Cynthia* is a loving parent, a decorated military veteran, and a transgender woman. Born and raised as Mike*, she knew at age eight that she was born into the wrong body. Seeing no way to be her true self, Cynthia lived out the first several decades of her life as a man, becoming a father to three children and taking on many traditionally male roles. She eventually enlisted in the military where she served multiple tours of duty and received a Purple Heart after being wounded in combat.
Struggling with her gender identity and PTSD from her military service, she felt lost for much of her life and even became suicidal. She finally decided in her retirement to become the person she always wanted to be and began her transition in 2015. Along her journey, Cynthia has faced and overcome many challenges, some of which are unique to those who transition later in life.
The struggle for acceptance and safety among the transgender community has finally reached the national conversation. Individuals in this community have long been left to live in the shadows, facing discrimination in employment and housing, being rejected by their families and peer groups, and at times even dealing with rampant violence. There is clearly much work left to be done, as some states are still seeking to create legal and systemic barriers to equality for transgender people.
Those like Cynthia who are transitioning as older adults face a unique set of obstacles. In addition to the aforementioned challenges that most if not all transgender individuals face, seniors in this group often have to deal with additional social and family difficulties, limitations in availability of senior housing, and a number of health-related challenges that are rarely discussed.
Isolation and Social Stigma in Senior Transgender People
Older transgender adults often live in isolation and without the social support they want and need. There is generally less acceptance of the trans community among older generations, which can make it very difficult to find a supportive community within the senior demographic. According to the Williams Institute at the UCLA Law School, 14% of those identifying as transgender are over the age of 65. Still, social and community support groups for these individuals can be scarce, particularly outside of large metropolitan areas. Living in a small town, Cynthia says that because there are not many resources for trans people and she doesn't generally feel comfortable in senior community groups, she has to rely on support and social interaction from neighbors who may or may not be accepting of her.
Family relationships can be the most difficult to solidify while transitioning as an older adult. There can be challenges when families have to consider modifying deeply established roles, such as father, mother, grandfather, or grandmother. A 2004 study by the Williams Institute outlined several stages a family may go through in a "period of adjustment" when a parent comes out as transgender to their family including disclosure, turmoil, negotiation, and balance. It can take a while for families who have well-established roles for years to adapt to a new normalcy. "It's hard to erase several decades of family members knowing you as a certain way, and then showing them a new you," says Cynthia.
Finding acceptance among friends does not come easy either. Cynthia lost a lot of long-time friends while transitioning. Some who knew her as Mike in the military didn't know how to process her new identity and rejected her outright. But she says that although it was difficult to lose these friends, it puts her current relationships into perspective. "Now I focus on the quality of my friendships, not the quantity of friends I have. The friends I make now generally love me for my true self."
Fortunately, there are programs emerging to help combat the issue of isolation in the senior trans community. Groups such as Lavender Seniors and SAGE perform outreach to elder members of the transgender community and provide a safe and welcoming place for them to socialize and find support. The reach of these programs remains limited, though, and tends to be concentrated in more progressive large cities.
The Transgender Senior Housing Crisis
Another serious challenge faced by transgender seniors is discrimination in and lack of availability of senior housing. According to a study on transequality.org, there are a couple of primary reasons for this shortfall. First, there is little to no outreach to LGBT communities in elder care. Second, there is little professional training among aging care providers on the unique needs of the LGBT senior community.
In nursing homes and assisted living communities, room assignments and bathroom facilities are often serious issues for transgender residents. Because there is currently no regulation at the national level in place for senior housing facilities, the providers themselves are typically left to determine how their transgender residents are cared for. Often, gender-segregated facilities are unwilling to accommodate these individuals and leave them in unacceptable living conditions or drive them away altogether.
Although Cynthia currently lives in a friendly independent retirement community with neighbors who accept her, she expressed fears about when she may need to move into assisted living. "If I end up needing assisted living or nursing care when I'm older I don't know if they'll force me to share a room with a man. If I have to pay for a private room I don't think I'll be able to afford it."
To address this crisis, SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders) launched the National LGBT Elder Housing Initiative. This program offers many solutions to the transgender senior housing crisis, including: 1) building LGBT-friendly elder care communities, 2) training existing senior communities to provide housing in a LGBT-welcoming, non-discriminatory manner, 3) lobbying for improvements in public policy relating to senior care, 4) educating LGBT seniors on their rights and how to locate accommodating senior living facilities, and 5) expanding LGBT-friendly services available in housing sites across the country. Ultimately, expanding such programs that incorporate solutions from both private industry as well as public policy are needed resolve the transgender senior housing crisis.
Health Concerns for Elder Transgender Adults
Older transgender adults can also have frequent complications when it comes to obtaining healthcare and maintaining good health. According to transequality.org, "there are clear health implications for transgender older adults who do not feel safe accessing healthcare providers: delayed care can mean that preventable illnesses are not identified and diagnosed in time, health complications worsen and the costs for care increase, among other consequences."
Research by the U.S. Transgender Survey has shown that those who do seek medical help are often met with providers who are poorly educated on transgender health issues. Many even report facing harassment, ridicule, and rough treatment by medical professionals, or have been refused treatment altogether. Cynthia says she has been fortunate to work with caring doctors, but issues have still arisen around her privacy in the doctor's office due to lack of training and awareness. "In waiting rooms at doctor's offices, I've been called by my birth name in front of other patients. It can be an embarrassing dilemma and potentially an unsafe situation when you're called Mike but look like a Cynthia."
Another health challenge that transgender seniors can experience is the stress that hormones and other medications used while transitioning can put on their bodies. Though studies have shown that hormone therapy for transgender people is generally safe, the amount of medications is very different for more mature individuals and can cause kidney and liver problems if not properly managed. Cynthia has experienced a lot of side effects from her medication that she attributes to her age. "If I were younger I wouldn't have to stay on these medications as long. As a mature transgender person, I have to regularly consult with my doctors to monitor my liver and kidney panels to make sure my levels are ok."
To help improve upon this situation, Jennifer Brock-Garcia, a psychiatric/mental health nurse practitioner specializing in trans-health, recommends a shift in healthcare education to help support transgender individuals. She states "there seems to be a lack of understanding and compassion in the medical field surrounding transgender patients. Physicians and other healthcare providers need (better) training about the medical and social aspects of transgender health. Ideally, this education should be a standard part of medical, nursing and physician assistant education programs."
Transgender Seniors are Making Progress
Though there is clearly still much work left to be done for trans equality and acceptance, significant strides have been made in recent years. Celebrities like Laverne Cox and Caitlyn Jenner as well as the hit TV shows 'Orange is the New Black' and 'Transparent' have shed light on transgender issues and brought them into the mainstream cultural conversation. Caitlyn Jenner's high profile case has also empowered many older people to transition later in life. Cynthia tells us "I had just decided it was too late for me, but when [Caitlyn] came out in her 60's, I decided there was nothing holding me back except for my own fear."
Additionally, legislative strides have been made in cities across the nation. Though some states like North Carolina and Texas have attempted or succeeded in creating discriminatory legal barriers, hundreds of municipalities have instituted laws that protect transgender people from harassment and employment discrimination. Some cities, like Austin, Texas, have even passed gender neutral bathroom bills to accommodate and protect non gender conforming individuals.
Jennifer Brock-Garcia says that one word which defines all transgender people is "courage," and Cynthia is certainly no exception. She displayed this courage throughout her career, frequently putting herself in harm's way in defense of her country and her fellow soldiers. This bravery guided her to transition into the person she wanted to be and to reveal her transformation to her friends and family, and now it enables her to meet the daily challenges that transgender people face.
Looking back now, Cynthia says she is very happy with the timing of her transition and even feels like there are some advantages to transitioning later in life. She feels confident because she's more financially stable now and can better afford her medications, new wardrobe, future surgeries, and the many other costs associated with transitioning. Also, because she is retired, she doesn't have to worry about what she calls "awkward workplace situations" with intolerant employers or coworkers. In fact, the National Transgender Discrimination Survey states that 70% of transgender adults age 65 and older reported having delayed gender transition to avoid discrimination in employment.
Cynthia loves her new life as a woman and has found that by and large, people are more accepting of her than she thought they would be. While she spent many years struggling with her identity, she has no regrets and is thrilled to be living her true self in her golden years. "I think I transitioned at the time I was supposed to transition. I've already been a son, a protector, a provider, and a soldier, and now I can just be the woman I am meant to be."
* The names have been changed for the confidentiality of our subject.