Despite the coverage surrounding Jorgensen and other transgender people, little attention has been paid to the issues facing transgender people as they age. Stigma, discrimination, transphobia and lack of research and understanding leave people who are transgender facing many challenges in their older years.
Many questions about health face trans folk, most with few answers. The effect of long-term use of hormone therapy has not been conclusively studied. Hormone therapy may increase risk of cancer, diabetes, osteoporosis and liver and cardiovascular disease. Sexual-reassignment surgery can lead to other health issues. There are more questions than answers for people who are trans and aging when it comes to their health.
The stress associated with transitioning, coming out, transphobia, homophobia and discrimination takes an enormous emotional toll. Depression, drug and alcohol abuse, isolation and suicide are issues found at higher rates in the transgender community than among other populations.
Finding qualified care providers is a challenge. Christine Macready, a 59-year-old transwoman from Lancaster, said, “I love my doctor, but I had to help educate her about my health-care issues.”
Whether it is a doctor, social worker, dentist or lawyer, trans folk face a lifetime of having to educate their service providers, friends and families. Think of your own experience educating people about your unique medical history. Now magnify that experience in an emergency room, trying to make an admissions clerk understand why the name on your Medicare card does not match your gender identity. Or explaining to an ER nurse which hormone therapy you are taking.
Insurance coverage issues present another obstacle to care. Joe Ippolito, a psychologist practicing in the Philadelphia area, cites the case of a transwoman in her late 60s. “As a result of using estrogen for many years, she began suffering severe pain in her testicles, which had never been removed. Medicare initially approved surgery, but when they realized that she was a transwoman, they denied payment. She fought a year-long legal battle, and won.”
Insurance coverage and competent health-care providers are important issues, but there is an even more disturbing reality for many people who are transgender. Lifetimes of discrimination and stigma in education, employment, housing and in social and family settings often combine to create an economic wall that many trans folk cannot surmount. Fifteen percent of transgender people report incomes of $10,000 or less, according to a 2009 study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force.
The little research that has been done suggests that, within the trans community, the most vulnerable population is that of trans people of color. Not only do people face transphobia, but also racism and ageism. Although looking for work, volunteering and serving as a community activist, Jaci Adams, 54, is unemployed and living below the poverty line in Philadelphia. Adams said, “I am fearful as I get older. What will happen to me?” She worries, “If I got sick and could not take care of myself, where could I go? Who could I trust to have my best interests at heart?”
These and other issues will be explored at this year’s Trans Health Conference in Philadelphia. The conference, which begins on May 31, is free and open to the public. “It is a great place for anyone to learn about these issues,” said Ippolito, one of the conference presenters. A program of the Mazzoni Center, the conference has workshops for consumers, providers and allies. “It is an opportunity for my gay brothers and sisters to learn about the trans experience,” said Ippolito. “Trans people cannot do this on our own. We need our allies to help us to ensure that our lives are safe and that we are not discriminated against.”
For more information about the Trans Health Conference, call 215-563-0652 or visit www.trans-health.org.
Ed Bomba is communications chair of the LGBT Elder Initiative. The LGBTEI, headquartered in Philadelphia, is dedicated to supporting and sustaining the lives of LGBT older adults. To comment on this column, suggest topics for future columns or for more information, visit www.lgbtei.org
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