In recent years, increased attention has been given to lesbians, gays, bisexual, and trans (LGBT) rights, yet older LGBT individuals, particularly trans persons, still face unique challenges as they age. Ageing policies and health frameworks often overlook the specific needs of this group, resulting in inadequate resources and support systems.
A recent study conducted at the University of Malta, Living as a Transfeminine Adult in Malta, focused on the experiences of older trans women, shedding light on their struggles with social, economic and health issues shaped by decades of marginalisation.
Many older trans individuals have faced lifelong discrimination, resulting in limited financial security, social isolation and mental health issues, further complicated by an ageing body and the double jeopardy of ageism and cisgenderism.
Globally, research estimates around two per cent of the population are trans, though this figure may be conservative due to the social marginalisation of trans individuals. Worth noting is that older trans persons experience cumulative disadvantages from years of discrimination, such as limited financial resources, job insecurity and insufficient pension funds. Many have faced workplace discrimination or concealed their identities, negatively affecting their economic status.
Additionally, older trans individuals tend to have less social support, increasing their risk for mental health issues like depression and suicidal ideation. Older trans women especially encounter compounded ageism, cisgenderism and sexism, often making their healthcare needs less adequately met due to underprepared care providers.
Locally, Malta’s progressive policy landscape, including first-place rankings in the ILGA Europe Rainbow Index and national policies for active ageing, marks positive steps towards inclusivity. However, real-life narratives from trans women in the study show that many remain apprehensive about discriminatory experiences.
Policy frameworks like Malta’s National Strategic Policy for Active Ageing (2023–2030) address the healthcare and social needs of non-heterosexual older people, including protections against ageist and cisgender discrimination. The country’s trans health policy ensures that older persons seeking transition-related care are informed of potential health risks associated with these treatments. However, real-life challenges persist for trans individuals as they grow older, particularly around healthcare support and the potential isolation they may face.
The study in Malta sought to gather insights into the daily lives of older trans women through narrative biographical interviews. Initial recruitment challenges meant the participant age was lowered to 50, leading to four participants − all trans women aged 50 to 56. Although ideally the study would have included both trans men and women, the predominance of trans women reflects broader demographic trends, as they have historically transitioned in higher numbers than trans men.
Experiences of past turmoil
The participants shared stories of hardship growing up in Malta during the 1970s and 1980s, when trans identities were not accepted. Most described familial rejection and social ridicule, often leaving them isolated or even driven to emigrate. These experiences led to feelings of confusion, shame and isolation. Those who later accessed gender reassignment surgery described it as life-affirming, aligning their physical appearances with their gender identities. For one participant, this surgery was a “life-saving” necessity, despite common societal misconceptions about it being elective or cosmetic.
Challenges of ageing as a trans woman
The participants noted an increase in resilience in middle age but expressed anxiety about ageing as trans women, particularly around societal acceptance and physical appearance. For instance, the prevalence of youthful beauty standards in media led some to spend heavily on skincare to counteract ageing. Another significant concern was the inadequacy of health services, as few healthcare providers are trained to address the unique needs of ageing trans women. For example, a lack of understanding about the specifics of trans women’s physiology led to substandard care for one participant when she experienced an infection.
Many older trans individuals have faced lifelong discrimination
Isolation, social exclusion and care needs
The study participants also discussed the social isolation they feared in later life, exacerbated by estrangement from families and reluctance among cisgender and heterosexual older adults to associate with LGBT peers. This concern extended to their likely reliance on long-term care facilities.
Some expressed worries about the availability of LGBT-friendly residential care homes, fearing discrimination and neglect. One participant, for example, wondered if she would find anyone willing to help her in old age, reflecting the loneliness many trans individuals face. She also suggested an “LGBT corner” in care facilities, where community support might mirror family dynamics and enhance well-being.
Ageism within the LGBT community
Although LGBT advocacy has made significant strides, older LGBT persons often feel sidelined by younger activists who, according to one participant, lack empathy for the unique challenges of older trans persons. The participants criticised these advocates for focusing more on media visibility than on meaningful support for older community members.
This generational gap has left many older trans individuals questioning if younger activists would still support them in their later years.
Long-term and palliative care
Another point of anxiety among participants was the thought of requiring residential long-term care, where shared spaces could expose them to potential transphobia. They also noted difficulties in receiving age-appropriate healthcare services, fearing ignorance of their specific needs.
Additionally, they worried about posthumous misgendering, where family members might reclaim their old gender identities in end-of-life and funeral arrangements, stripping them of the identities they had worked hard to establish.
The study, though limited to four participants and focusing only on trans women in their 50s, provides critical insights into the challenges of ageing as a trans person in Malta. It also underscores the pressing need for a more inclusive approach to ageing for trans individuals, addressing systemic challenges they face in social, economic and health contexts.
Future policies must bridge the gap between intent and implementation, ensuring that older trans persons can age with dignity, respect and access to equitable care. It highlights the need for further research to inform active ageing, dementia care and service standards for older trans adults.
Training healthcare and social care practitioners in the needs of trans individuals could help address some of these issues in order to ensure that ageing LGBT individuals, particularly trans persons, are not overlooked as they navigate the unique challenges of later life.
Tea Cekic, a nurse, wrote this article on behalf of the Maltese Association of Gerontology and Geriatrics (MAGG).