Trans Ageing: Future Research Directions

Yesterday Jess Bradley from Action for Trans Health attended “The future of LGBT ageing: Rethinking research directions” at The University of Manchester, and helped run a session on trans ageing. This article briefly discusses some of the issues that older trans people face and suggests some area for future research which has been identified by Action for Trans Health alongside suggestions which arose from discussion at the event.

Trans people face discrimination across all areas of life, which means that when compared to our cis peers, we often have less robust support networks, higher instances of mental and physical health problems, and may experience loneliness.  This is particularly a problem for older people, who may feel excluded from youth orientated LGBT spaces as well excluded from cisnormative older people’s groups . Beyond these more general issues, we have identified three main areas of interest; being trans in a care environment, healthcare issues in later life, and transition whilst being older.

Accessing care:

  • Trans people often delay seeking care due to a general distrust of the medical establishment and a perception of the institutional environment as being transphobic. This is compounded when considering that trans people in general have less financial access to high-quality care due to discrimination in employment and the costs of transition related care (when not NHS funded). However, delaying accessing care can have a negative impact on mental and physical health as well as a strain on social relations.
  • Few care providers have the necessary training to be able to cater to trans specific needs in a non-discriminatory environment. As such, trans people are often forced to educate care providers or clinicians themselves on basic trans etiquette such as not asking intrusive/irrelevant questions, not getting flustered when peoples’ bodies don’t necessarily match with gendered assumptions, and keeping patients confidentiality.
  • Trans people face higher level of domestic and personal abuse than their cis peers. This abuse can come from family, friends, or from staff in a care / clinical environment. Care workers may need to navigate very complex social situations where abusive situations may appear.

Healthcare in later life:

  •  It is now possible for trans people to change their gender markers on their NHS records when they get legal recognition of their gender. However, this means that trans people are often not automatically invited to attend some screenings (eg. prostate, cervical, and breast cancer screens) in later life which may be medically relevant to them.
  • Very little is known about the long term effect of hormone therapy on trans patients. Particular areas of concern include how hormone therapy might alter bone density or may result in blood problems later in life.
  • Very little research has been done into how hormone doses should change as patients get older, and how hormone treatments interact with various other drugs (which may be increasingly important as a person ages as they are likely to take more medications).
  • Trans people have an increased likelihood of experiencing particular health complaints depending on what medical interventions they have had. A trans-feminine person who has had bottom surgery is at increased risk of rectovaginal fistula and urinary tract infections, and a trans-masculine person on hormone therapy has increased risk of liver problems and diabetes.

Transitioning in later life

  • Many trans people may choose to wait until later in life, after family and work commitments are less pressing, to undergo any transition related healthcare. However, often older people often have more entrenched social roles and so making these changes can sometimes be more complex at this time.
  • Older people may have increased health issues, ie. heart disease or high blood pressure, which can make transition related medical interventions riskier.

Research Directions

Key areas for action may include:

  •  Longitudinal / cohort studies on the long term effects of hormone treatment on trans patients.
  • Research into the interaction between hormone therapy treatments and other medications.
  • Studies to identify effective training on the needs of trans patients for carers and clinicians.
  • Research into the effect of dementia and similar conditions on gender identity.
  • Studies on how best clinicians can best support lay carers of older trans people
  • Investigating the inclusion of a question of trans identity on large surveys conducted by the Office of National Statistics so that researchers are better placed to utilise large studies to in their work. How would this question(s) be worded, and how can people encourage accurate self-reporting?