Older Trans/Nonbinary People

Overview

Written by SAGE

Transgender/nonbinary older adults have a unique set of needs, challenges, and strengths. Learning about the history of gender identity and how culture impacts aging in the United States can help providers to understand the needs and experiences of older trans community members.

An overview of trans “generations”

Trans and nonbinary people have lived in every era and culture; some transitioned early in life while others affirmed their gender identity later in life. As a result, trans elders typically fall into one of three “generations.”

Generation One transitioned from living as the sex they were assigned at birth to another gender between the 1960s and 1990s. The World Professional Association for Transgender Health (WPATH)—formerly known as the Harry Benjamin International Gender Dysphoria Association—was formed in 1979 and began issuing transition guidelines. Before these guidelines, almost no information was available to the public; at best, someone might have found some clinical literature on trans people.

During this time, police in many places arrested people under laws against “cross-dressing” or “masquerading.” Some police also enforced a so-called “three-article rule,” arresting people who were not wearing at least three items of clothing associated with their sex assigned at birth. Historians note that this “rule” was not an actual law, but it was widely used to justify harassment and arrests (Ryan, 2019). This meant that people expressing their gender identity in a way that was most affirming faced risks of violence, legal troubles, and harassment. As a result, this generation — who would become today’s trans older adults— managed to live without outwardly expressing their gender identities, died by suicide, or invented their own unique ways to live in the world.

Many trans individuals did not know anyone else who was trans and may never have connected with the trans community. However, community and resilience formed among this generation. Black and Latine trans/nonbinary people formed close-knit communities in ballroom scenes during this same era, forming lasting relationships as a means of survival.

Generation Two transitioned between the 1990s and the 2010s. During this time, the internet changed everything for trans people. Suddenly, individuals could sit in their own homes or a library cubicle and privately start asking questions that led them to discover terms like “transsexual” and the fact that people can, and have, “changed their sex” (using the phrasing of the time). Every iteration of online communication—bulletin boards, listservs, LiveJournal, etc.—featured trans-focused groups. This information-seeking and sharing took another leap forward with the launch of Google in 1998.

During this time, trans people also began to organize more publicly. In-person support groups sprang up in many places: Boston, D.C., San Francisco, and Milwaukee, among other cities. There had been national conferences aimed primarily at trans women, but 1995 saw the first one aimed at trans men. Nationally distributed transgender magazines were available if you were lucky enough to find them. With a name for themselves and a bit of a roadmap for what to do next, many adults began socially and medically transitioning. Others chose not to transition, often due to fear of the increasing transphobia or because they had well-established families and careers they did not want to jeopardize.

Generation Three—where we are now—started around 2010. This generation has been greatly influenced by YouTube, which has allowed individuals to upload how-to videos about the stages of transitioning, as well as tips on makeup and homemade packers. Learning “how to be trans” was no longer limited to those in cities; anyone could learn from the privacy and security of their own desk.

At the same time, broader culture in the U.S. became increasingly aware of trans people. As awareness of trans people grew, many adults decided they still did not want to take action regarding their gender identity because the risks were too high. However, many people changed their minds as they grew older and began transitioning at an older age to affirm their gender identity and live their authentic lives.

Older trans/nonbinary survivors may be of any of the above “generations.” The ways that people discuss their identity, their experiences as a trans person, what sort of medical care (if any) that they seek may be influenced in some part by the culture around them and their experiences as they age.

For example, two 65-year-old trans women may have very different life experiences. One came out as trans at a young age and experienced both the cultural rejection of trans people and the trans cultural and activist movements in 1970s-2000s. She initially received hormones through friends, not through healthcare professionals. She may have both strong lifelong connections to trans communities and experiences of trauma and violence from being an out trans woman. She may feel left behind by younger generations and evolving ways of talking about gender (or she may have stayed connected and embrace these changes).

The other woman did not come out as trans until 2020. She came out into a world that knew much more about transgender life and with greater access to professional healthcare. She also came out into a world with a rapidly increasing level of state-sanctioned hate against trans people. Depending on her life before transition, she may or may not have strong connections to trans communities. Some people who come out later in life have lived with primarily cisgender friends. Others may have been connected to trans communities. Either way their community may or may not be supportive of their gender.

These life experiences can influence what each person wants from service providers, what they feel comfortable discussing with helping professionals, and what sort of external support systems they have.

Experiences with violence

Regardless of when an older trans person began to question their sex assigned at birth, trans/nonbinary community members have faced trauma. Western civilization not only has not provided a role for trans people but also has a long history of active hostility toward those who do not conform to traditional gender roles. Adults have lost spouses, children, work, and more when they transitioned.

In fact, the Caring and Aging with Pride longitudinal study in 2013[1]  found that its transgender older adult participants reported experiencing an average of 11 incidents of discrimination and victimization during their lives, compared to an average of 6 for cisgender lesbian, gay, or bisexual (LGB) older adult participants. In other words, trans older adults report nearly twice as many incidents of discrimination and victimization as their lesbian, gay, and bisexual peers.[2]

Providing trauma-informed care does not require knowing the specific trauma(s) older trans/nonbinary adults have experienced. Older trauma survivors may be surprised to find their trauma becoming more salient over time. Many trauma survivors successfully suppress their memories and/or trauma symptoms for many years through substance use, overwork, devotion to childrearing, or other diversions.

When discussing trans older adults, it is worth highlighting trans veterans. Today, transgender older adults are far more likely to be military veterans (41%) than the general public (~1%), lesbian, gay, or bisexual older adults (24.4%), or the transgender population as a whole (20%).

Military veterans have a higher risk of experiencing combat-based traumas, but transgender military veterans seem to face a special risk: one study found that transgender veterans are nearly twice (23% to 12%) as likely to have experienced sexual assault in the military as their cisgender peers. Additionally, veteran specialists advise service providers to ask people if they “ever served in the military,” as some who would say yes to that question do not see themselves as “veterans.”[3]

Barriers to services

Medical care: As a result of years of discrimination and generational trauma, one of the biggest challenges facing transgender older adults is fear of mistreatment in everyday situations, such as medical care. This often leads to avoiding seeking medical care or waiting too long to seek care. This also includes a fear of mistreatment in elder care settings and housing. Many people have increasing medical needs and potentially more complex medical needs as they age. Few elder care physicians, with skills in aging related health, are also competent in trans health care.

Elder care: Often, transgender older adults fear a lack of cultural competence from staff and community members in long-term care settings, leading to reluctance to enter such facilities. Additionally, transgender older adults are more vulnerable to financial stressors. With the rising cost of long-term care, it is often out of reach for transgender community members. A lack of safe and supportive housing for transgender elders and a lack of cultural competence in home health and other long-term care services both contribute to housing insecurity and the question, “Who will take care of me when I can no longer care for myself?”

Financial insecurity: Years of discrimination toward transgender people have also led to financial insecurity. As a result of workplace and housing discrimination, trans/nonbinary people were often fired from their jobs, evicted from their homes, or discriminated against in the job and housing search processes. This has had a lasting effect, leaving older trans/nonbinary individuals with little financial security as our community ages.

Social isolation has a lasting physical and mental impact on older adults. The intersection of transgender identity and aging exacerbates social isolation for transgender older adults. They are less likely to have children and more likely to live alone than their cisgender counterparts. This loneliness, compounded with fear of rejection from family, friends, community resources, and the public, increases social isolation among our trans elders. Social isolation is said to have the same effect on the body as smoking 15 cigarettes a day.[4]

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