This article was originally published April 14, 2023 on the SAGE Perspectives blog.
As part of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS; PI: K.I. Fredriksen-Goldsen, PhD), we found that compared to older straight women, older lesbians and bisexual women were less likely to have health insurance or to have had a recommended breast cancer screening within the last two years. Because transgender older adults tend to experience overall more adverse health outcomes and even greater barriers to accessing affordable, high-quality healthcare than non-transgender LGB older adults, in this study we decided to compare their respective rates of getting eight preventative health-screenings recommended by the U.S. Preventive Services Task Force (USPSF) for Americans aged 50 and older.
Our sample was composed of 165 transgender and 2,349 non-transgender adults aged 50 and older. The transgender participants were statistically younger and more likely to be Hispanic, have less education, and be living at or below 200% of the Federal Poverty Level. We found that transgender older adults are not just less likely but are significantly less likely to have received four of eight of the USPSF recommended preventive health screenings as shown below.
Experiencing chronic discrimination and victimization is stressful, and chronic stress is a major contributor to chronic health conditions such as cardiovascular disease, high blood pressure, and depression. Sexual and gender minorities (SGM), which includes lesbian, gay, bisexual, and transgender (LGBT) people, overall have poorer health outcomes compared straight Americans according to the National Institutes of Health.
The National Academies of Sciences, Engineering and Medicine have recognized that older transgender adults have some of the most adverse health outcomes of any marginalized populations in America. These poor health outcomes are not the result of any inherent characteristics of being transgender, but arise from the chronic discrimination, victimization, and social marginalization they experience throughout their lives.
In addition, transgender people face numerous barriers in getting the healthcare they need. In our research, we found nearly a third of transgender people have experienced verbal harassment in medical settings, and about 20% have been denied care outright. In addition, 21% haven’t told their medical providers that they are transgender, and fully half express concern that their care providers don’t know how to provide transgender-specific care. As 66-year-old participant in one of our studies stated: “Isolation, finding friend support, caregiving and health are the biggest issues older gay persons face. Who will be there for us, who will help care for us without judgment?” Transgender people also experience economic barriers to getting the care they need as they are more often covered by Medicaid, which directly prohibits gender-affirming care in 14 states.
Research on healthcare for transgender people in general, as opposed to mental health and transition-related care, is still somewhat new in the U.S. Most of what we do know comes from research with younger transgender people, yet it is around the time we turn 50 that many chronic health conditions begin to emerge. Regular preventive health screenings in older adulthood are important for multiple reasons; not engaging in such screenings bear multiple costs. Early detection of chronic diseases and their markers means that they can often be treated sooner, less expensively, and with better outcomes.
Over the next decade, the U.S. Department of Health and Human Services’ Healthy People 2030 national plan seeks to improve the health and well-being of all Americans – including transgender older adults. Meeting this goal will require that we address the social determinants of health disparities. Perhaps a key challenge and opportunity is to include transgender experiences and voices in the design and implementation of research related to transgender lives and health, such as the voice of this a 56-year old transgender woman who has participated in our research: “I have had an overwhelmingly positive experience with my gender transition so far, but I would say that my primary concern about the future is with access to healthcare and potential discrimination as a senior transgender person, especially if the need arises for emergency or long-term care.”