Principal Investigator: Dr Paul Willis

Lead institution: Swansea University 

Award amount: £142,846

Members of the TrAC project team

Trans Ageing and Care (TrAC): Dignified and inclusive health and social care for older trans people in Wales

Very little is known about trans people’s health and social care needs in later life, owing to a lack of research at local, national and international levels. Much of what exists relates to younger people and tends to be focused on health and mental health issues associated with gender reassignment or sexual health, with older trans people’s needs often overlooked. The lack of evidence on the health and social care experiences of older trans people means that it is unclear whether they are receiving inclusive care in later life, in line with the Equality Duty for public services.

Dr Willis and his research team embarked on their project in 2016 to improve understanding of the health and social care needs of older trans adults and to examine whether current health and social care services providers and professionals are meeting those needs in Wales.

Project aims:

  1. To identify the health and social care needs of trans people and their hopes, expectations and concerns about service provision in older age. Life-history interviews were conducted with 22 older trans adults, 19 of which were seeking or had sought to transition from the sex assigned to them at birth, two of which identified as cross dressers and one person as ‘gender fluid’.
  2. To examine attitudes and perceptions of health and social care professionals towards older trans people. 165 health and social care professionals across Wales completed an online questionnaire, which assessed their knowledge about trans’ legal and medical issues in later life, familiarity with trans individuals, levels of support for trans civil rights and beliefs about gender diversity and trans issues.
  3. To produce digital stories and guidelines for health and social care practitioners on supporting older trans people in later life. Three engagement workshops were held, bringing together trans individuals and health and social care professionals from different parts of Wales and four digital films were produced about older trans people’s stories with filmmakers Fox and Owl from My Genderation.

Key findings:

Trans people’s journeys through the healthcare system:

  • The majority of interviewees described obstructed journeys through the healthcare system to access the gender identity clinic in London (where Welsh residents are currently referred). They described numerous hoops they had to jump through, lack of knowledge about trans needs and, once referred, the continual delays and cancellations when waiting for appointments.
  • Interviewees reported very mixed experiences of GPs, with some having highly positive experiences and others detailing transphobic experiences (for example, being told they had to pay for hormone prescriptions because the GP didn’t agree). The most common theme was GP’s lack of knowledge about treatments and pathways.
  • Trans patients were reluctant educators in having to find out information for their GPs or having to chase up GPs continually to make referrals. Others reported being misgendered on their medical records and letters of correspondence (for example, use of incorrect gender pronouns) and receiving transphobic responses from healthcare staff, such as district nurses, that suggested they were not ‘deserving’ of NHS care and treatment.
  • Individuals seeking gender affirming treatments relied heavily on the knowledge of trans peers to know what questions to ask and how to navigate through ‘the system’.
  • When accessing the gender identity clinic, interviewees described the power imbalances and pressures to present in the “right way” (in the eyes of the professionals) as “sufficiently feminine” or “sufficiently masculine” to be able to progress through the system.

Practitioners’ knowledge and awareness of trans issues

  • People responding to the questionnaire were mostly white and female from a wide range of professional roles including GPs, clinicians, mental health staff, social workers, and people in healthcare management and administration.
  • Respondents were trans-aware and familiar with trans issues (with media being the most popular source of information) and were generally supportiv Save & Exit e of trans civil rights.
  • There were gaps identified in knowledge about trans issues in later life and a call for more education and training.

Much more information on the project findings can be found on the project website, including recommendations for change in Wales and the four digital films on older trans people’s life stories. You can also watch a film about the research design and aims of the project. The research team have also produced guidelines for healthcare professionals and social care workers to help make their practice and service more trans inclusive.

The project was delivered in collaboration with Unique Transgender Network and the Older LGBT Network for Wales and culminated in a launch event at The Senedd in Cardiff on the 4th April, 2019 where the research findings were shared.

Members of the project team: Dr Paul Willis (School for Policy Studies, University of Bristol), Dr Michele Raithby & Dr Christine Dobbs (Centre for Innovative Ageing, Swansea University) with Dr Elizabeth Evans and Dr Deborah Morgan (Centre for Innovative Ageing, Swansea University), Jenny-Anne Bishop OBE from Unique Transgender Network and Cecilia Dubois.

Other co-applicants on the project were Prof Vanessa Burholt, Dr Penny Miles and Dr Matthew Roberts.