The New Gender Paradigm

The True Meaning of Dependence

For a transsexual dependence has a greater impact than the inconvenience & embarrassment of having to ask for help.  During childhood, dependence upon parents allows them to impose wrong gender living -- a transsexual girl is forced to pretend to be a boy and vice-versa.  Parents force the girl to wear pants and play with toy trucks instead of dolls.

The moment transsexual becomes independent, they transition to right gender living.  A transsexual woman can finally dress as a woman and pursue feminine interests.  A transman can wear pants, fix cars and enjoy football on the tube.

A return to dependence during the senior years means being forced back into the wrong gender pretense.  Family members who exiled the individual after transitioning are once again in control.  They force her back into pants; they place her in the men's section of the nursing home with a male roommate.  The nurses address her as "sir", force her to use the men's restroom, and allow her beard & body hair to grow wild.  The doctor stops all hormones.

And there's nothing the individual can do about it except suffer.   

GLBT-Specific Locations

Since many retirement communities and assisted-living facilities don't welcome people from the GLBT population,  designated locations have begun to appear:  Triangle Square Hollywood (Los Angeles), the Anderson Apartments (Philadelphia), Spirit on the Lake Housing Co-op (Minneapolis), Rainbow Vision (Santa Fe NM), Fountaingrove Lodge Retirement Community (Santa Rosa CA).  During 2014, two more are scheduled to open in Chicago & San Francisco.  Another community is beginning development in Palm Springs.


SAGE is the leading GLBT seniors advocacy group.  One of their projects is to create community-based support associations.  The goal is to meet self-care needs so seniors can stay out of assisted living as long as possible.   ...A central clearing house is established so that elders in the community can make their needs known.  Volunteers and community service agencies have a single place to go in order to connect with people in need of their services. 

Like so many other GLBT advocacy groups, the focus is primarily on the gay & lesbian population, which outnumbers the transsexual population by far.  

Nursing Care

Transsexual-unique nursing care is discussed in detail in the New Gender Paradigm Medical Protocols.

Affirmative Policies?

Every transsexual must carefully review a facility's policies before admission.  Beware if there aren't any written policies.  Watch for the following issues:

-- Non-discrimination policies should not only be written, but also displayed prominently for all to see.

​-- Assignment to gender-segregated housing must be done on the basis of gender identity.  It must not be made according to biology or legal documents.

​-- Roommate assignments are always a problem.  Whenever possible, transsexuals should be assigned to single rooms.  Otherwise roommates must be consistent with the individual's gender identity.  Provisions must be made to protect the transsexual's privacy while dressing and bathing.

-- Gender expression (clothing, hair styling, personal grooming, etc) must be according to the individual's request and modeled on their pre-admission appearance.  Doctors, family members or administrators cannot overrule the individual or impose wrong gender expression.  

-- Transsexuals must be allowed to use restrooms consistent with their gender identity and gender expression.  Restrooms must be designed to preserve the privacy of all occupants.  Transsexuals must not be restricted to unisex restrooms or any other special arrangement.  Policies must state that if other guests lodge complaints about restroom arrangements, then that other guest has the option to use a unisex restroom. 

-- Likewise, transsexuals must use dressing rooms, locker rooms and shower facilities consistent with their gender identity.  Arrangements must be made to preserve the personal privacy of all residents.  

-- Information about a resident's transsexual status, surgical history, or hormone regimen is protected by federal law.  Disclosure or "outing" by any employee or contractor must be specifically prohibited.

-- A member of the administrative staff should be designated as an advocate for GLBT residents.  They conduct regular diversity training, provide input to the staff on GLBT issues, and act as a line of communication between residents and staff. 

-- A written formal policy must be available for handling resident complaints.  A member of the administrative staff must be designated to receive and mediate the complaints.

Stage 3:  Assisted Living

And finally there's assisted living -- a permanent move into a nursing home that occurs when the individual needs full-time support.  Someone with solid reliable support from family & friends can delay the move until the last possible moment.  But family support is a problem for most transsexuals.

The other part of the equation is the individual's healthcare needs.  A senior may be bedridden, but only require assistance in self-care that can be provided by anyone:  cooking, shopping, laundry, bathing, etc.  But if the individual needs IV infusions, regular lab tests and cardiac monitoring, a medical facility with a trained staff is the only option.  As discussed above, transsexuals tend to have worse-than-average health.

The bottom line is that transsexuals tend to move into assisted living at an early age.  ...If they can find a facility.  Very few nursing homes accept transsexuals.

Almost half of nursing homes are affiliated with religious groups that consider transsexuality to be a sin.  ...And religious groups are exempt from anti-discrimination laws.  For non-religious homes, transsexuals are a complication they'd prefer to avoid:  If any of the other residents make a complaint ("men in the women's restroom," for example) and the transsexual will end up on the street.

Bad Examples

A transsexual is just like anyone else. A transsexual woman is Really a Woman. A transman is Really a Man. They're not "abnormal" or "variant". They don't have a mental disorder.

Trouble starts when someone else decides that a transsexual is a "special case" or needs "special handling". Even people who are "trying to help" call a resident meeting to "explain about transsexuality" -- to "warn" the other residents or teach them how to interact with the new admission.

A transsexual is given stigma only when they're thrust into the spotlight for being somehow "different" or for needing an explanation.

Do you really need to ask someone with long hair, wearing lipstick and a dress whether they're a "he" or a "she"? Asking the question implies that you can't tell; that they pass poorly. It outs the person in a public setting. Do you ask about "he" or "she" in other social situations?

The Healthcare Crisis

The senior years are characterized by a struggle to maintain health & independence.  A healthy lifestyle and health maintenance visits during adulthood pay great dividends by prolonging Stage 1 and slowing Stage 2.

Except most transsexuals are denied access to quality healthcare:

   -- Health maintenance screening during adulthood doesn't take place due to a lack of insurance coverage.  Screening protocols for transsexuals aren't followed.

     -- Larger numbers of transsexuals live an unhealthy lifestyle, especially obesity, smoking & other substance abuse problems.

     ​-- Transitioning denial by the healthcare system often leads to inconsistent use of street hormones.

     -- When available, hormone regimens are inadequate.

     -- Puberty denial in particular has major adverse effects on later health.


Osteoporosis is the single greatest healthcare threat to transsexual  elders.  The body's calcium stores are acquired throughout adolescence.  After the mid-20's, all people gradually lose calcium.  The rate of loss depends on the hormone levels that are present.  Women especially loose calcium during pregnancy and after menopause.

In the case of transsexuals, the absence of hormones during puberty denial prevents calcium stores from being accumulated.  During adulthood, inadequate hormone regimens increase the rate of hormonal loss.  Once the senior years are reached, the calcium stores have been depleted -- a state known as osteoporosis.  Without calcium, bones become brittle and break easily.  ...Resulting in immobility and prolonged hospitalizations.

Unfortunately, it's very difficult to determine whether an individual has adequate calcium stores.  Blood calcium levels remain normal even in advanced cases of osteoporosis.  Screening can be done using x-rays of the wrist, vertebrae or hips -- but only after it's too late.  The most definitive test is the DEXA scan, which actually measures the density of calcium present in the bone.  However, the test only becomes reliable during the 40's -- again, too late for decisive intervention.

Even so, few transsexuals undergo osteoporosis screening due to inadequate financial resources, a lack of medical training for physicians, and widespread complacency (or even hostility).      

Everyone goes through three distinct stages as they reach the senior years:

Stage 1: Senior Independence
These are the golden years; a time to reap the benefits of a successful & productive life. The senior years are traditionally measured from the date of retirement -- around 60 - 65 years young. Most people are still healthy enough at this point to travel the world and go on cruises. It's a time to relax and maybe take in a little golf....

Well, it used to be that way. Nowadays government spending and the economic slowdown have forced large numbers to put off their retirement until the late 60's or early 70's. The so-called golden years are now spent working. Tight finances have pushed travel and recreation into the sole province of the privileged class.

Except Stage 1 doesn't apply to most transsexuals. Life as a transsexual is characterized by unemployment, limited opportunity, low wages and blocked career progression. There aren't any pensions or retirement funds. Most transsexuals have to continue working as long as they can in order to survive.

Stage 2: Increasing Dependence
The clock is ticking. At some point, aging erodes health to the point that the individual isn't able to take care of herself -- often during the mid- to late-70's. Many face chronic diseases like arthritis, cancer or cardiovascular disease. But even minor illnesses take a greater toll than they did before. Stage 2 is rarely a steady decline, but episodes of debilitating illness lasting several months at a time. It's still possible to live independently most of the time, but from time to time there's a sudden rush to the emergency room, a hospitalization, followed by months of gradual recuperation.

A person needs assistance during that recovery phase. Traditionally, the assistance was provided by family, religious groups or service organizations. Grandparents might initially move in with their adult children. As they become able to take care of themselves again, they return home with someone checking in from time to time. Unfortunately, families have grown smaller and splintered. Religions have become superficial; congregations are too busy to help the needy. Much of elder care has shifted to the government through visiting nurses and paid caretakers.

Dependence is a catastrophe for the transgender community: too often they've been disowned by their families. They're excluded from religious congregations and resources. Little money or insurance is available for paid nurses. Any assistance usually comes from informal groupings with other GLBT seniors. However in many areas, laws & policies prohibit non-family members from visitation & decision-making roles.

Transsexual Seniors