The manifestation of multilevel stigma in the lived experiences of transgender and gender nonconforming older adults.

Abstract

Transgender and gender nonconforming (TGNC) people experience disparities in mental health when compared with non-TGNC sexual minorities and the general population. One line of inquiry with respect to these disparities is the examination of stigma and its connection to emotional and psychological well-being. Recent conceptualizations of stigma draw attention to multiple levels-individual, interpersonal, and structural-that are thought to impact well-being for TGNC people. However, little is known about how multilevel stigma is experienced by TGNC older adults, who navigate stigmatizing environments over a lifetime and who may be especially vulnerable to its cumulative effects. We conducted an interpretive content analysis of biographical interviews with 88 TGNC adults aged 50 and older, from across the United States, obtained from the photography and interview project To Survive on This Shore. Our analyses suggest that TGNC older adults' mental health is indeed impacted by multiple levels of stigma. Individual level stigma is experienced as ongoing vigilance about aspects of oneself that break gender norms, often manifesting in internal conflicts. At the interpersonal level, TGNC older adults navigate unpredictable relationships marked by conflicting expressions of love, acceptance, strain, and exclusion. Structural stigma manifests in constraints brought about by transphobic policies and social norms but also sparks intentional action on the part of TGNC older adults to resist and change these social forces. Clinical interventions to combat stigmatization can use life narratives and a focus on consciousness-raising to promote empowerment and well-being for this group of older adults. Public Policy Relevance StatementTransgender and gender nonconforming (TGNC) older adults experience multiple levels of stigma over the course of their lives, which often negatively impact their well-being. However, these older adults also find ways of resisting stigmatization and engage in action to improve both their own lives and those of TGNC youth. Autobiographical life narratives hold the potential to inform interventions to reduce stigma and promote therapeutic gains for this group of older adults.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…Aging presents specific social, physical, and mental health challenges for TGD persons. While the literature on aging and transgender elders is limited, many older TGD adults have experienced a lifetime of stigma, discrimination, and repression of identified gender (Fabbre & Gaveras, 2020 ; Witten, 2017 ). This experience affects TGD elders’ interactions with health care systems (Fredriksen-Goldsen et al., 2014 ; Kattari & Hasche, 2016 ; Walker et al., 2017 ).…”

LGBTQ individuals’ lived experiences of hypervigilance.

“…Transgender and gender nonconforming older adults ( N = 88) in biographical interviews described lifelong “constant awareness of potential rejection” and “constant monitoring of perceived flaws,” which the authors coded into a category they labeled “hypervigilance of potential rejection” (Fabbre & Gaveras, 2020, pp. 5–6).…”

Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Nonbinary Adults 50 Years Old and Older in the United States

“…As the majority of studies of LGBT populations define older adults as 50 years old and older and to be consistent with this research, 50 years old and older was used as the age criterion for this study. [35][36][37][38][39][40] Variables A detailed description of the survey question for each dependent variable is provided in Table 1. In this analysis, the following variables were included: sociodemographic (marital status, education, employment, income, race/ethnicity, and age); health care access (health insurance, personal doctor, delayed health care due to cost, and medical checkup in the past 2 years); disability (deaf/difficulty hearing; blind/difficulty seeing; difficulty concentrating, remembering, or making decisions; difficulty walking or climbing stairs, difficulty dressing or bathing, and difficulty doing errands); health risk and healthy behaviors (current smoker, heavy drinking, meeting physical activity recommendations, flu vaccine, pneumonia vaccine, and HIV test); and general health and chronic diseases and conditions (general health, poor physical health, poor mental health, high blood pressure, high cholesterol, asthma, coronary artery disease, skin cancer, other cancer, COPD, depression, arthritis, and obesity/overweight).…”