Transition in retrospect. Experiences of trans women over 50 years of age after their medical transition prior to 2014

Background
Most research on the effects of gender-affirming medical treatment (GAMT) describes the period during, or shortly after GAMT. Little research is done on long-term wellbeing and need for care (Dhejne et al., 2011). Older trans individuals are described to be extra vulnerable, but their situation is not well studied (Kreukels, 2013). Older trans individuals are at an increased risk for the effects of stigmatization, because they transitioned in a period when transitioning was rare and social acceptation of gender diversity less. Effects could be shame, guilt and social withdrawal leading to less social support and worse mental- and physical health outcomes than cisgenders of the same age (Fredriksen-Goldsen et al., 2017).With the results of this study we hope to improve care to trans individuals and to support them in successful ageing.
Method
This qualitative study explores the narrative experiences of twenty trans women of fifty years and older who started their GAMT before 2014 in the University Medical Center Groningen (UMCG). An expert panel chose seven important topics for an interview, that was applied in a semi-structured fashion. Elements of the Grounded Theory Method were used to systematically collect and analyse qualitative data and to subdivide the data in relevant categories (Charmaz, 2017). After each interview thematic analysation was performed until saturation was reached. All participants, aged 51 to 85, are patients of the UMCG and were approached by their practitioner. This study was ethically approved by the ethical commission of the UMCG.
Results
No participant expressed regrets about their GAMT. All participants reported an improved mental wellbeing after GAMT. Most participants currently feel relatively healthy, despite side effects of hormone therapy and complications after gender affirming treatment. Of the 20 participants 11 did not experience the burden of stigmatization anymore after transition. This seems to be influenced by coping strategies and passability. Although most participants have a social network, more than half of them report feelings of loneliness. This is influenced by ageing, COVID measures and psychological problems. Several participants mentioned religion and spirituality as both a supportive factor and as a barrier during coming out, transitioning and in current daily life. 9 participants had a partner before GAMT, the relation has ended afterwards for 5 of them. Most participants no longer had sexual intercourse with a partner, mostly due to loss of sexual desire. Participants mentioned on the topic ageing as a transperson: fear of decay of their appearance and long term complications of gender-affirming treatment. Participants offered several advices to help improve medical and psychological
Conclusions
Participants in this study reported to feel better and less vulnerable after GAMT than suggested in the literature. Negative experiences before and during transition are seen in a more positive perspective afterwards.
Further quantitative research on trans women is recommended to validate and quantify the outcomes of this study. Similar research could be done with trans men. Also, it is recommended to do further research on sexuality of trans individuals and on physical long-term effects of gender-affirming treatments.