, the Medicaid “spend down” policy may come into force. (Cahill 2002)

Assisted Care

Fear of disability is profound throughout the community, such as this anecdote from a recent transgender health survey:

I feel that as a disabled trans person I will be treated disrespectfully at best. i[sic] have many experiences already that have shown me that even as someone who can currently advocate for myself quite well, it is a struggle to get even basic care. I shudder to think what’s going to happen when I’m less able to self advocate. I’m afraid of there not being trans-safe spaces as an elder, spaces where our bodies are being handled and moved around and manipulated for basic functioning. I just don’t know, and it really scares me. (Witten 2014)

Transgender elders may easily find themselves in a position of helplessness, due to an accident or illness, whereby someone assisting them who is within their home may discover their secret life – either the fact that they had a history living as another gender, or that they are closeted.

Almost three quarters of elderly transgender persons live alone, which may present a strong incentive to seek a nursing home or assisted living. (Fredriksen-Goldsen 2013²) Nursing homes and assisted living centers may have outdated policies which preclude people legally considered of the opposite sex, who are not married, from rooming together.

Jenny, a 45-year-old nurse, told of a transgender woman who had lived all her life as a woman, but had never had sex reassignment surgery. She now had dementia and lived in an aged care facility run by a religious charity. Staff there forced her to live as a man. (Cartwright 2012)

The fear of entering a nursing home and being mistreated can cause some transgender elderly to seek any other way out. The following statement reflected the views of many respondents to a transgender health survey.

I’d personally rather commit suicide than go into the elderly care ‘‘I can afford’’ due to the exceptionally poor quality of it & the extremely high incidences of sexual/physical/mental abuse that happens there. (Witten 2014)

This is highly sobering, as it reflects the violence and abuse which a transgender person just expects will be part of daily life, and when one is helpless to defend themselves against it, the result could be akin to torture.

 The End

Many transgender persons, especially those who are not “out” to their families, friends, and loved ones, worry about how their funeral will proceed.

As a Mexican gay man, my fear is that my family will not be able to be around as I don’t live in the same city. Dying alone without family would be unbearable. Although currently single a partner in life is the ideal situation of course. (Witten 2014)

Others have darker views.

I plan on committing suicide at 60 or earlier. (Witten 2014)
The day that I need a caregiver, I will implement my end of life suicide plan. (Witten 2014)

Inheritance

Imagine that you are a transsexual woman who was legally married before transition, but suddenly has found herself in a potential “grey area,” where based on how her gender is viewed may be considered female, and thus no longer married. Now imagine that your spouse suddenly dies, and leaves no will – or a will stating that the assets go to her husband or spouse. Now imagine that your children, who never accepted your transition, come forward to challenge the will or to claim the estate, declaring that you are no longer married. Even if you may be ultimately found by a court to be the lawful beneficiary, the court time and costs could be lengthy and large, respectively.

Many estate-related problems can be avoided by setting up a revocable living trust, along with a Corporate Trustee. Unfortunately, due to the expense of setting up estate planning (as well as the effects of depression from lifetime stigmatization), one large study found that only 49% of elderly transgender persons had a will, and just over a third had a power of attorney for health care – percentages which are significantly lower than even other LGB elderly persons. (Fredriksen-Goldsen 2013¹) A study of elderly transgender San Franciscans found only 48% had a power of attorney for health care, 32% had a will, 16% had a power of attorney for finance, and 12% had a trust. (Fredriksen-Goldsen 2013²) It should be noted that none of these items are mutually exclusive – for example, trusts typically contain powers of attorney and flow-down wills. As a result, the true number of transgender persons who have adequate end of life financial planning is likely under a third.

Another problem with inheritance is indirect, in that some transgender adults wish to or are forced to remain closeted the duration of their lives. For these transgender persons the future holds even more fear. From a survey of transgender adults, we have the following sober perspective.

I cross-dress in secret. I do not want anybody to know about this either before or after I die. I irrationally hope that I will somehow know when I am close to the end and will be able to throw away my feminine clothing such that it will not be found after my death. I fear that I will die unexpectedly (heart attack, etc.) while cross-dressed and that I will not be able to hide or destroy my clothing, and that this fear will lead to anxiety throughout my later years. (Witten 2014)

Another fear which was expressed from that same survey reflects upon disposal of the transgender person’s final remains.

I am mostly concerned when it comes my time to go, that because I have not had all my surgeries that I will be looked at as a freak at the end of my life…Right now I have had just top surgery and have no intention of getting bottom surgery, so when I die, and they get me ready for cremation my secret will be out and I may once again be looked at a freak or a weirdo, and that would be horrible, to live your life as a man, and have everyone around you accept me as a man, then at the end have the secret let out of the bag and everyone call me a freak again, I may [not] be around to hear those words again, but it would be still terrible knowing that people know my secret after all the years living in secret. (Witten 2014)

Are We Making Progress?

As younger and younger persons start coming out as transgender, and thus are more likely to follow “normal” life trajectories, the trans-specific problems of aging may be minimized. (Witten 2014) One can also hope that the general tide of transgender acceptance will raise all of our metaphorical boats, and that the younger generation of transgender kids, and those who love and accept them, are likely to be our caregivers as we age.

What Have We Learned?

This article is very lengthy, because I wish it to be complete. But let us summarize the key points of aging and retirement in transgender life.

1. The long-term effects of hormones are not known with reliability. In general, transgender persons should be much more diligent than the average person in watching for early warning signs of cancer, heart disease, and liver disease. Ask your physician about the possibility for transdermal hormone delivery, as well as the advisability of taking aspirin daily.
2. Smoking and tobacco use should be discontinued well before age 55 if at all possible.
3. You should ensure that your estate and marital property is protected by a revocable living trust.

Other Resources

Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE)

This group was started in the late 1970s and started out as “Senior Action in a Gay Environment.” The purpose of the group is to provide LGBT older adults with the unique resources they need to age successfully. The site is very comprehensive, with information for consumers and clinicians alike.

National Resource Center on LGBT Aging

This is a project operated by SAGE. The site contains excellent and free information for LGBT older adults, aging organizations, and clinicians. Content includes webinars, documents, and links to other resources.

Lavender Health

This site was developed, and is currently maintained, by a team of nurses who “have experience in LGBTQ communities, both as members of the communities and as providers, researchers, and educators.” Of special interest are the two PowerPoint presentations free for downloading: “Introduction to LGBTQ Healthcare Issues” and “Culture is More than Ethnicity: Best Practices for LGBTQI Communities.” The presentations can be accessed directly at http://www.lavenderhealth.org/educationFiles/mediaEd.html

National LGBTQ Task Force

The Task Force works to identify and correct discriminatory practices against LGBTQ individuals. Free downloadable research reports and resources specific to aging are available.

References

Administration for Community Living (ACL). US Department of Health and Human Services. Census Data, Population by Age Group. Accessed 8 October, 2014.
http://www.aoa.gov/Aging_Statistics/Census_Population/census2010/Index.aspx

Caenegem, E. Van et al. “Low Bone Mass is Prevalent in Male-to-Female Transsexual Persons Before the Start of Cross-sex Hormonal Therapy and Gonadectomy” Bone 54 (2013): 92–97.

Cahill, Sean and South, Ken “Policy Issues Affecting Lesbian, Gay, Bisexual, and Transgender People in Retirement” Generations 26.2 (Summer 2002): 49-54.

Cartwright, Colleen et al. “End-of-life Care for Gay, Lesbian, Bisexual and Transgender People” Culture, Health & Sexuality 14.5 (May 2012): 537–548.

Ettner, Randi and Wylie, Kevan “Psychological and Social Adjustment in Older Transsexual People” Maturitas 74 (2013): 226– 229.

Fredriksen-Goldsen, Karen I et al. “Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population” The Gerontologist (2013¹) doi:10.1093/geront/gnt021.

Fredriksen-Goldsen, Karen I et al. “Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future” Report prepared for the LGBT Aging Policy Task Force, San Francisco, CA. Report published by Institute for Multigenerational Health, University of Washington, Seattle, WA. July, (2013²).

Fredriksen-Goldsen, Karen I et al. “Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services” Journal of Gerontological Social Work 57 (2014): 80–107.

IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC:
The National Academies Press.

Lapauw, Bruno et al. “Body Composition, Volumetric and Areal Bone Parameters in Male-to-Female Transsexual Persons” Bone 43 (2008): 1016–1021.

Ong, Yong-Lock and Davies, Pam “Conflicts of a 90-Year-Old Transsexual” Psychiatric Bulletin 21 (1997): 720-722.

Persson, Diane I. “Unique Challenges of Transgender Aging: Implications From the Literature “ Journal of Gerontological Social Work 52 (2009):633–646.

Witten, Taryn M. PhD. “Geriatric Care and Management Issues for the Transgender and Intersex Populations” GCM Journal (Fall, 2002): 20-24.

Witten, Taryn M. PhD. And Whittle, Stephen PhD. “TransPanthers: The Greying of Transgender and the Law” Submitted to the Deakin Law Review, 11 March, 2004.

Witten, Tarynn M. PhD. And Eyler, A. Evan MD. “Transgender Aging: The Graying of Transgender” LGBTIQ\APHA Newsletter, 2006.

Witten, Tarynn M. PhD. “It’s Not All Darkness: Robustness, Resilience, and Successful Transgender Aging” LGBT Health 1.1 (2014): 24-33.