On Friday, February 8th, researchers from The University of Bristol and Swansea University hosted a practitioner workshop regarding developing inclusive health and social care services for older trans people in Wales.

Presenting were:

Paul Willis, University of Bristol
Michele Raithby, Swansea University
Chris Dobbs, Swansea University
Cecilia Dubois, Swansea University

In 2016, The House of Commons Women and Equalities Committee brought forward a Parliamentary report which identified pervasive transphobia in public services. Furthermore, a recent 2018 LGBT survey reports lower life-satisfaction with trans participants. Additionally, there has been little research on older trans adults, with the data often hidden in other LGBT samples. The TrAC (Trans Ageing and Care) project, a mixed-methods study, looked at health and social care provision for older trans people and sought to identify good practice and make wider recommendations for change in light of lack of research evidence specific to older people’s lives.

The National LGBT survey, conducted in July 2018 by the UK Government, had some interesting findings.

• Trans respondents had lower scores than cis-LGB people and general population.
• 16% of trans respondents had sought healthcare or medical treatment outside the UK.
• 21% of trans respondents stated that their specific needs were not taken into account when accessing healthcare services
• There were significant issues when accessing gender identity services

While there is little research on older trans adults, as stated previous, some findings are available. There are many who choose to transition later in life due to fears in facing discrimination in the workplace as well as loss of financial and social status. Many also experience worries in growing old alone due to being trans. Furthermore, there have been many instances of incidents where trans people face discrimination in the NHS, including dead naming. The hashtag #transdocfail illustrates many of these harmful incidents.

The TrAC Project

The main aims of the TrAC project were to identify health and social care needs of 50+ trans people in Wales, to examine attitudes and perceptions of health/social care professionals, and to establish person-centred services for older trans people in Wales.

In doing do, they undertook an online survey of health and social care professionals. There were 167 participants (93% white, 91% from the UK with an average age of 37).

The overall findings suggested that participants in the survey had an awareness of trans issues as well as trans civil rights. The lack of significant results suggests that participants were those who already had an interest in trans issues.

The second part of the project involved life-history interviews with trans adults. There were 22 participants between ages of 50-74. Two self-described at crossdressers, one identified as gender fluid, 4 were trans men and 15 were trans women.

There were variations in the language used to describe themselves and not all were transitioning or sought gender-affirming treatment. Many participants felt that they could now life their life fully, yet often did not discuss growing older with others in their life. A small number had concerns about financial status in later life; others were home owners and had pensions and were less concerned.

Most participants reported no immediate health concerns, but there were concerns about risks of taking hormones in later life, especially if there was a family history of other medical issues. There were fears of living with dementia and receiving social care, especially fearing forgetting they had transitioned and fear of fitting in social care environments and a fear of potential negative treatment by staff.

Many participants had experienced issues with family including misgendering, outing, and experiencing a lot of emotional labour in supporting others in their life, especially around non-acceptance of their gender identity. That being said, all participants stated that they had supportive people in their lives.

Participants experienced inconsistency with their GP’s. They had to become educators to their GP’s and self-advocate for treatment and support they needed as many GP’s had a lack of knowledge around trans issues, including how to progress to gender affirming treatment. There was both direct and indirect resistance from GPs from lack of knowledge over hormone prescribing and being misgendered in medical records and correspondence.

In Wales, there was an ongoing struggle with bureaucracy, delayed and increased waiting times, and the frustration of having to travel to England for services. Wales only referring to one clinic in England lead to long waiting times and frustration. Therefore, some went privately to pursue further care.

There were mixed findings from the Charing Cross GIC, which is where those in Wales are referred. Some were very pleased whereas some reported long waiting times and the additional expense of having to travel to London

Participants would like to see the following in the future in Wales:

1. Increased knowledge and trans awareness

2. A GIC in Wales and decreased bureaucracy

3. Better standards of care

4. Recognition of gender dysphoria as important as a cancer diagnosis

5. Concerns that care quality may decrease

6. more information for older trans people about GI pathways

7. Dignity, respect and fair treatment later in life

As part of the project, there were digital stories recorded from some participants. These videos will be screened at the project launch on 4th April. We had the opportunity to view two clips, which were extraordinarily powerful and illustrate the challenges those in the trans community face.

Lastly, the project also ran engagement workshops across Wales and 1/3 of the participants were trans.

What needs to change according to participants:

1. A need for compulsory education and training in medicine, education, social work

2. Benchmarking what to expect for professionals and trans individuals

3. GPs knowledge and awareness at the heart of good care

4. Enhancing social support for trans individuals is also needed

There are planned outputs for the project:

1. Digital stories produced by Fox and Owl Fisher

2. Information sheets for health and social care

3. Policy briefing

4. Launch event at the Senedd on the 4th of April.

ExChange thanks the presenters and participants for taking part in this event.