"Editor’s Note: This article appears in a March 28, 2002 article on Trans-Health, a website that provides information on health and fitness for transgender and transsexual people."

At True Spirit Conference this year, Jude Patton and Hawk Stone presented a session entitled "Growing Older and Being Trans." Patton and Stone are both older transmen; their presence alone, even before examining the amount of work they’ve done for the trans community over the last few decades, is a welcome indication to all of the young people (and I’m calling everyone my age at 27 or younger, young) that we do have a future: that older trans people exist, and that we can plan for our futures despite the twin obstacles of aging and being trans.

Patton and Stone discussed a series of issues that significantly affect the well-being of older trans people, taking into account not just aging, but long-term effects of transition, coming out as trans in a relative vacuum of peers and resources, and the psychological ramifications of a medical emergency outing someone who’s lived in a community for years where no one knows he or she is transgendered.

Hoping to delve more deeply into the issues and some possible solutions, I interviewed Hawk Stone via email. [I sent the interview questions to both Stone and Patton, but Patton was unable to respond.] Legal and Medical Issues

Legal and medical issues dovetail in issues of power of attorney, marriage and inheritance, medical proxies, and nursing care. A medical emergency outing a trans person can set off a chain of events that may cast doubt on an elderly patient’s ability to choose his or her care, and the rights of a spouse to make medical decisions for a transgendered patient. A hospital administration not accepting, for instance, a woman as the legal wife of a patient revealed to be a female-to-male transsexual, could mean that the patient’s wife would not be allowed to make medical decisions on his behalf, unless they had legal documentation testifying to that desire on the part of the patient.

J.C.: Do you have any recommendations for trans people who want to protect their (or their heirs’) rights to inheritance?

H.S.: Justin, in light of the devastating decision in the Gardiner case which was just handed down on Friday [March 15, 2002], I’d say there’s precious little one can "really" do legally ahead of time. Courts right now seem very set upon seeing post-op transsexual people who marry as being in a same sex marriage—and they seem determined to undermine those legal marriages. Resolving this legal dilemma will undoubtedly take many years here in the US. Actually in other areas of the world, the UK and Australia, things look much more hopeful in these regards.

My suggestion would be to rely upon other legal recourses couples/individuals may have—that might be speaking with one’s attorney and drawing up a document—a will or otherwise—in which the transperson is very clear about their intentions—much the way gay and lesbian couples and individuals handle things now. My suggestion is that one must think ahead about these things and prepare for them, especially if there are likely to be those who will be unhappy with the deceased’s wishes. Often, there are things which can be done in advance to prevent these problems.

My first consideration would be for the person to have a consultation with legal representation and to receive in plain language and possibly in written documentation a good understanding of the inheritance laws and stipulations in their particular jurisdiction. In some states in the US, for instance, people can specifically disinherit a family member regardless of reason. Others they cannot. For married couples I would never rely upon the part of the inheritance laws as they apply to married couples. I would write a document which overrides that—i.e. —I want Mary Jones to get my estate regardless of whether she’s declared my legal wife or not. I do not want Sam Jones and Julia Jones, my children to receive any benefit of my estate…— I’m not an attorney, but things can be done to get around this in many cases, because the deceased is making their wishes clear. Also for couples, married or otherwise, to have everything in both names is best—then the surviving person can at least have a chance of 1/2 the holdings.

Also, I would suggest to the person that they tell either verbally with witnesses or through a notarized letter as many of their friends and colleagues and relatives what their wishes and intentions are. These collaterals can be used in court to support a case for the deceased intentions.

Of course, for closeted transsexual people, this may be difficult or impossible for them, and they potentially can suffer devastating losses and trouble for being outed upon death.

This points to the imperative that transgender civil rights legislation which would cover these issues be passed with all due haste.

It also points to me a problem which transgender inclusion in ENDA would only partially solve. We have 50 states and therefore 50 ways potentially of legislating transgender civil rights. One can see the problem already in that. Having a Federal level civil rights bill which uniformly addresses these issues would be the best case scenario. But that is tricky politically both within and outside the transgender community because of the difficulty of developing consensus around such issues as birth certificate change, legal identity changes, marriage laws, etc., which are all states rights issues and about which there are currently many opinions—legally, medically, and politically. Helping Older Trans People

J.C.: How do older trans people who are not in touch with the larger trans community get information about advocating for their own care and legal issues? How can those of us in the community help?

H.S.: Here is where the importance of the media comes in. Making people aware of services and programs available in the community is vital—making sure connecting with these services is confidential is essential, too. Having articles in local media—not just the LGBT or alternative media, but mainstream media is important. Having senior all citizen services alerted to and educated in trans elder issues—as well as being made aware of services available for trans elders is important. Developing informational materials which can be widely disseminated in the community—to health care providers, to religious organizations, senior organizations, etc., is important.

How can the community help? Develop awareness of trans elders and their needs; value their lives, experience and stories and understand and be compassionate about the fact that elders may sometimes see the world very differently from younger people and their needs must be met in that context. You can be allies who advocate for elders. You can network with elders to develop programs and supports which meet their needs—like a meals on wheels program or a rides to a support group program or a program of visiting shut-ins or those in care institutions. Working for Change

J.C.: What recommendations do you have for trans people of any age who want to make changes in the medical community where they live?" He responded:

H.S.: To make changes in our local community—not just the medical community—we need to do several things—

first, we need to be out—it’s much harder to be manipulated by the system if you’re out;

second, we need to act as advocates and allies to people who chose not to be out and to protect them and their right to their own lives;

third, we need to educate, educate, educate—everyone;

fourth—we can do that in many different ways—through community forums, education in our schools and universities, through the various media, and mostly importantly through the visible lives we lead.

I am never in a sense "off the clock"—I am educating whether I am at the grocery store, the movie ticket line, the restaurant or digging in my garden. I would encourage people to have the bravery and courage to speak up when they hear bigotry, to educate not escalate. All of this places pressure on the medical community to make changes. I would encourage allies to ask their medical providers about their trans awareness and encourage them to get educated; I would develop programs to educate medical students if there is a local medical school. And I would like above address any discrimination I was witness to very professionally, but vigorously. Some members of our community believe it is important that trans people not be the educators. I think it’s important we’re not the sole educators, but I’d much rather be the educator than at this historical point in time leave that to someone who may not have the best information. Seeing Age and Experience in a Positive Light

In Stone and Patton’s presentation, other issues they addressed include long-term effects of hormone use, sexually active elders and HIV/STD risk, and living in areas without trans resources. Patton cited a Dutch study published about 2-3 years ago, following both MTFs and FTM for 25 years that indicates there is no apparent risk to long-term use of hormones. In talking about sexual activity, they talked about the renaissance of sexuality that often accompanies transition, and the ageist assumption of most medical professionals that older people are not sexually active. It’s important that the medical community be educated on the very real risks to sexually active elders of HIV and other STDs. The elderly are a quickly growing demographic within the community of people living with HIV.

Because of economic factors—elderly people living on pensions and Social Security income—many older people live in rural areas, far from the resources more readily available to trans people in large cities like New York and San Francisco. This is another reason education of the medical community has to be widespread, and not limited to "gay ghettoes."

J.C.: The main issues I have notes on [from your presentation at TSC] are long-term effects of hormone use, marriage and inheritance, nursing home care, critical emergency care, sexually active elders and HIV/STD risk, economic and health choices surrounding chronic disease and HRT, living in areas without trans resources, closeted trans elders who are not in touch with the trans community, health events "outing" trans elders, online elder communities, and advocating for access to care. Do you have any additional information or resources applicable to any of these? Am I leaving any out?

H.S.: I think additional issues for me are that we need to focus on the positive—not just the deficits that come with aging. How do we actively involve elders in our community? and honor the lives and wisdom of our elders? How do we see them through their vitality instead of always framing them through their losses? How do we see aging as a positive step in life? These are not just trans issues but elder issues. How do we keep elders in the community as opposed to "retiring" them to the fringes of the community?

J.C.: Do you have any direct quotes… that you think it’s important I include in the article?

H.S.: "It would be my vision that we see the whole of the life span from birth to elderhood as not a series of separate stages through which one moves in a hierarchical sense—where the young are below and the elder are above, where there is divisiveness and the creation of barriers hierarchy brings—but rather that we are all at different points on a very fluid circle where connection and mutual respect and honor around the circle are what is most important, where each point on the circle is equally cherished and seen in its own integrity."