When it comes to the issue of transgender people's health, the general perception might be that surgical-reassignment surgery is the most pressing concern. However, transgender people face a number of issues that are unique to the community, and these have a direct impact on their lives as they age. For instance, they tend to be disproportionately underemployed or unemployed because of societal stigma and/or because many of them may start careers over after transitioning and/or feel compelled to start new lives in new places. As a result, transgender elders tend to have little or no retirement savings and must depend on programs like Medicare and Medicaid. When placed in retirement communities or supervised care facilities, they may face transphobia on the part of the very people who are supposed to tend to them. Consequently, transgender elders are often reluctant to ask for treatment even for dire medical conditions.
These and other issues were addressed in a daylong trans aging forum April 17 at Center on Halsted, 3656 N. Halsted. It was led by Loree Cook-Daniels, the founder of Transgender Aging Network and an aging policy analyst, advocate and trainer. The event was designed for social services providers, health care professionals and advocates, and was co-sponsored by FORGE ( For Ourselves: Reworking Gender Expression ) , an umbrella organization that houses the network. According to Cook-Daniels, who spoke to Windy City Times, trans aging concerns are of special concern since "trans people are so vulnerable to discrimination and curiosity. I really want to train providers to think through what it is they need to know. My feeling is that most professionals want to do the right thing, they want to treat people respectfully even if they don't particularly like their lifestyle—and that means treating people respectfully. But if you don't know how to do that, you can really make mistakes."
The morning session addressed the distinction between what providers and others working with transgender elders need to know in order to provide the best care for their clients, and what they might only be curious about. For instance, asking for the client's age might be relevant if the agency only served a particular age demographic, but curiosity as to whether the client "still" had a penis would be disrespectful and irrelevant. Cook-Daniels emphasized that the job of the provider was to "serve your clients, not meet your own needs." She said that providers needed to understand that transgender clients "will usually know how they want to be treated, and often they will have advice/experience you can draw on." Cook-Daniels said that the four cardinal rules for providers, when working with transgender clients, were: partner with the client in a mutually respectful relationship, use the terms and pronouns preferred by the client, know what ails them and why and "take your curiosity elsewhere."
The intensive included various group exercises where participants worked together to test their knowledge about transgender community and aging concerns. Statistics were eye-opening. For instance, while 10% of the general public have depression in a given year, that number ranges from 37%-52% among FTM ( female-to-male ) and MTF ( male-to-female ) transgender adults. Another specific concern for providers and advocates is the higher risk of HIV infection. Many transgender elders have transitioned relatively later in life, and have often been in marriages where they were not exposed to HIV-prevention education. In addition, given that negotiating disclosure about transition with new partners can in itself be very difficult, issues like condom negotiation can be even more so.
Overall, the intensive appeared to be both enlightening and useful for the participants. Jamie Woods, who identified as an MTF lesbian transgender woman, is a board member of the Milwaukee Metropolitan Community Church. She talked to Windy City Times about class and economic differences in the transgender community, saying that there are "people who can afford surgery versus people like myself who can't afford surgery." Woods pointed out that surgery was not the only health issue for transgender people, and expenses add up: "You need to see a doctor at least once or more often a year. You also need lab work, some doctors insist on that once a year, some more than once a year. They need to check to see that your liver and other organs are working properly, see what your hormone levels are, to see if the dosages need to be adjusted." She said that "in light of the growing number of poor people, we need some form of universal health care and that needs to address LGBT issues."
Kim Rogers, a master's student in the University of Chicago School of Social Services, echoed the concern about access to health care for transgender clients. She said she was there "to increase my knowledge about the transgender community as it's aging … we need to understand how gender dynamics can be complicated. We're going to have the largest generation in continued elder care living arrangements, so we just have to start thinking about the diversity of that community." Asked if she did a lot of these intensives, Cook-Daniels said that she usually does much shorter workshops: "We have no funds for travel. We're trying to get funded so we can take this on the road and take it other places."
