8 - Gender-affirming surgery in later life: centring older adults’ perspectives to promote equitable access and person-centred surgical care

Summary

Introduction

Gender- affirming surgery in older adults is an often- overlooked aspect of healthcare for transgender and gender diverse (TGD) populations (Gamble et al, 2020). Older adults may not be perceived as appropriate surgical candidates based on age- related assumptions about patient preferences and postoperative outcomes. Moreover, older age may intersect with race/ ethnicity and gender identity to compound inequities in access to quality care for older TGD individuals, particularly for older TGD persons of colour (Bloemen et al, 2019; Javier, 2019). Access to financial resources (Javier, 2019); health education, especially as information in the TGD community is more widely shared in online spaces (Cipolletta et al, 2017); and lack of information specific to gender- affirming surgery and sexuality (Javier, 2019) for older TGD individuals can present further barriers. To date, older TGD- identifying adults’ perspectives have remained largely absent from the discourse on gender- affirming surgery, including desire for surgery, access to surgical procedures and postoperative needs and support.

This chapter examines theoretical and practical considerations for older TGD individuals who have undergone or may desire gender- affirming surgery. The authors are based in New York City, United States. Thus, while we have made sure to include data and perspectives from beyond our geographic location, our frame of reference is informed by gender- affirming surgery and trans populations within the US, especially as it pertains to insurance and public policy. One of us is transgender and one of us is cisgender, and we both have professional experience in gender- affirming surgery research within a large academic medical centre. Our approach to this work is framed by our lived personal and professional experience in transgender medicine and surgery, bioethics, gerontological social work and social policy, and surgical practice more broadly. We focus on the importance of amplifying older adults’ perspectives to inform patient- centred care and underscore the need for strong community and social support to ultimately ensure respectful and competent care for older TGD individuals.

While of course there are trans people of all ages who do not seek gender-affirming medical interventions, the focus of this chapter is on gender-affirming surgery and the barriers and other considerations that may factor into older trans adults’ healthcare experiences.