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Transitioning Gender in Britain When You’re Over 60

VICE News spoke to older people transitioning genders about the extra issues facing their generation — anger from their children, a lack of understanding from peers, and medical issues relating to age.

by Cat McShane
Oct 29 2015, 12:40pm

Dawn's son struggled to accept her new identity after she begun her transition aged 62.

The biggest celebrity story of this year is Olympian turned Vanity Fair cover girl Caitlyn Jenner, who transitioned gender at the ripe age of 65, to an overwhelmingly positive reception. But for the growing number of British over-60s who transition gender each year, life can be much more difficult.

In the UK, gender reassignment has been available on the National Health Service since the 1960s. But the system is under strain, with referrals to one of the country's seven NHS gender identity clinics (GICs) growing by 20 percent every year. An average of 284 new referrals are made every month. 

Although there is an 18 week target for the length of time patients will have to wait between first going to their doctor and attending a GIC assessment, the typical wait is closer to a year. For those who've spent a lifetime in the wrong gender identity, this wait is too long.

Ex-mechanic Teraina went to Thailand to transition privately, barely a year after first going to her GP about her feelings. She was 67. "The older you are, the less time you may have to do it, you want to crack on and get it done," she said. "I felt I couldn't live with my body not matching my brain gender."

Dawn, 62, lives in a working class part of the north west of England. She took the NHS route, starting her transition five years ago. Most GICs require two separate clinicians to agree the patient has a condition known as gender dysphoria — doctors look for a long history of feeling a mismatch between their brain and body — their inner self and their outer shell. Any other reasons or conditions that could be causing these feelings must be ruled out before medical treatment such as hormones can be authorized. 

Once she had been given the go-ahead for transition, Dawn started living fulltime as a woman. The NHS requires people to spend two years living the "real life experience" as a person of the opposite gender before it will perform surgery, if the transgender person wishes to operate.

Sadly for Dawn, on the eve of her final surgery to create her vagina last year, a serious age-related heart condition was found, meaning the operation was too risky to carry out. "For the first time in a long time I wanted to take my own life," she said.

Related: California Becomes First State To Pay For Inmate's Transgender Surgery

Other criteria for safe surgical transition can also militate against older people. A patient's Body Mass Index needs to be less than 30 and their waist less than 37 inches (94 cm), but as people age, waistlines thicken and conditions like diabetes are more common, leading to weight gain.

Sixty-four-year-old Rona in Wales needed to lose 12 kilograms in order to have her much longed-for surgery, but as a self-proclaimed chocoholic couldn't shift the weight. She'd given herself four months to lose it, after which she said she might decide not to pursue surgery. But she was also desperate to "meet my maker as I was intended".

Despite these additional factors, the NHS does not discriminate against age. James Bellringer is one of the UK's most recognized gender reassignment surgeons and has performed over 1,000 male to female surgeries across his 16 year career. 

Fewer older transgender people opt for surgery than their younger counterparts, but there are those that want it no matter what their age or the risks involved. The oldest person Bellringer has given a full vagina to was 85.

"In terms of cost effectiveness this is possibly the best operation the NHS does," he said, reflecting on the £10,000 operation. "Even in a 70-year-old you've got 15 years significantly improved quality of life."

While for younger transgender people, it's their parents that need to get their heads around a transition, for the older people it's their adult children. Dawn's son, Lee, was 28 when he first learned of his dad's wish to live as a woman. He was shocked and handled the situation badly.

He admits he was aggressive with Dawn, and would say "I'm the man of the house now." Lee believes his dad's transition made an alcohol problem worse as he grappled with the news. He attended support groups and four years later is positive about the changes in his dad.

Teraina's son, who'd only lately lost his mum, felt like he'd lost his dad too and also showed a lot of resistance, not wanting to see his dad in women's clothing. University made him more accepting, and the two now live together again in London.

For partners, the news is just as challenging. 67-year-old Barbara first found out her husband was cross-dressing twenty years ago when she discovered women's clothing in their wardrobe. She immediately thought he was having an affair. Relieved at the news he wasn't, they agreed he could wear women's clothes in private.

"It may seem strange but it brought us closer together, it was our secret," Barbara said.

However, when he decided to transition fully four years ago to become Jane, Barbara had an identity crisis.

"It was very confusing, one thinks one isn't feminine enough or attractive enough," Barbara said, subsequently realizing, "it was nothing to do with me, it was Jane who needed to be her real self."

Related: The Threat of Sterilization Is Darkening Europe's Transgender Quest for Identity

Although far from homophobic, Barbara had another concern. "I didn't want to be considered a lesbian but I don't know why. I wanted to be seen as me always."

The risks of being isolated from friends, family and community are high. Some 40 percent of children of trans people don't see their parents. For this reason, the support of other older trans people is vital.

Jenny Anne and Elen are a transgender couple in their seventies. They run a community house in North Wales where people can stay during their transition or afterwards if they need respite and support.

Many people they had helped, at different stages of transition, were at a summer party they held for the LGBT community. Dawn had been a frequent visitor, especially in the early days of her transition when her family were less supportive. Another woman, Jenny, also in her seventies, counseled a younger man questioning his identity by explaining her experiences pre-transition.

"I joined the Airforce and tried to pretend I was a man," she told him. "And I got through it. But it just niggles away at you all the time. One day I came home and had a heart attack and I thought, I have to change, and I've not looked back since."

Some older transgender people come with the baggage of growing up in a much less accepting era. Dawn is scared of the medical profession. As a teenage boy, Dawn's GP betrayed her confidence and told her dad that Dawn had confessed her feelings of being a girl. Dawn's father severely beat her, a trauma she has struggled her whole life to get over.

Related: Transgender Iranian Refugees Are Struggling to Outrun Prostitution and Violence

Friends who grew up in a previous generation also struggle. Jane's friend Ginny said that when she first heard of her friend's transition, she felt her only reference points were British female impersonators like Danny La Rue. "I had to go on a journey with you," she said.

Financially, coming out as transgender can be a risk at a later age as it's too late to start again. Teraina's partner, Anna, was bullied by her line manager and had to retire ten years early, losing half of her pension. Despite this financial blow, she remembers her leaving party fondly, colleagues buying her lipsticks and nail varnish.

Teraina suffered too, being outed in the national press in 2010 with a cheap headline, a figure of fun because of her masculine profession. Her experiences were very different to Caitlyn Jenner's. "Personalities can control the media, they've got the money, power and knowledge, I'd never had anything to do with the media." She felt "thrown to the wolves." Customers tailed off and she sold the business for a small sum.

Looking to the future, some trans women expressed concerns they might end up in a care home where their gender isn't respected, especially if they haven't had surgery. 

There is also the concern that if a trans person has dementia, they may experience confusion over their identity. There is research underway at the Centre for Innovative Ageing in Wales, led by Dr Paul Willis, to establish the health and social care needs of older transgender people.

Despite the comparative ease that younger people can transition, with much bigger parts of their lives led in their true identities, very few people told VICE News they regretted not transitioning earlier. Teraina said, "I wasn't ready, the world wasn't ready."

Related: Pakistan's Transgender Community Is Hiding Out in a Hostile City

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