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Transitioning Later in Life: A Guide for Trans and Non-Binary Older Adults

Written by Sammie Westelman.

Older Adults Belong in the Trans Community

While often stereotyped as young, the trans and gender-nonconforming (TGNC) community is composed of people of all ages. Unfortunately, the visibility of TGNC older adults in our culture is sorely lacking. Without possibility models to look towards, some TGNC older adults feel that it’s ‘too late’ for them to transition, or to live in closer alignment with their gender identity. The truth is, there are no ‘time limits’ on coming out: TGNC people begin their transitions as early as childhood, and as late as in their nineties. It’s never too late to embody your own identity on your own terms.

Trans elders deserve to be celebrated in their gender identities, and to be meaningfully supported through their transitions with inclusive and accurate resources. With that in mind, this article will explore some common experiences of transitioning in older adulthood, explain your options for medical transition, address some prevalent concerns, and provide further resources for TGNC older adults.

What is Transition?

Transition refers to the steps that TGNC people take to affirm their gender identity. It can also be used to describe the time during which these steps are taken. The most important thing to remember about transitioning is that it is different for everyone. Some TGNC people don’t even use the term ‘transition’ to describe how they live in alignment with their gender identity, and that’s okay too.

Transition comes in three major forms: social, legal, and medical.

• Social transition can include using new names, pronouns, and honorifics; ‘coming out’ at work, school, or community spaces; and changing one’s gender presentation (clothing, hair, body modifications).
• Legal transition involves name or gender marker changes on government documentation, such as driver’s licences, birth certificates, and passports.
• Lastly, medical transition includes any medical care that helps people live in alignment with their gender. For example, gender-affirming care like hormone therapy and voice training can be part of a medical transition. Gender-affirming surgery is another major form of medical transition that many choose to pursue. TGNC older adults may have particular considerations regarding surgery, some of which are explored below.

Regardless of which steps you choose to take (or not take!), remember that you get to decide what transition means for you. No single process is necessary to ‘make’ you ‘trans enough.’ At the same time, there is no shame in needing something – like gender-affirming surgery – as part of your transition.

Gender-Affirming Surgical Care: Your Options Explained

There are many forms of gender-affirming surgery, including ‘top surgery’ (e.g. breast augmentation or chest reduction), ‘bottom surgery’ (e.g. phalloplasty, metoidioplasty, vulvoplasty, vaginoplasty), facial surgeries (e.g. facial masculinization, facial feminization surgery, androgynization and non-binary options), and body contouring (e.g. liposuction, skin excision, BBL). We encourage you to explore the pages for each of these surgeries to determine if and how they would contribute to your transition goals. You can also speak with one of our experienced, board-certified surgeons in a free online consultation to discuss your gender affirmation goals, your surgical needs, and any concerns you may have.

Common Concerns and Insecurities

While older adults can and do medically transition, older TGNC populations remain understudied in LGBTQ+ research. To bring awareness to this important and underserved population, the Gender Confirmation Center (GCC) conducted a quality improvement project. We surveyed our older patients – those who are considering or have completed surgery – to understand their unique needs. While this was not a research study and these findings are not exhaustive, we hope that making these concerns more visible will support older patients, particularly those interested in gender-affirming care, throughout their transitions.

Our findings suggest that those who consider or receive gender-affirming surgeries later in life can struggle with:

• Visibility: Gender fluidity and expansiveness are too often associated with young folks, which may alienate TGNC older adults. Further, TGNC older adults aren’t frequently represented in online materials, such as surgical before and after photos. A lack of elder representation in these materials can dissuade this population from seeking the care they need.
• Support Systems and community: Social isolation and loneliness are already common among older adults. TGNC older adults must also contend with generational stigma against LGBTQ+ people, which may further isolate them from their communities. The periods leading up to and following surgery require significant emotional and physical support; without a guarantee of this support, TGNC older adults may feel they need to forgo care. We encourage you to speak with your care team and explore these resources if you are concerned about getting enough perioperative support.
• Familial and social relationships: TGNC older adults – especially those who come out later in life – can be concerned about how their transition will affect their social and familial relationships. We recognize the difficulty of reconciling the desires for surgery with the anxieties of potentially losing your meaningful support systems. We want you to feel supported in your decision to pursue surgery, so please refer to this list of community centers and organizations geared towards older TGNC folks.
• Physiological health and medical clearance: Older adults may worry about how their pre-existing health conditions will affect their eligibility, ability to heal, and aesthetic results from gender-affirming surgery. At the GCC, we don’t have a maximum age for surgical care. Instead, your surgeon will determine and consider your individual physiological health before making a surgical plan, which could even include specific accommodations (such as a post-op overnight stay in the hospital) for your personal health concerns. Read on for more information regarding medical clearance for surgery.

Am I Healthy Enough for Surgery?

Before any surgery, you will need to undergo a physical examination with your surgeon or primary care provider. In the same appointment, you’ll also discuss your health history and goals for surgical results. This will help your provider determine your eligibility for surgery. Factors like your skin elasticity and general health will have a much greater effect on this eligibility than your chronological age. For your safety during surgery and healing, it’s vital to be thorough about your health history and disclose all conditions you have and the medications you’re taking. Other factors that will affect your eligibility for surgery may include:

• Your BMI
• Your smoking and drinking habits
• Your blood pressure
• Your history of bleeding disorders, lung disease, heart disease, and strokes

These conditions won’t necessarily prevent you from being a good candidate for surgery, but you may need to get medical clearance from your physician and/or surgeon first. For more information about getting medical clearance for surgery, visit this page.

TGNC Older Adults Benefit From Gender-Affirming Surgeries

Despite these concerns, findings from the GCC’s quality improvement project show that older adults experience the same quality-of-life improvements that other TGNC patients do after receiving gender-affirming care. In the words of one patient:

I am able to look in the mirror and what I see aligns with my internal sense of self… In public, I feel safe and am able to navigate the world with confidence… Also, I feel confident, grateful, and empowered to live my dreams whereas before transitioning I was mired in self-doubt and fear.

These findings are also supported by peer-reviewed research, which shows that gender-affirming care significantly increases quality-of-life for TGNC people, regardless of their age. In fact, this study even suggested that older TGNC people might benefit the most from receiving gender-affirming care, at least in terms of quality-of-life improvements. At the GCC, we firmly believe that transition can begin at any age, and wish to help all who think that gender-affirming surgeries will help them experience greater gender alignment.