Author: Anjali Jaster
Introduction
Health dominates and controls every aspect of human life. With too much deterioration of health, we die. It is that simple. However, awareness and attention to health, and health impacts, are not always at the forefront of the studying of humans–nor in our conversations either. While this is not said to put anyone at blame, it can be considered a flaw of humanity, in which we have become so enthralled in growth and development, histories and futures, and the wealth and successes of humankind that we sometimes forget to consider what will be the end for us.
In medical experiments and developments, there is great excitement and awe surrounding medical transformations–for research developments, new medicines, successful procedures, and cures for diseases. While I am not diminishing these successes, it is important to point out that the focus can be so much on the achievement that healthcare providers do not stop to consider each cost and implication that could arise later in the patient’s life. These ideas feel especially prominent when considering trans-affirming healthcare, the developments of gender-affirming hormone therapy and sex reassignment surgery, and the altering of mental wellbeing that transitioning can cause.
For the creation of this syllabus, I was inspired by a nursing course I took about aging which gave me a humbling glimpse into the lives of our elders. It is normal that for those not in this stage of life, being an older adult is not the easiest to comprehend, and we like to believe that “I will be the exception. I won’t be in pain, I won’t get ill, I’ll be fit, I’ll feel youthful.” Although there’s no harm in optimism, it is beneficial to acknowledge the ways we might struggle early on. This is one benefit of engaging with this syllabus I hope to provide, for there to be a new awareness of the ways aging might be a difficult (or different) experience for trans people, so that preventative measures against disease and mental health struggles can be taken when possible. I hope to bring a new layer into the trans studies curriculum that places consideration of long-lasting wellbeing at the center of these conversations.
Hil Malatino, in their essay “Surviving Trans Antagonism,” highlights the importance of trans care and more specifically, aftercare. Through their discussion of the vulnerability and destruction that can exist for trans individuals as they transition and fight their way forward in a world that does not see them equally, Malatino brings forth the necessity of healing through care webs (3). Their outlook is one I value, because I have great respect for the strength of trans communities, and how these support systems are what lead to the continuation of life. This idea of the importance of caring for each other in times of immense pain and struggle directly relates to how many of the sources in this syllabus are built on the values of trust and building supportive relationships through shared experiences. Which is especially important when aging, as it can otherwise be a profoundly isolating time of life.
Further, in Mikey Elster’s article “Insidious Concern: Trans Panic and the Limits of Care,” they examine how the world’s concern for trans youth is more of a hope to maintain and support the population of youth in general–which normally tends to follow a path which prioritizes those who are privileged and already recognized more in society (409). Although the intention might exist that all youth are deserving of the same success and rights, it is the actions which fall flat when it comes to giving the youth in minorities a better chance in life. This revelation of how trans care for youth can have a holistic and diverse claim, but can still be extremely biased and unequal in its practices holds a similar reality for the care of elders. Although a healthcare practice may cater towards aging individuals generally, not everyone’s needs are the same, and there is often a lack of consideration for those who might need a different spectrum of care. There is also a missing piece in systems of care which do not consider the medical procedures trans elders may have undergone–that could still have implications on their body to this day. Since the medical processes of a trans person are not the norm, they are often not considered in the development of ‘standard’ treatment plans in medical settings. Aging can already be a very vulnerable and lonely experience, so when adding the layer of seeing a doctor who has not even acknowledged the differences of caring for a transgender individual, growing old can become even more disheartening.
This syllabus engages with multiple research studies, which examine the health conditions trans people are at risk for as they age, whether this be for medical reasons pertaining to gender-affirming medical treatments they received earlier in life, or due to stress and fear from living in a world which does not consistently view them as human. One illness that is touched on specifically relates to the impacts of dementia and how this syndrome is unique for trans individuals who face an ageist and transphobic society. Many of their struggles arise from having the same self-identity, but being unable to express themselves in a knowledgeable way to doctors, who are quick to see what they say as untrue due to their memory loss and deteriorated cognitive function. Thus, diminishing these patients’ chances of receiving individualized care. The other sources focus on the shared reflections of older trans adults, as they move through their senior years. Between a memoir, documentary series, research study, and news article, these personal stories are explored, with the concerns of aging transgender adults better understood. Although not in lieu of the ways in which these individuals continue to embrace and be proud of who they are in life.
I wish for this syllabus to be a new educational support for the trans community (and its allies), one which provides an important look into medical conditions they may be at risk for, and the ways in which they can use their knowledge to take preventative and protective measures. Additionally, this is also for healthcare providers, to supply them a few moments of pause to consider the impacts of gender-affirming care procedures that are less researched and the negative effects that may arise down the road. In addition to allowing critical reflection surrounding the potentially transphobic reasons why the negatives of these gender-affirming treatments might not be shared in the first place.
Education is vital to freedom, to social justice, and to trans justice as well. Understanding one’s body, the health risks one might have, and how we can prepare if not prevent this potential deterioration falls into the category of expansive knowledge. Therefore, these observations and teachings are the supports which can solidify identity, strength, and individuality in the trans community. In order to ensure the ability for trans individuals to lead long, powerful, and supported lives, the medical care they receive must be thorough, safe, and destigmatized. Although this continuity of care is necessary throughout life, close attention must be paid to our elders in the trans community because of their small existence in the past, plus their vulnerabilities which might be taken advantage of. Furthermore, while better prioritization of good health is necessary in broad terms, if an emphasis is not specifically applied to assuring the wellbeing of minority groups, then humanity can never succeed in being an equitable race.
Recommended Readings
Adan, Matthew et al. “Worry and Wisdom: A Qualitative Study of Transgender Elders’ Perspectives on Aging.” Transgender health vol. 6,6 332-342. 2 Dec. 2021, doi:10.1089/trgh.2020.0098.
This study focuses on arising themes between conversations with transgender elders who have expressed their main concerns about their experiences with aging. Seven themes were pinpointed from nineteen interviews, which provided insight into the challenges transgender individuals are facing that are not well-researched or well-examined in many scholarly contexts. As the development of this article prioritized the feelings and experiences of trans elders, they incorporated quotes from these elders into their analyses and one which stood out was “[loneliness] can be more prevalent for trans people, because so many have had their families or partners abandon them and never rally back” (Adan et al. 338). Transgender elders’ fears of loneliness was one of the most prominent takeaways of this study, and this anecdote helps clarify the ways in which loneliness can be a result of direct transphobia, not only growing older and losing people over time. Although this is only one small reflection on the transgender aging experience, the comprehensiveness of this study is what makes it a valuable source for this syllabus, as it brings forward a transformational understanding of the everyday fears and exhaustive mental overwhelm of transgender elders. It is also a strong source because the write-up provides substantial insight into the personal reflections and worries of trans individuals specifically through a lens of research. Highlighting the impactful presence of health concerns–in addition to more culture-based dynamics–that cause serious anxiety for these elders, ones which are not always obvious or assumed by anyone outside of the trans community. For there to be a fight which exists for trans justice, a broad but abundant understanding of the neglect and harm facing aging trans individuals is necessary, and this article covers the expanse of these ideas extremely effectively.
Alfonseca, Kiara. “After Decades of Fear, Some Transgender Elders Celebrate Freedom and Progress.” ABC News, ABC News Network, 3 June 2024, abcnews.go.com/US/afterdecades-fear-transgender-elders-celebrate-freedom-progress/story?id=110435380.
This article brings a more positive light to the aging experience for transgender individuals, as those who were interviewed for this publication shared their pride in who they are, the trusting community they have found in other trans elders, and how they have overcome being afraid (as much as they can). They reflect on the changes in transgender rights and the world’s views of LGBTQ+ people since the time when most of these interviewees were transitioning, and the general consensus is that times feel safer and more joyous for them now in their identities. One quotation that is all-inclusive of the outlooks of these interviewed elders is described as: “For these transgender elders, aging has brought out a youthful viewpoint on life – one filled with friendship, joy and learning” (Alfonseca). This reality is conclusive of the conversations conducted with these individuals, as the article continues to return back to the ways in which these older trans adults are creating joy, freedom, community, and self-expression in their everyday lives. The reflections of these elders are greatly impactful because they showcase how beyond their struggles with identity and being accepted, they hold immense pride in the body and the person they are aging as. This source felt prominent to me because it provides a much more buoyant representation of the correlation of the aging experience and being transgender. As much as I wish to use this syllabus as a source of education to be able to better comprehend how aging can be unique for trans individuals, so that we can become more aware of how trans elders can be at greater risk too, it is also of value that the positive parts of aging are shared more widely, because these recognitions can bring a lot of hope.
Baril, Alexandre, and Marjorie Silverman. “‘We’re Still Alive, Much to Everyone’s Surprise’: The Experience of Trans Older Adults Living with Dementia in an Ageist, Cisgenderist, and Cogniticist Society.” Science Direct, Elsevier, Mar. 2024, www.sciencedirect.com/science/article/pii/S0890406524000033#section-cited-by.
This study brought attention to how dementia can be a unique struggle for transgender individuals, through discussions with four care providers of trans/non-binary people living with dementia, as well as two trans people with dementia. This article realizes the ways dementia not only impacts elders due to cognitive decline and memory loss, but also how this loss of self impacts one’s ability to express their gender, and thus alters medical providers’ beliefs about what their gender identity is (and should be). The conflict with doctors is where myriad issues arise for trans elders with dementia, as is expressed here: “You have memory issues, so I don’t really know if I can trust what you’re saying [about your gender]” (Baril and Silverman 7). This example of the types of conflict doctors often create is severe because medical staff can utilize their power over those who are cognitively impaired to oppress the patient’s personal experience with gender. This fact is especially dangerous for trans adults with dementia because their memory loss places them in a more vulnerable state, and without an advocate with them, their chances of facing discrimination due to stigma are likely. The significance of this source pertains to how aging trans people already face copious stereotypes without a neurocognitive disorder, so with dementia viewed as a ‘social death,’ there becomes a greater risk for a loss of one’s sense-of-self. In my own learning about dementia, I built a new appreciation for the ability of our brains to connect and maintain memories, as well as a newfound respect for those losing this capability. With this knowledge, I feelI hold a responsibility to teach others to be more sensitive about the impacts of this disorder. Additionally, I believe studies of dementia hold a powerful place in trans studies because of the value of personal identity and gender expression, and how dementia takes a lot, but it does not have to steal who someone is.
Ceolin, C et al. “Getting old in the desired gender: a systematic review on aging diseases in transgender people.” Journal of endocrinological investigation vol. 47,8 (2024): 1851-1862. doi:10.1007/s40618-024-02353-y.
This article discusses how gender-affirming hormone therapy can have negative impacts on patients, and it is explored through the lens of age-related illnesses that arise. A search was conducted to find articles which explore the occurrences of these illnesses, which led to the conclusion that transgender people are at potentially higher risk for cardiovascular disease, chronic disease, depression, and cognitive disorders. The quotation: “The prevalence of homophobia, transphobia, rejection, and discrimination experienced by TGD [transgender] individuals, collectively termed ‘minority stress,’ disproportionately impacts their overall health and carries significant clinical implications” (Ceolin et al. 1857) proves how chronic stress and the weight of not feeling accepted in one’s community can hold real life implications on one’s health. Although the overall view of maintaining health often surrounds the choices and habits of humans, the idea missing from this conversation is how the structures of racism, transphobia, and other harmful human practices can severely and irreparably deteriorate health. However, the evidence in this article works to uncloud these assumptions. These understandings of disease pertain so greatly to the success and fulfillment of a trans person later in their life and it is important for anyone in trans studies–or as a trans person or ally themselves–to have an understanding for the medical procedures that are often a part of transitioning, and the risks that are attached to them. The understanding of how mental health can also decline with age for trans people is invaluable when assessing signs and symptoms, and I hope to give students the opportunity to interpret these facts as they read this article. Any class which lingers on the study of humans holds ideas of health and the maintenance of life in the background at least, so it is significant to me that a trans studies course incorporates analyses on health as well.
Kermode, Jennie. Growing Older as a Trans and/or Non-Binary Person by Jennie Kermode. London, Jessica Kingsley Publishers, February 18, 2021.
This book provides trans individuals and caretakers a personal look into the life of an older transgender adult, by weaving together stories of transgender elders with those preparing to enter that stage of life. In addition to anecdotal sharing, this source incorporates a detailed historical explanation of how trans/non-binary lives have changed throughout time. Two significant points in Kermode’s introduction discuss the reasons as to why the idea of the existence of older trans adults might feel rare. For one, the greater initiation of hormone therapy and gender-affirming surgery in the 1990s means there are not as many older adults who have medically transitioned (which is often seen as the more ‘obvious’ way of transitioning). Additionally, the author writes that “rates of mental illness and suicidal ideation are higher among trans people who lack the opportunity to transition, so it’s probable that fewer trans people made it to old age” (Kermode 11). This realization is an important recognition of not only why older trans adults might be neglected, but also of the heartbreaking realities that exist in the trans community. Kermode’s reflections guarantee the necessity of the inclusion of this source in my syllabus because they took time to acknowledge why the lack of thinking about trans elders exists, while connecting this to the significance of the older individuals who are here, and the stories they can share. I support this ideology in the creation of this syllabus because it is necessary to call-out and understand how stereotypes about minority groups have come into existence (for trans elders specifically in this context), in order to bring forth more attention and care for these individuals, as well as a respect for the difficult but beautiful lives they have led as they move into seniorhood.
My Genderation. “Growing Older as Me.” YouTube, YouTube, Mar. 2019, https://www.youtube.com/playlist?list=PLbeZBtR_FvDG0D7KbYV6WhjNnGbLO6PtK.
This is a short documentary series created in correlation with the Trans Ageing and Care Project in Wales, and the videos explore the stories of older trans individuals, their experiences with growing older in their bodies, and their realized needs as well. It is a compilation of four to eight minute videos that each spotlight a different individual, following them in their life as an aging trans person. One video focuses on a transgender woman named Annabelle, who shares her difficulties in receiving the medication she needs for her gender dysphoria, and her conflicts with the general practitioner who discounts her experience and needs. Annabelle’s reflection: “I’ve heard lots of stories about GP’s being obstructive…I find not necessarily obstruction but a lack of understanding and a lack of urgency” (“Growing Older as Me” 3:10-3:22) examines how medical providers get in the way of aging transgender individuals and the care that they need. Whether this comes from transphobia, a lack of care, or a disregarding of these patients’ gender dysphoric experiences as a severe issue, these beliefs of doctors place a barrier between trans elders and access to the empathetic healthcare they deserve, which puts them at a higher risk of developing the health conditions that have been discussed earlier in this syllabus. This is a valuable source because it shares the experiences of aging transgender people in a personal and engaging manner. These short videos are easy to show in class or assign as homework without them taking up much time, and because of the format, it lends itself automatically to reflective group discussion. I value having items on the syllabus that are not as textual or analysis heavy, and films are always engaging for me personally, which is why I included this. Additionally, this documentary series and its themes are a pretty rare creation, and I want to be able to showcase these unique stories to students.
Works Cited
Elster, Mikey. “Insidious Concern: Trans Panic and the Limits of Care.” Duke University Press, Transgender Studies Quarterly, 1 Aug. 2022, read.dukeupress.edu/tsq/article-abstract/9/3/407/319361/Insidious-ConcernTrans-Panic-and-the-Limits-of.
Malatino, Hil. Trans Care. University of Minnesota Press, 2020. Project MUSE, https://muse.jhu.edu/book/78334.
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