TRANSGENDER AGING
case studies in housing, healthcare and community SCOTT VALENTINE
FORWARD
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INTRODUCTION
1
VISIBILITY HOUSING SAFETY HEALTH COMMUNITY
8 25 44 62 84
APPENDIX
108
REFERENCES
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“I now understand who I am and what I am and I don’t have a problem with it. I don’t mind appearing like this I don’t mind when I have a lot of make up on or don’t, it does not matter to me anymore because society’s changed a lot in my view. I realize now this was more my mental problem, not the public’s mental problem. I think we are the last generation over the age of 30 or 40 years-old that will begin transitioning [late in life].”
–Karen (59Years-Old)
INTRODUCTION The Last ‘Gender-ation’ Time is a force. In order to mark its inevitably passing, we create social markers, a measurement, rending its invisible presence more tangible. From the birthdays we celebrate to those pinnacle moments denoting life accomplishments, these periods of time can leave their trace on us. Threads of grey hair and wrinkles act as such physical markers. These physical indications of time usher in a new era of one’s life advancing over time. Though aging affects everyone at different rates, the aspiration to age successfully is a concern anyone can sympathize with. For one particular vulnerable population among the baby-boomers’ generation, this is not only a primary concern but runs parallel to other significant changes in their lives; aging as their authentic selves. We have yet to fully grasp how aging and transitioning for the Transgender population are affected by each other (Kimmel 2006). With an increasing presence across both cultural and political realms, the aging Transgender community inhabits a unique position. For aging specialists, little is known about the Transgender community. By identifying and better understanding their overall well-being, a tremendous affect could begin rippling through many other ethnic and racial barriers (Kimmel 2006). For any community to age successfully, multiple contributing factors should be identited (National Wellness Institute 2015; Burger 2009; Mertens and Ginsburg 2009). For this study, the factors of housing, healthcare and social networks were addressed. Using each of of these areas as a lens, all converged into well-being, the primary concern of this research. This exploratory qualitative study was the first of its kind, documenting Transgender aging individuals’ anticipated needs across the United States. This
research looks to create a baseline of working knowledge of Transgender older persons’ needs and concerns, extending a broader understanding of whom and how are vulnerable communities aging in the United States in addition to broadening our understanding of aging. Though the Transgender community has recently seen a more visible presence in the world, they have always been there. We just were not paying attention. With younger generations viewing gender an ever increasingly more fluid concept, aging Transgender individuals are perhaps the last generation of individuals who will need to transition late in life. This ‘gender generation’ beckons us to resolve systemic issues in order to account for future generations. As an overview, Transgender history will be briefly mentioned in order to understand the long lineage of misunderstanding and disenfranchisement. This section will then discuss the lack of protections in housing, healthcare and social reforms which can be viewed as deliberate and calculated moves suppressing the Transgender community. This discussion will then be followed by a methods section, going through a description of recruiting individuals. The value of using focus groups as a qualitative method for this particular population provided for their narratives to also be captured. Such an approach gave this vulnerable community a voice rather then assigning them a value or percentage. The results will take form in the three sections analyzing the six focus groups. The reader will see the emerging trends from these focus groups being organized into themes within each chapter. Discussing the results in this manner will allow for more intersectional issues among the three over arching topics: housing, healthcare and informal social networks to be identified. Lastly, the final section entitled ‘well-being,’ will suggest
VISIBILITY The Great Divider: Age, Access, History and why Transgender Aging Matters When considering the future of aging in the United State, it is essential to further our knowledge of such vulnerable communities like the Transgender community (Mallon 2008). A long history of a clear definition perpetuated a common misunderstanding of what Transgender meant. During his ground-breaking study on Human Sexuality, Dr. Alfred Kinsey came across a young child who identified as the gender opposite their biological gender. Dr. Kinsey made a colleague aware of his findings to endocrinologist and sexologist Dr. Harry Benjamin (Meyerowitz, 2002). Dr. Benjamin quickly began work, discovering many others who identified psychologically opposite to their biological gender. His inquiry blazed a new trail of medical research and soon began to widely circulate information on his findings. Dr. Benjamin became world famous, after he successfully performed sex reassignment surgery on a much celebrated figure within the Transgender Community, Christina Jorgensen, in 1952 (Stryker, 2000). Over the years, through his careful documentation and research on Transgenderism, he developed guidelines for Standards of Care for Transgender individuals, which are still used today (WPATH 2011). Yet until recently, in 2013, both the American Medical and American Psychological Associates (AMA and APA) recognized Transgender as a disorder, resulting from Gender Dysphoria, or a disorder where one’s emotional and psychological identity did not align biologically (DSM IV, 2013; AMA:2014).
With a long history of systematic exclusion, and resent legal issues discriminating against them, aging is a particular area long avoided. Known as the baby-boomer generation, those born between 1946-1964, have begun to retire en masse (US Census Bureau: 2012). This generation is an incredibly diverse population, reflecting the ever increasing multi-cultural landscape of American society (US Census Bureau: 2012; JCHS, 2014). As birth rates decline, an anticipated problem emerges. The baby-boomers are projected to become 20 percent of the overall population by 2030 or 1 in 5 Americans (Federal Interagency Forum on Aging-Related Statistics: 2012). Their health and social service needs will become a top priority, bringing about important challenges and stresses to institutions that have been able to support both previous and current cohorts (US Census Bureau Aging Stats, 2012; Ortman, Velkoff & Hogan, 2014, Lott 2007). It is widely known that many pre-existing social and governmental resources already fail to accommodate those with various and/or multiple cultural identities: especially those who are Transgender as no clear language exists safe guarding gender expression (SLRP, 2015; Knohel et al., 2015; Dean, 2014, Movement Advancement Project, 2016). Even though there is a standardization of care for Transgender individuals it does not include caring for an aging Transgender individual (Kimmel, 2006; Masotti, 2006; WPATH, 2015). Most jarring is the lack of inclusion and a working knowledge of gender and sexual minorities within the fields of Gereontological health, urban studies and aging services (Cahill et
What is your current housing situation?
HOUSING rent home home owner own condo
rent condo shelter/group home homeless
Trans-Utopianism: Place-Making and Creating One’s Own Space ‘I would love to see someone design a compound, a complex, a collection of small houses that are specifically for the Transgender aging community,’ came flying out of Vanessa’s mouth as the conversation began to escalate. Surprisingly, every session ended in a similar fashion where a tremor of hope ran through each room, continuously growing in magnitude as each session pined for some kind of community-based development for them. Two conversations in particular stood out among the sessions those where Jean and Mitch were in attendance. Within Jean’s session the group’s discussion broke it down based on practicality as they all began to collaborate and plan on how this could be a possible solution. As Jean began to joke about having too much space and Florence mentioned she should just move in. A back and forth between the two women began. At one point rent would be based on services rendered such as cooking and cleaning; a bartering system. They then quickly began imagining hosting larger gatherings for holidays and birthday for both of their already large, and growing,
Discovering a lack of safe spaces, everywhere.
Have you ever been the victim of violence because of your gender expression? If yes, how many times.
SAFETY
Have you ever experienced harassment becuase of your gender expression by a social or healthcare professional? How many times?
Yes No 1-3 5-7 8-10 I Stopped counting How many times have you called the police becuase of threats for being transgender?
Is your healthcare provider Transgender supportive?
Yes
No
A Prescription for Compassion Across institutional healthcare practices, Transphobia continues to take on many forms (Formby, 2014, Tod and Hirst, 2016). Despite healthcare increasingly becoming more accessible and affordable in the United State because of the Affordable Care Act, there is still work to be done for the Transgender and aging populations to make this system more inclusive for them. This section presents reoccurring themes heard from participants. Affirming healthcare is an essential component for any Transgender individual wishing to live a life as their authentic selves. Presently, there is no single kind of appropriate gender transition medical program, as not all Transgender individuals require the same kind of interventions. There continues to be a lack of complete understanding of Transgender individuals by both medical professionals and their staffs. In this section we hear from Transgender individuals with varying kinds of wants and desires associated to their own journey to authenticity. What we can establish from each individual’s responses shows how vital it is to receive compas-
sionate care for their overall well-being; a privilege some had had before they transitioned. You will quickly see, how drastic their care changed, merely based on how many people are miss-educated on Transgender individuals (Kesling, 2015). Insurance coverage for many procedures has become an interesting matter to be discussed as well. This section on healthcare will begin with an overview of what transitionary care entails: pharmalogically, emotionally and in some cases surgically. In general, for any patient, healthcare begins by receiving access through insurance or other affiliated programs. Following the overview of Transitionary care, I will present many of their experiences of watching a changing system while also attempting to figure out how to navigate one which still does not give full access to vulnerable populations. The pursuit of healthcare will continue in following sections as well. As a patient, one sees three factors conjoin: the social, medical and insurance systems when we reach out to medical professionals. Interactions with support staff such as administrators, nurses, laboratory technicians, is a ritual we often disregard, but to a Transgender person, a misstep, lack of knowledge and bias could mean a refusal of treatment. To bring this section to a close we explore how inequality within the healthcare system affects the outcomes for this population (Bentley: 2014). We will look first at the Trans male participants who are statically under-represented in any kind of LGBT and Transgender healthcare. The section will be brought to a close with the inclusion of powerful stories of Florence and Eve. While they each described their personal acceptance as Trans women, their thorough research on transitionary care should be noted. Additionally, each of their stories eluci-
HEALTH
COMMUNITY Constructing Confidence: Aging in a Post-Human Digital Era When discussion turned to social networks, informal resources and networks were key for well-being. I was surprised to hear from a majority of them how the internet was a tool most widely used for their well-being. The range of its use varied from a form of therapy, a research tool to learn more, and a place to purchase discounted hormones. The internet was a neutral territory, a safe space for many of them to inhabit without any social anxiety or fear of being found out. If you recall Florence talked extensively about using the program SecondLife for many years before transitioning because it was a way, “…to explore the world as a female...it was like therapy”. Many, including Florence, harnessed the internet to research and study more about transgender identity and health in addition to community. Or as Ann eloquently stated “The onset of the internet, that was a God send, a total blessing for the Transgender community. It opened up ways to communicate with others that are just like you. All of a sudden you are no longer alone.”