By: Plume Community Member (they/them)
When you don’t know a word to be able to say who you are and how you feel in the world, you can feel all alone. For many older transgender people like me, who grew up in a time or place when there was no gender-affirming healthcare, this meant decades of internal struggle and mental and physical challenges. My experience was that being trans would have to mean a lifetime of loneliness and isolation.
So, coming out later in life felt incredibly empowering. It’s as if after a lifetime of struggle, I was able to reclaim my life and live in my best and most authentic self for perhaps the first time.
Starting your transition later doesn’t mean you’re new to your identity
If you are an older adult, you might have plenty of experience with gender dysphoria. Coming out later in life means you may face questions or criticism from family, friends or colleagues about why you waited to reveal your truth. But the reality is, for many people, it may have been impossible to do so.
“I have known all my life … for as long as I can remember,” one person told researchers.
Seeking help later in life doesn’t mean one just recently started struggling with gender identity. One study among transgender patients showed no significant difference between the age when those over and under the age of 40 first reported feeling of conflict or stress that they identified as a gender other than the one they were assigned at birth. In turn, older patients reported living with gender dysphoria “most of” or their “entire” lives.
These findings are important because left untreated, gender dysphoria can negatively impact your mental and physical health. At any age, access to gender affirming healthcare improves quality of life and can even be life-saving, according to researchers.
Why do people wait to transition?
Older transgender or nonbinary (NB) people may delay or avoid transitioning earlier in life because of family, work or social constraints. Many may have health insurance through work, but at the same time fear losing their job if they transition—especially in a state that may not have discrimination protections for transgender people.
But perspectives can and do change as people age and become increasingly aware of how much time they have left. One transgender woman who began transitioning in her early 70s told researchers in one study she decided to seek gender-affirming care as she became more and more aware of the limited number of days she had to embrace her authentic self.
Another transgender woman in her 60s found her worldview changed the older she got. She said that the things that kept her from transitioning earlier in life mattered less.
She said, “Your whole frame of reference to life starts morphing or changing. And so I started becoming a little more anxious about [thinking] am I actually going to die, actually pass on to the next life, without experiencing being who I am?”
Finding social support whether through family, friends or new connections in the transgender and queer communities is important at any age. But it can be especially helpful for older trans adults just coming out who may feel better on hormone therapy and yet also struggle with social isolation. In midlife, transgender individuals can sometimes struggle with sadness and fears of being targeted for criticism, according to research. That’s why many older transgender adults find various coping techniques to combat loneliness. Plume offers support groups for people who are new to estrogen and testosterone, or who are hoping to connect with other trans folks. (These groups are included in your Member benefits.)
What about Medicare and other medical access?
Medicare is the federally funded insurance program for older Americans. In 2016, the United States Department of Health and Human Services enacted new rules to protect older transgender adults from discrimination in healthcare.
The rules, which also apply to gender non-conforming (GNC) people, state Medicare cannot deny coverage for care that is sex-specific just because the gender on your Medicare card or identification lists a different gender identity than the one you identify with.
For the most part, research shows older transgender women and nonbinary patients seeking medical intervention can still safely access medical care, though every patient is different. Family medical history, smoking, your individual body’s needs, and other factors can also affect your transition options. Work with your medical provider to determine your best choices for gender-affirming hormone therapy such as estrogen, testosterone, progesterone, T-blockers, and other medications.
Transitioning earlier in life perhaps was impossible for many of us, who lacked access to gender-affirming healthcare. Speaking for myself, I lacked even the basic vocabulary to understand my own personal struggle. Older people also may have faced family, work, and religious obstacles that blocked or limited our understanding of what it means to be transgender.
But being older and coming out later in life makes your struggle no less real or the need for treatment any less urgent. You’re never “too old” and it’s never “too late” to begin this part of your gender journey.
This Plume Community Member (they/them) is a freelance writer living in the Washington, DC area. A former newspaper reporter, they have written extensively on healthcare and issues such as access to life-saving medication.
As the largest provider of gender-affirming care for the trans and nonbinary community, Plume is committed to providing information about many types of information, including questions about hormones like estrogen and testosterone, gender transitioning tips and experiences, and guidance on social transition and self care.
While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition, your mental health and emotional needs, or your health care needs regarding gender-affirming hormone therapy. If you are experiencing an emergency, including a mental health crisis, call 911 or reach out to Trans LifeLine.
