Transgender and Gender Nonconforming Health and Aging

Description

The only text that focuses specifically on transgender health in older adults This text addresses the specific lack of clinical educational support for transgender and gender nonconforming (TGNC) individuals as they age. Chapters are written by multidisciplinary healthcare experts who present topical discussions in five critical areas: essential foundational information needed to understand the life experience of older TGNC people; mental and behavioral health issues; social service considerations; specific concerns for nurses; and unique long-term medical concerns for providers. In addition, special attention is placed on providing care for TGNC veteran populations, including strategies to access social services and Social Security, and developing support networks. Transgender Health and Aging is an excellent resource for clinical and research professionals from a variety of medical disciplines, including geriatricians, primary care physicians, psychiatrists, public health officials, social workers, nurses as well as nonprofessional audiences interested in transgender healthcare in older adults. Foreword......Page 6 Contents......Page 8 Contributors......Page 10 1.1 Introduction......Page 12 1.2.1 Gender Identity and Gender Expression......Page 14 1.2.3 Transition......Page 15 1.2.4 Disclosure......Page 16 1.2.5 Resilience......Page 17 1.2.6 Gender-Affirming Communication......Page 18 1.3 Cultural Context and Generational Cohort......Page 19 1.4 TGNC Health Disparities......Page 20 1.5 Affirmative Care......Page 24 References......Page 27 2: Endocrinology, Hormone Replacement Therapy (HRT), and Aging......Page 32 2.1 Physiologic Theories of Aging......Page 33 2.2 Patient Assessment......Page 34 2.4 Insurance and Financial Costs of Care......Page 35 2.6 Primary Prevention and Health Screening......Page 36 2.8 Feminizing Hormone Treatment......Page 38 2.9 Masculinizing Hormone Treatment......Page 42 Appendix A: Medication Prescribing and Dosage Resources......Page 43 References......Page 44 3.1 Introduction......Page 47 3.3 Multiple Chronic Conditions......Page 48 3.5.1 Cardiac......Page 51 3.5.4 Hemorrhage......Page 52 3.5.8 Repeat Surgeries......Page 53 3.6.1 Breast Augmentation......Page 54 3.7.1 Vaginoplasty......Page 55 3.7.2 Phalloplasty......Page 59 3.8 Metoidioplasty......Page 63 3.9 Long-Term Complications......Page 65 References......Page 66 4.1 HIV in Older Adults......Page 71 4.2 HIV and Transgender Health Disparities......Page 72 4.3 Intersectionality and HIV Risk......Page 73 4.4 Health Concerns for Transgender People Aging with HIV......Page 77 4.5 Conclusions and Implications......Page 82 References......Page 83 Recommended Reading......Page 87 5: Transgender Intimate Partner Violence and Aging......Page 88 5.1.1 Defining the Population......Page 89 5.1.2 Distinguishing Aging T-IPV from Other Violence Types......Page 90 5.1.3 Culturally Appropriate IPV Measures......Page 91 5.2.1 Past-Year Victimization Prevalence......Page 92 5.2.2 Lifetime Victimization Prevalence......Page 93 5.2.3 Tactics......Page 94 5.3 Help-Seeking and Help-Giving......Page 95 5.3.1 Challenges in Help-Seeking......Page 96 5.3.2 Challenges in Help-Giving......Page 97 5.4 Discussion......Page 99 References......Page 101 Recommended Reading......Page 104 6: Substance Use and Recovery in the Transgender and Gender Nonconforming (TGNC) Older Adult Community......Page 105 6.1 Isolation......Page 108 6.2 Stigma and Discrimination......Page 109 6.4 Regret......Page 110 6.6 Lack of TGNC Affirmative Care and Chronic Pain......Page 111 6.7 Violence......Page 112 6.8 Protective Factors and Resilience......Page 113 6.9 Treatment and Intervention......Page 114 References......Page 117 7.1 It Starts in Childhood......Page 121 7.2 Adult Violence and Trauma......Page 123 7.3 Little-t Traumas......Page 124 7.4 Health Results of Trauma......Page 126 7.4.3 Expectations of Rejection......Page 127 7.5 Aging-Specific Issues......Page 128 7.6 Resilience......Page 130 7.7 Trauma-Informed Care......Page 132 References......Page 136 Recommended Reading and Resources......Page 137 8: Religion, Spirituality, and Health Behaviors: Intersections with Gender Diversity and Aging......Page 138 8.1 Impact of Spirituality and Religion on Health and Wellbeing......Page 139 8.2 Stigma, Discrimination, Coping, and Resilience......Page 140 8.3 Religion, Spirituality, and Aging......Page 143 8.4 Religion, Spirituality, and Gender Diversity......Page 145 8.5 Engaging and Utilizing Religious and Spiritual Connections......Page 147 8.6 Assessing for Spiritual and Religious Relevance and Strengths......Page 151 References......Page 152 9.1 Defining Intersectionality Theory, Social Identities, Privilege, and Oppression......Page 158 9.1.1 Gender Identity and Sexual Orientation Identities......Page 160 9.1.2 Racial and Ethnic Identities, Immigration, and Language......Page 162 9.1.3 Social Class and Education Access......Page 163 9.1.4 Religious and Spiritual Identities......Page 164 9.1.5 Disability Identity......Page 165 References......Page 166 10.1 Introduction......Page 168 10.2 Brief History of Aging Services in the United States......Page 169 10.3.1 Knowledge Limitations......Page 170 10.3.2 Intersectionality of Identities and Health Disparities......Page 171 10.3.3 Comparisons of Concerns on Aging......Page 172 10.4.1 Individual Level Concerns and Barriers......Page 173 10.4.3 Current Transgender Older Adult Focused Programs and Services......Page 174 10.4.4 Need for Legal Supports and Protections......Page 175 10.5.1 Count Me In: Threats to Representing Older Transgender Adults......Page 176 10.5.2 Recommendations to Improve Transgender Representation in Aging Service Networks......Page 177 10.5.4 A Better Future Starts with You......Page 178 References......Page 179 Recommended Reading......Page 181 11.1 Introduction......Page 182 11.2 The Aging Experience of Transgender and Gender Nonconforming Adults......Page 183 11.3.1 Family of Choice......Page 185 11.3.2 Naturally Occurring Retirement Communities (NORC)......Page 186 11.3.4 Intergenerational Housing......Page 187 11.3.5 Village Model......Page 188 11.4.1 Independent Caregivers......Page 189 11.5 Residential Care......Page 190 11.5.1 How to Find TGNC-Affirming Care......Page 191 11.6.1 Care Planning......Page 192 11.6.2 Tips for Effective Care Planning......Page 193 Appendix A......Page 194 References......Page 195 12: End of Life: Honor and Celebration of TGNC Individuals......Page 198 12.1 Transgender and Gender Nonconforming Older Adults and the Process of Facing Death......Page 199 12.1.1 Life Review......Page 202 12.2 Memorials as Site of Oppression......Page 203 12.2.1 Working with Families and Caregivers......Page 205 12.3.1 Queering the Funeral......Page 206 12.4 Recommendations of Key Elements for TGNC Memorial Planning......Page 207 References......Page 209 13.1 Introduction......Page 210 13.2 Survey Data......Page 212 13.3 Discussion......Page 213 13.4 Retirement......Page 216 Appendix A......Page 218 Recommended Reading......Page 222 14.1 Introduction......Page 223 14.2 Laura K. 65......Page 224 14.3 Rachael B. 66......Page 225 14.5 Estelle M. 66......Page 227 14.6 Jesse H. 63......Page 228 14.7 Gina E. 61......Page 229 14.9 Stefanie C. 73......Page 231 14.10.2 Körper......Page 234 14.10.3 Psyche......Page 235 14.10.5 Body......Page 236 14.10.6 Psyche......Page 237 Index......Page 239