U.S.

For aging transgender population, retirement can be bittersweet refuge

While it could mean the end of pretending, the golden years can also come with health care issues, intense isolation

She calls it her “firewall.”

At home, Alice can live as the woman she knows she is. But at work, she has to use her “boy name” — the one on her birth certificate. There’s a co-worker that has joked about using “fags and trannies” as target practice. The day she goes to work as Alice would probably be the day she quits, or gets fired.

At 60, Alice has been forced to make the choice between living an authentic life and living her retirement in poverty. Her firewall is more than a matter of principle — it’s a matter of survival. In Missouri, where she lives, Alice could still be fired for being transgender. That’s why there’s a firewall between home and work, and why she asked to be referred to only as Alice. Her firewall is her double life.

“The problem is, most of us who are older are looking at life after work,” she said. “And we realize that it could well be lived in poverty. We can be true to ourselves, but at what price?”

In the end, living an authentic life is a financial risk for transgender individuals. A 2013 study found that transgender workers report unemployment rates two times higher than the population as a whole, and are generally underemployed, more likely to have lower income and more likely to be in an unstable housing situation.

But there’s always retirement, right? Not always.

As more and more transgender individuals get older, the unique challenges they face are becoming apparent. Shortfalls in health care could mean the difference between life and death for some. Discrimination in retirement communities or assisted-living facilities could tarnish the golden years, and a later-in-life transition could leave some ostracized from the families they’ve loved their whole lives.

For a transgender baby boomer such as Alice, retirement could offer a relief from the workplace discrimination and the double life many have begrudgingly become used to in order to put food on the table. Alice will finally be able to be Alice all the time. It’s the beginning of a new chapter, but a happy ending is still uncertain.

“What it comes down to in terms of older trans people, our biggest problem is finding health care,” she said. “That’s one of the crosses we have to bear.”

She’s had a host of health issues over the past year, but knows of only two physicians in her area who see patients for trans-specific health concerns and offer an open and accepting practice. In the past, she and other people she knows have been turned away from clinics or met with hostility from doctors who refused service based on religious views or other grounds.

Medical questions

June LaTrobe.
June LaTrobe at a demonstration in Chicago's Lakeview neighborhood in the wake of the DOMA and Prop 8 rulings in June.
Kate Sosin

But even for those who have not had as much trouble finding health care, such as June LaTrobe, a 72-year-old transgender woman living in Chicago, there’s still a noticeable gap in knowledge surrounding trans-specific health concerns.

“In general, most of the information or data on hormone replacement therapy is based on experiences 25 years ago for postmenopausal women,” LaTrobe said. “What you have is doctors who are learning by seeing their patients. The information they have is so old it’s not really connected.”

A 2011 study published in The Journal of the American Medical Association found that the average time dedicated to LGBT-related health issues in American medical schools amounts to a mere five hours over the course of the entire curriculum. When it comes to transgender-related health concerns, the number is presumably even smaller.

For LaTrobe and others, that gap in knowledge can be the difference between life and death. This year she had to stop taking her hormones, having discovered a blood clot in her leg that her doctor believes could be just one of the little-known side effects of extended hormone therapy that will become more and more common among transgender seniors.

However, there has been some progress on the health care front for older transgender people in terms of access. LaTrobe said the Affordable Care Act opened up doors for the transgender community, specifically the reforms surrounding pre-existing conditions. She said being transgender was effectively considered a pre-existing mental disorder by major insurance companies for many years.

But a lot of that depends on where you live. Chicago, LaTrobe’s home, is further ahead on trans issues than other places such as Missouri, where Alice lives.

“In general, that is an area which nationwide is improving,” LaTrobe said. “I’ve had a number of health problems in the last year. I never felt that I was getting a funny look … that I was in any way being treated different.”

Going back into hiding?

At 72, LaTrobe is still able to live on her own on a fixed income. Long-term care and assisted living aren’t things she’s thought about yet. But for those people who are entering a retirement community, the move can be a regressive step.

Even though today’s world is more accepting of transgender individuals, largely driven by younger generations, it doesn’t mean the older generation is any more accepting, said Joe Ippolito, a Minnesota-based psychologist and transgender activist. That can spell trouble for transgender men and women as they age and enter end-of-life care.

“I’m starting to hear about this issue when (transgender people) are going back to the gender they were born in for the fear of being outed in these facilities or not (being given) appropriate care in nursing homes or assisted living facilities,” he said.

Those individuals disappear into retirement or assisted living communities, taking on the name and gender on their birth certificates, often cutting all ties with any of the LGBT communities they had been a part of before.

“Anyone can relate to getting older,” Ippolito said. “But we have these additional concerns around being discriminated against.”

‘Not belonging anywhere’

It was discrimination, even when unintentional, that motivated Loree Cook-Daniels of Milwaukee to start FORGE, a transgender support network with a focus on aging issues. For the past 10 years the organization has been hosting workshops for professionals on how to meet the needs of aging transgender people.

“When we talk about LGBT issues, we kind of lump it all together and don’t realize the differences,” Cook-Daniels said. “On the ‘T’ in particular.”

And the demographics aren’t waiting for those like Cook-Daniels and Ippolito to catch up. Not only are the early pioneers of the transgender community getting older, but more older people are coming out and transitioning. There’s no way to know exactly how many, but the general consensus is the number of older transgender individuals is on the rise across the board.

“Any time you have a gender transition, that needs a huge amount of support,” Cook-Daniels said. “Not only for the trans person, but their family members. The lack of support for family members of the trans community is still acute.”

More resources would mean that fewer later-in-life transitions end in divorce, Cook-Daniels said. However, seniors who transition often face another challenge — one that any grandparent would find heartbreaking.

“It’s the loss of the grandchildren,” she said. “Oftentimes the adult children freak and cut off access to the grandchildren. And that is incredibly painful to these people.”

That’s a problem that can’t be fixed by a law or statute. Instead, Cook-Daniels said, it’s a matter of changing society — one mind at a time.

“It’s really hard to describe the feeling of not belonging anywhere,” Alice said, her voice choking up. “The best I can describe it is standing out in the rain, looking through a window at the rest of society and knowing they won’t accept you.” 

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