Gerontological Social Work Addresses Transgender Aging

Diane Persson, long-time member of the Transgender Aging Network and colleague of Houston’s late transgender/HIV activist Brenda Thomas, was pleased to send me a copy of her new article, “Unique Challenges of Transgender Aging: Implications From the Literature,” which has just been published in the Journal of Gerontological Social Work, 2009 (Vol. 52, pp. 633-646).  (http://dx.doi.org/10.1080/01634370802609056 )

As the title implies, there’s no new data in this article, which is instead focused on using existing documents to build a transgender 101 for social workers new to transgender aging issues.  The first section gives definitions; models the dimensions of biological sex, gender identity, gender expression, and sexual orientation; and looks at prevalence estimates.  This section does (very briefly) mention autogynephilia (a highly controversial and contested theory that calls male-to-female (MTF) transsexual women sexually attracted to men “homosexual” and says other MTFs are motivated by an “erotic desire to become women”) without noting the controversy around it.

The next section focuses on issues for transgender seniors.  In my opinion, her section on typical health concerns should not be relied upon.  Her sources do not include any of the more recent transgender medicine books, and some of what she states as fact are hotly debated (for instance, whether estrogen use truly raises MTFs’ risk of breast cancer and osteoporosis).  She also says nothing about typical FTM surgeries and their potential complications, injection silicone, or the outrageously high rates of HIV found in some MTF population samples. 

She’s on firmer ground when she moves to barriers to care, and her construction of a table of actions health care professionals can take to address transgender aging issues is especially useful:

Category Approach
Program/Policy Include gender identity, as well as sexual orientation, and establish policies to address transgender needs.
Operative status Acknowledge the different needs of pre- or nonoperative from postoperative individuals.
Hormone use Recognize that although hormone use is usually life long, not all hormones are legally prescribed.
Time of transition Individuals transitioning earlier in life versus later in life have different concerns regarding employment, family, health, and legal issues.
Documentation Name and gender designations both need to change, and some documents have service implications (e.g., social security, employment/Veterans Administration/health records).
Social support Ask specifically what you need to know, such as “Do you have a caregiver?”  “Who provides your emotional support?”
Language Clarify what name and pronoun the transgender individual uses.
Publications Include trans-specific information and brochures.
Training Provide staff with necessary training, materials, and support they need to understand transgender aging issues.

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