Recently, I was chatting to a really sweet friend of mine, Susan*, who I’ve known for almost all my adult life. You’d like Susan. Everyone does. She’s generous with her time, home and just one of those nice people that you want to be around. But she hides a secret, which many in the transgender community would be surprised about.
In her own home, she potters around doing her thing. Susan is the woman she knows she has always been. However, at work, it’s a different story. She goes to work in “drab” and uses her male name. At the male dominated environment where she works, the talk in the canteen is laddish and regularly makes fun of gays and trannies, leers at women, talks of beer and football. She feels isolated, desperate not to give any signs away. If you were to ask her, she’d tell you the day she ventures into work as Susan would probably be the day she quits, or is dismissed.
Now approaching retirement, Susan is starting to think about what life after work will look like for her. Although she’s excited about the opportunity she expects retirement to bring in terms of finally being able to express herself as a woman full time, she wonders if she’ll be able to fund her transition (her plan is to downsize to a flat and put some money away in case she needs to move into care) she worries about the possibility of losing contact with her family and precious grandchildren, even the effects of taking hormones at an older age will be. She also wonders about the quality of care she can expect to receive if she moves into a care home.
Susan isn’t alone in thinking about these things either. As more and more transgender individuals get older, the challenges they face are becoming more apparent. But while mainstream media focusses attention on the issues the younger generation face, the challenges early trans pioneers like Susan are facing goes largely un-noticed but grows more urgent. It’s a situation which has three key elements.
Firstly, studies have shown transgender employees are two and a half times more likely to be unemployed than mainstream society. Moreover, where they are employed, they are more likely to be in jobs which pay on or close to the national minimum wage. At best, many will live in rented accommodation or worse an unstable housing situation. Life as a trans person can bring a huge financial disadvantage which can continue to spell trouble for them as they age, retire and enter end-of-life care. Although Susan is one of the lucky ones in terms of her employment status, she’s concerned about what she sees as a life descending into the poverty trap by funding her own transition.
Secondly, there’s the subject of on-going treatment. In general most of the information or data on hormone replacement therapy is based on experiences for post menopausal women which is some 30 years old. So there’s a noticeable gap in knowledge surrounding transgender specific health concerns. Doctors are literally having to learn by seeing their patients. Hardly surprising when you consider that the average time dedicated to LGBT health issues within most graduate medical training programmes is less than a day over their entire curriculum, though this figure is improving. I recently heard at a support group that a transgender woman had to stop taking her hormones, having discovered a blood clot in her leg. Her doctor told her this could be just one of the little-known side effects of extended hormone therapy.
Thirdly, there’s the subject of end of life care itself. Research suggests transgender people are afraid of residential care facilities. As Susan herself explains “I’m afraid of growing old in care and being psychologically abused because care staff will refuse to let me live in my preferred gender identity, if I can’t afford to transition, leaving me vulnerable to harassment and mistreatment. While researching this article, I came across the following statement “Transgender people are three times more likely to kill themselves rather than enter a home and be at the mercy of staff”
So, what can be done to improve these situations ?
Although its a long term fix, getting more transgender people into full time, well paid employment will help. This will require more companies to embrace LGBT diversity recognising it as a business advantage rather than a penalty. Work and the jobs employees do require skills and behaviours which are independent of gender identity and progressive companies are beginning to recognise this and support and reward it. Improved support for families is an important aspect too. There are an ever increasing (and changing) number of organisations which support transgender people, but still comparatively few that offer support to their significant others, siblings and children. Further, there is the subject of training and education for care home support staff. These people have enormous power to ignore (and thus erase) an elderly transgender persons identity, for example by using the wrong pronouns or names, an uninformed staff member essentially negates a lifetime of struggle. These people are often lowly paid and under immense pressure in their roles and, in most instances receive no training on specific trans care issues. Lastly, more research into the effects of the physiological effects of long terms hormone replacement therapy needs to be undertaken to improve the understanding of this on transgender peoples health.
Still so much to do.