Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 251
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding 6 Later Adulthood The cohort of LGBT people currently in later life grew up and moved into adulthood in much less supportive environments than those experienced by younger cohorts. Before entering adulthood, the oldest of this cohort would have seen, in 1952, the creation of an official diagnosis that listed homosexuality as a sociopathic personality disturbance (Bayer, 1987) and watched Senator McCarthy include gay men and lesbians on his blacklist. As adults, this cohort witnessed routine harassment by authorities, as well as the Stonewall Rebellion in 1969 and the American Psychiatric Association’s removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders in 1973 (see Chapter 2 for a full historical overview). For all adults, later life is known as a period of both growth and decline (Baltes et al., 1999), with studies on the latter vastly outnumbering those on the former. Significant research effort has begun focusing on the diseases and disorders that accompany old age and the lifestyles of the elderly, including dementia; the living environments of later life; the need for and delivery of care from both interpersonal and institutional perspectives; the related social, and especially family, relations of older persons; end-of-life preparations; bereavement; and the personal and environmental characteristics of successful aging. These areas of research are certainly not restricted to heterosexual persons; the experiences of aging LGBT persons may be similarly characterized, with the addition of the legacies and experiences of stigma. In fact, studies of aging among LGBT elders will generate new knowledge about aging in general as questions are framed and concepts considered that fall outside of traditional “heteronormative” perspectives.
OCR for page 252
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding The committee chose to define the start of later life, while a vague and contested concept, as generally coinciding with retirement. The bulk of the empirical literature on LGBT aging, however, makes reference to a variety of (mostly younger) ages than this traditional cut-off point and is included in the discussion that follows. Ages younger than the traditional retirement age are included in this chapter in the context of preparations for later life, mainly as pertains to the well-known “baby boomer” cohort, the next in line to become seniors. This age issue is part of the recurring pattern noted throughout this report: much of the empirical literature on which the report draws either does not provide an age breakdown or uses a breakdown that does not match the age ranges used to organize the chapters of the report. Thus, the text that follows builds upon, and sometimes includes references to, studies and observations from the preceding chapter on early/middle adulthood. In so doing, it highlights the continuous nature of the life course while at the same time elucidating the particular circumstances of the later years. In general, LGBT elders have not been the subject of extensive research; a recent publication reviews some of the extant literature and echoes this statement (see Fredriksen-Goldsen and Muraco, 2010). Just as aging is infrequently considered in LGBT research, the field of gerontology has infrequently considered LGBT aging issues (Scherrer, 2009). The studies in this area that have typically been reported have used small and mainly regional samples, often recruited from public venues, such as community centers, street fairs, and pride festivals. The vast majority of studies include self-identified LGBT persons; if studies describe samples of LGBT persons otherwise identified, they are highlighted below. The studies in this area also focus disproportionately on gay men and lesbians; few studies have focused on bisexual or transgender elders. Most studies, moreover, have a high representation of white individuals; very few articles have been written on racial/ethnic minorities. Although many samples include LGBT older persons of color, they are often in proportions insufficient for further analysis; thus, very little is known about these groups. The same is true for other metrics of diversity (such as rural residence, culture, or religion). Finally, almost no published research exists on the very later years of LGBT persons—ages 85 and older. Given the limited research in this area, this chapter draws significantly on the few large-scale studies that have included older LGBT persons (and those approaching later life). It also includes a variety of more regional studies with less representative and smaller samples, as noted above. When possible, these restricted samples are described within the limiting parameters of the cited studies. This chapter examines research that has been conducted on the health of LGBT elders and factors that influence their health outcomes. It begins
OCR for page 253
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding by describing research on the development of sexual orientation and gender identity in this age group. The next two sections examine first mental health status and then physical health status. The chapter then addresses in turn risk and protective factors; health services; and contextual influences, including demographic characteristics, the role of the family, and end-of-life issues. The final section presents a summary of key findings and research opportunities. DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY Although the age at which gay men and lesbians come out appears to be earlier today than in previous cohorts, there remains great variability in the time of coming out and evidence that the process may extend over the life course (Brown et al., 2001; de Vries and Blando, 2004). Grov and colleagues (2006) conducted a cross-sectional street-intercept survey with 2,733 participants at a series of LGB community events in New York City and Los Angeles. Their sample was broken down into five age cohorts, the oldest of which was 55 and older. The authors found that women and men in the youngest cohort (aged 18–24) reported coming out to themselves at younger ages than women and men in the oldest cohort. The average age of coming out to self and coming out to others for the youngest women was 15.88 and 16.87 years, respectively; the average comparable ages for the oldest cohort of women were 24.90 and 27.38, respectively. The average age of coming out to self and coming out to others for the youngest men was 15.01 and 16.94 years, respectively; the average comparable ages for the oldest cohort of men were 20.31 and 24.11, respectively. Uneven and smaller subsamples of racial and ethnic minority LGB persons prevented fuller analyses; however, within-cohort analyses revealed no racial differences in the age at which participants came out to themselves and others. In the Still Out, Still Aging: The MetLife Study of Lesbian, Gay, Bisexual and Transgender Baby Boomers (MetLife, 2010) national survey of LGBT people aged 45–64 (n = 1,201), the extent to which LGBT respondents reported being out varied significantly. Transgender and bisexual respondents were far less likely to be out: only 39 percent of transgender and just 16 percent of bisexual people were completely or mostly out, compared with 74 percent of gay men and 76 percent of lesbians. The majority of gay men and lesbians reported having completely or very accepting families; for transgender and bisexual respondents, these percentages were lower (42 and 24 percent, respectively). Almost one-third (31 percent) of bisexuals said family members were not very or not at all accepting, a far higher percentage than the next least-accepted subpopulation of transgender people (12 percent).
OCR for page 254
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding LGBT respondents were also asked about the extent to which they disclosed their sexual orientation and/or gender identity with a variety of people. Although more than a quarter (29 percent) said they were open with anyone, many reported that they were guarded with some people. For example, 33 percent had not disclosed to their neighbors, and more than 30 percent had not disclosed at work (32 percent for coworkers and 30 percent for supervisors); 20 percent were guarded with their siblings and their parents, while 28 percent were guarded with other family members. There were also other groups of people to whom the participants had not come out—acquaintances (30 percent), people at the place where they attended religious services (16 percent), health care providers (16 percent), and even “closest friends” (12 percent). Bisexual people were less likely to disclose their sexual orientation than the other subpopulations; only 12 percent of bisexual people said they were open with anyone, compared with 30 percent of lesbians, 38 percent of gay men, and 28 percent of transgender respondents (MetLife, 2010). In his secondary analysis of 372 men aged 50–85 in the Urban Men’s Health Study—a probabilistic sample of men who have sex with men obtained in San Francisco, Los Angeles, Chicago, and New York using a modified random-digit dialing approach—Rawls (2004) found that almost 5 percent of the men in this sample had never told someone they were gay or bisexual; half of the men had not told someone else they were gay or bisexual until after the age of 21 and about one-quarter of the men until after age 26. Considered by current age, the proportion of men who reported that they had disclosed their orientation to many in their social environment significantly decreased over the three age groups in the sample—50–59, 60–69, and 70 and older. Of interest, among the older two groups, there were no significant differences between those with lower and higher levels of disclosure in their experience of distress and depression. This latter finding in particular is reminiscent of results of earlier research, particularly Lee’s (1987) study of older Canadian gay men and Adelman’s (1990) study of a small sample of gay men and lesbians over age 60 in the San Francisco Bay Area. In both of these studies, those with lower disclosure reported greater happiness and life satisfaction, leaving open questions about the time/cohort and/or life-course consequences of coming out. Transgender persons who are visibly gender role nonconforming in childhood tend to come out at an early age (Bockting and Coleman, 2007). For the older generations, this was typically during adolescence or early adulthood; today’s generation typically comes out in childhood or shortly after the onset of puberty (Möller et al., 2009; Wallien and Cohen-Kettenis, 2008). However, transgender persons who are not visibly gender role non-conforming in childhood typically do not come out until much later in life, during midlife or beyond. This is a particularly common developmen-
OCR for page 255
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding tal pathway among transgender women (as opposed to transgender men) (Doctor, 1988; Landen et al., 1998). Some transgender people who were not visibly gender role nonconforming in childhood do retrospectively report cross-gender feelings in childhood, whereas others do not. Most do, however, recall cross-dressing during adolescence. Initially, such cross-dressing is often sexually arousing, and may be restricted to particular articles of clothing (e.g., lingerie) and, possibly, compulsive (i.e., fetishistic). After many years of cross-dressing in private, the main motivation for cross-dressing may shift toward more fully doing so for comfort and, eventually, to express a cross-gender identity. This developmental pathway has been described as late onset (as opposed to early onset [Doorn et al., 1994]), secondary (as opposed to primary [Person and Ovesey, 1974]), marginal (as opposed to nuclear [Buhrich and McConaghy, 1978]), or autogynephilic (as opposed to homosexual) transsexualism1 (Blanchard, 1989). Thus, according to these typologies, most transsexual men and many transsexual women experience a strong cross-gender identity starting in childhood (primary transsexualism). For many transsexual women, however, the cross-gender identity develops more gradually over the life course and increases in intensity, and after years of compartmentalizing this identity privately, these transsexual women come out during midlife or beyond to transition and pursue hormone therapy and/or surgery to feminize. At a later age, however, hormone therapy is less effective at feminizing, either because it cannot reverse the long-term masculinizing effects of testosterone or because only lower doses of feminizing hormones can be prescribed given the higher prevalence of medical contraindications and chronic disease among older individuals (Dahl et al., 2006). For these individuals, years of being “in the closet” and in effect delaying experiences of felt stigma may have mental health implications, although research comparing the mental health of those who come out early versus later in life has yielded mixed findings (see Lawrence, 2010, for a review). What is clear is that the majority of transsexual individuals who come out later in life benefit from treatment of gender dysphoria and are satisfied with sex reassignment (Lawrence, 2003, 2010). For transgender people, coming out later in life also means working through developmental events commonly experienced earlier in life, such as a kind of “second adolescence,” first experiences in the other gender role (including dating and sexual experimentation), and exploration of 1 As a reminder, transgender is an umbrella term that encompasses a diverse group of individuals who depart from traditional gender norms. Transsexuals are those who desire to feminize or masculinize their appearance through the use of hormone therapy and/or surgery (or have already done so), and they are included in the broader category of transgender people. This discussion refers to a specific type of transsexualism that involves a developmental process occurring later in life.
OCR for page 256
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding one’s masculinity or femininity (Bockting and Coleman, 2007). Many who come out later in life are heterosexually married and have a family, whose members face their own process of coming to terms with their loved one’s transgender identity (Emerson, 1996; Lev, 2004). MENTAL HEALTH STATUS Some significant literature examines the potential challenges faced by LGBT persons in later life; there have been few empirical studies in this area, however. Some of the many challenges reported include the present and past effects of stigma and discrimination and a greater reliance on nontraditional sources of support, such as friends and other non–family members, in an environment in which such support frequently is not recognized either formally (by policy, for example) or informally (by social organizations and family members, for example) (see Barker, 2002, for a discussion of “friend” caretakers to the elderly in general). Confronting these challenges is believed to tax the mental health of LGBT elders, as discussed below. It is important to note, however, that LGBT people in later adulthood typically are well adjusted and mentally healthy. Studies using probability samples indicate that the majority of older LGB adults do not report mental health problems (Cochran and Mays, 2006; Herek and Garnets, 2007). While national probability samples of the transgender population are not available, studies based on nonprobability samples similarly show that the same is true for many if not most transgender adults (Clements-Nolle et al., 2001; Nuttbrock et al., 2010). Mood/Anxiety Disorders Limited data are available on mood or anxiety disorders among older LGBT individuals. The reports available in the literature typically are for an adult population undifferentiated by age, obscuring the particular experiences of older adults. Depression Among older adults in the general population, estimates of the prevalence of major depression range from less than 1 percent to approximately 5 percent, but can reach 13.5 percent for those who require home health care (NIMH, 2007). Compared with these estimates, studies of both older gay men and older lesbians have found elevated levels of depression. Shippy and colleagues (2004) found that 30 percent of a sample of 233 gay men aged 50–87 reported depression. Bradford and colleagues (1993), reporting
OCR for page 257
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding on the National Lesbian Health Care Survey of 1,925 self-identified lesbians aged 17–80, found that among the approximately 3 percent of the sample over age 55, 24 percent reported having experienced depression at some point in their lives. Valanis and colleagues (2000), analyzing data from the Women’s Health Initiative (n = 93,311), found that 15–17 percent of lesbians aged 50–79 had been depressed. In a household probability sample of 2,881 men who have sex with men (analyzed by age decade), Mills and colleagues (2004) found a rate of depression of 17 percent among men aged 50–69 (n = 397) and 5 per cent among men aged 70 and older (n = 41). Not having a domestic partner, a recent history of antigay threats or violence, not identifying as gay, and feeling highly alienated from the gay community were associated with both distress and depression. Based on data gathered from 416 self-identified lesbian, gay, and bisexual adults aged 60–91, Grossman (2006) found that most older LGB adults in the study appeared to have developed some resilience to the minority stress in their lives. However, signs of emotional distress were still present in their lives. For example, 27 percent reported feeling lonely, 10 percent reported sometimes or often considering suicide, and 17 percent still wished they were heterosexual. For 93 percent of participants, having known people who were HIV-positive or had died of AIDS was an additional factor that caused emotional distress. Several authors have commented that older transgender adults have particularly high rates of depression (e.g., Cook-Daniels and Munson, 2010). Empirical evidence is sparse on this point, however. A recent study by Fredriksen-Goldsen and colleagues (2011) offers some data on this and other points of relevance. The study was based on an 11-site sample with a total of 2,560 self-identified LGBT persons between the ages of 50 and 95 (including 175 transgender persons) recruited through agency lists, respondent-driven sampling, and in-depth interviews. Thirty-one percent of the LGBT persons in this sample were depressed; transgender persons reported significantly higher levels of depression than nontransgender persons, although the exact percentages were not known. Suicide/Suicidal Behavior The National Institute of Mental Health (NIMH, 2007) identified a national average of 11 suicides per 100,000 in the general population; persons over age 65 died by suicide at a rate of 14.7 per 100,000. From another perspective, the proportion of older adults in the United States is about 12 percent, but the elderly account for 18 percent of the nation’s suicides (Statewide Office of Suicide Prevention, 2009). These statistics differ dramatically by gender: men die by suicide at a rate five times that among women.
OCR for page 258
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Even against this backdrop, the lifetime risk of suicide attempts appears particularly high among gay and bisexual men, as reported in a metareview by King and colleagues (2008), although this analysis had no age-specific focus. Others have reported an elevated risk of suicide attempts and suicidality in samples including older gay men and lesbians. For example, Paul and colleagues (2002) examined suicidality by age cohort using data from the Urban Men’s Health Study—a household probability sample of 2,881 men who have sex with men in four major U.S. cities, 14 percent of whom were age 25 in 1970 (meaning they were 55 in 2000). The authors found that 12 percent of this group had attempted suicide (equivalent to the percentage in all other age cohorts), with the mean age of first attempt being 37.4 years (one-quarter of men in this cohort who had attempted suicide had done so before age 25). In a study using the previously described data set of 416 self-identified lesbian, gay, and bisexual adults aged 60–91, D’Augelli and Grossman (2001) found that 13 percent of their sample had attempted suicide (an attempt was especially likely among those who had been victimized at some point in their lives, as described further below). Among the study participants, better mental health was correlated with higher self-esteem, less loneliness, and lower internalized homophobia. Compared with women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants’ sexual orientation (D’Augelli and Grossman, 2001). Although some studies examining suicidal ideation and attempts among transgender adults include individuals in later adulthood, these studies typically do not provide analyses of their data according to the age of participants. Therefore, it is difficult to identify findings that are specifically pertinent to transgender individuals in later adulthood. These studies are discussed in the previous chapter on early/middle adulthood. As noted frequently throughout this chapter, research on LGBT elders is sparse, an observation that is apparent in this section. It is also important to note that much of what is known about suicide attempts or ideation is for “any time in the lives” of these persons as currently assessed. Many of these behaviors and thoughts may well have occurred in much earlier years and thus are not related to experiences in later life (and perhaps even intimate particular resilience among older, surviving adults). Transgender-Specific Mental Health Status Studies on the mental health of transgender people include participants in later life, yet data for this age group typically are not presented
OCR for page 259
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding separately. One recent study, however, does provide some insight into the mental health of older transgender individuals. While this study encompasses midlife participants, its focus on older in comparison with younger adults makes its inclusion appropriate. Nuttbrock and colleagues (2010) conducted Life Chart Interviews with a convenience sample of 571 transgender women in New York City and compared data from older (aged 40–59, n = 238) and younger (aged 19–39, n = 333) participants. Two-thirds (66.3 percent) of the older as opposed to 84.1 percent of the younger participants reported coming out in one or more interpersonal contexts (family, friends, work, school). Lifetime prevalence of depression was 52.4 percent for the older group and 54.7 percent for the younger group. Among the older group, 35.5 percent reported depression during two or more life stages (early adolescence, late adolescence, early/young adulthood, early middle age, later middle age); depression was high during early adolescence (23.5 percent) and remained relatively constant into early (24.8 percent) and later (26.1 percent) middle age. This pattern differed from that of the younger group, in whom depression was extremely high during early adolescence (38.4 percent) but then declined significantly into early middle age (19.1 percent). Lifetime prevalence of suicidal ideation, planning, and attempts among the older group was 53.5 percent, 34.9 percent, and 28.0 percent, respectively; 6.7 percent reported suicide attempts during two or more life stages. For both the older and younger groups, gender-related stigma (gender-related psychological and physical abuse) was associated with depression. PHYSICAL HEALTH STATUS The now well-known health concomitants of aging are similarly represented among heterosexual and LGBT older adults, although they may be exacerbated by factors associated with gender identity and sexual orientation. These factors are rarely studied, and thus are fertile ground for subsequent research. For example, data suggest that LGBT adults, including older persons, rate their health more poorly than heterosexual adults. The Massachusetts Department of Public Health issued a report in 2009 that included 1,598 LGBT and heterosexual adults (with mean ages in the range of middle adulthood). Among participants, 67.3 percent of transgender adults (n = 35), 73.5 percent of bisexual adults (n = 100), and 78 percent of gay and lesbian adults (n = 749) rated their overall health as “excellent” or “very good,” compared with 82.5 percent of heterosexual adults (n = 371) (Massachusetts Department of Public Health, 2009). In a national study comparing more than 1,200 LGBT people aged 45–64 with a group of just over 1,200 individuals aged 45–64 from the general population, the MetLife (2010) survey found that the percentage
OCR for page 260
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding reporting recent receipt of (and need for) care was greatest (19 percent) among the 5 percent of the sample identifying as transgender—comparable to the percentage of lesbians, somewhat greater than the percentage of bisexual women and men (17 percent), and much higher than the percentage of gay men as well as women and men from the general population (9 percent). Finally, Fredriksen-Goldsen and colleagues (2011) found that almost one in four (23 percent) of their sample of 2,560 LGBT adults aged 50 and older reported that their general health was poor. Sexual/Reproductive Health Although the study of sexuality has seen tremendous growth over the last 60–70 years, beginning with Kinsey’s groundbreaking research in the 1940s and 1950s, research on sexuality and aging has lagged. It is likely that research in this field is largely undeveloped as a result of ageism and inaccurate beliefs about sexuality ending in later life. As Schlesinger (1996) has noted, myths surrounding older persons and sexuality (i.e., that older persons are sexually undesirable and are not desirous of or capable of sexual expression) continue to influence our culture’s perspectives on sexuality and the elderly. Research has shown that these beliefs are false and that many adults continue to be sexually active throughout their lives (Lindau et al., 2007). While the very notion of a gay and lesbian gerontology raises the issue of sexuality directly (de Vries and Blando, 2004), limited research has explored sexual health among older LGBT people. In contrast, there is some research on sexual dysfunction in these groups. Erectile dysfunction has been associated with aging among men, although no research has investigated the extent of the problem among men who have sex with men. Rawls (2004) reports on a reanalysis of existing data on men who have sex with men who either identified as gay or reported same-sex contact in the Urban Men’s Health Study (Catania et al., 2001). Of the total sample of 2,881 men, 372 between the ages of 50 and 85 were included in the analysis. Among these men, 38.5 percent reported some “sexual difficulties” in the year prior to their interview. Of those reporting sexual difficulties, just under two-thirds cited health problems and/or medications as a contributing factor, and more than one-third cited psychological problems. Some reference to sexual dysfunction is included in research on prostate cancer, as noted by Asencio and colleagues (2009) in their qualitative focus group study of 36 midlife and older gay men (the majority being aged 50–70). The authors found that the fear of sexual dysfunction would influence respondents’ decisions about how to treat prostate cancer, with age, socioeconomic status, and race moderating this association. Little empirical research has explored sexual functioning among older lesbians, bisexuals, and transgender persons. In terms of reproductive
OCR for page 261
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding health, Moore and colleagues (2003) report high rates of polycystic ovarian disease in transgender men, with implications for the risk of endometrial cancer. The literature includes some discussion (and controversy; see, e.g., Garnets and Peplau, 2006) about “lesbian bed death.” Early research (e.g., Kehoe, 1989) on older lesbians found large numbers reporting no sexual experience in the previous year and low rates of sexual satisfaction. Kehoe’s study was conducted with 100 self-identified lesbians over age 60 who responded to calls for participants posted in lesbian and feminist newsletters and bookstores, women’s centers, and college and university campuses and associations. Little published research has followed this early, groundbreaking work to support or challenge its findings, and the concept remains in the lexicon of the literature. Valanis and colleagues (2000) report on the Women’s Health Initiative study, which included women aged 50–79 of postmenopausal status (n = 93,311). Women were placed into five sexual orientation groups based on their responses: heterosexual (n = 90,578), bisexual (n = 740), lifetime lesbian (sex only with women ever) (n = 264), adult lesbian (sex only with women after age 45) (n = 309), and never had adult sex (n = 1,420). The authors compared reproductive health outcomes and behaviors among the participants. Their results demonstrate similarities in oral contraceptive use and rates of pregnancy and hormone replacement therapy among the five sexual orientation groups. The rate of oral contraceptive use was highest for bisexual women (54.6 percent), and also high for adult lesbians (52.1 percent) and heterosexual women (45.4 percent). Heterosexual women had the highest rate of hysterectomy (41.5 percent), although the rates were similar for adult lesbians (35.0 percent) and bisexual women (39.6 percent). Adult lesbians, lifetime lesbians, bisexual women, and heterosexual women had similar rates of ever using hormone replacement therapy (HRT) (66–71 percent), higher than the rate among the no adult sex group (48 percent). These results reveal that, despite differences in sexual orientation, rates of hysterectomy, oral contraceptive use, and HRT use are extremely similar. Valanis and colleagues also found high rates of ever being pregnant among the bisexuals (80.8 percent) and adult lesbians (63 percent) compared with the lifetime lesbians (35 percent). In the aggregate, these data indicate that pregnancy and parenting may play a significant role in the lives of many women who have sex with women, with relevance for psychosocial and physical well-being. Cook-Daniels and Munson (2010) have been among the very few to study sexual practices and behaviors among transgender elders. They report on a sample comprising 272 transgender participants and/or their intimate partners aged 50–79, generated by means of an online survey in which participants were recruited through listservs directed to transgender adults and
OCR for page 282
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Mental Health Status Depression levels and suicidality appear to be elevated among older lesbians and gay men. Less research has been conducted in this area among bisexual and transgender elders. Physical Health Status It appears that rates of hysterectomy, oral contraceptive use, and hormone replacement therapy may be similar for lesbians, bisexual women, and heterosexual women. Lesbians and bisexual women may have higher rates of breast cancer than heterosexual women. Data on whether lesbians have a higher risk for cardiovascular disease are conflicting. Limited research suggests that transgender elders may experience negative health outcomes as a result of long-term hormone use. HIV/AIDS impacts not only younger but also older LGBT individuals. However, few HIV prevention programs target older adults, a cohort that also has been deeply affected by the losses inflicted by AIDS. Disability among LGBT elders is a topic rarely considered in research. Risk and Protective Factors LGBT elders experience stigma, discrimination, and victimization across the life course. Little research examines violence experienced by LGBT elders, but some studies suggest that LGBT elders report high rates of lifetime experiences with violence. Some research suggests that, compared with their heterosexual counterparts, LGB elders may have higher rates of tobacco and alcohol use. Research on tobacco and alcohol use among transgender elders is largely lacking. There is some evidence of crisis competence (resilience and perceived hardiness) within older LGBT populations; however, this concept is not yet well understood and has not been thoroughly researched. Very limited data suggest that education may play a protective role in the lives of some older LGBT people. Health Services Limited research suggests that LGBT elders may be less likely to seek health services than the general population.
OCR for page 283
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Some research suggests that older LGBT individuals do not believe they will receive respectful care in old age and may delay seeking care for fear of discrimination. Long-term care for LGBT elders has not been the subject of many empirical studies. Contextual Influences Research on the influence of sociodemographic characteristics on the health of LGBT elders is very limited. The role of families in the lives of older LGBT people has been underresearched. Lesbian and gay elders are less likely than their heterosexual peers to have children, and their other kinship ties are not well understood. Families of choice appear to be a source of support for LGBT people in later life. Research Opportunities While the above findings provide some information on the health status of LGBT elders, there is a dearth of data on a number of topics in this area. Even among the studies that exist, lesbians, gay men, bisexual men and women, and transgender people are not equitably represented. Very little is known about transgender and bisexual aging in particular. Similarly, more research has focused on the first part of later life, while almost no published research exists on LGBT populations aged 85 and above. In studies whose participants represent a wide range of ages, age is rarely considered as a factor. Thus, while the potential exists to better understand this cohort, researchers often miss this opportunity by failing to include age as a variable. Both cross-sectional and longitudinal research is especially needed to explore the demographic realities of LGBT aging in an intersectional and social ecology framework, to allow an understanding of the mechanisms of both risk and resilience in LGBT elders, and to identify appropriate interventions for working effectively with this cohort. These parameters could be brought to bear in research in the following areas: Demographic and descriptive information, including the percentage of elders who are LGBT and how that percentage varies by such demographic characteristics as race, ethnicity, socioeconomic status, geography, and religion; also, the general experiences and health status of older LGBT adults and how these vary by demographic characteristics, the percentage of LGBT elders who are parents, and the trajectory of LGBT identity and experiences (particular bisexual identity) over the life course.
OCR for page 284
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Family and interpersonal relations, including the experience of LGBT aging and family life (e.g., experiences with biological kin across generations, “chosen family” ties and relations), the effect of the greater likelihood of childlessness (particularly among older gay men), and experiences of grief and loss (including multiple losses); also intrafamily and domestic violence (e.g., caregiver/provider abuse, intimate partner violence) and anti-LGBT victimization. Health services, including barriers to access (particularly related to identity disclosure and interactions with providers), utilization rates, long-term care issues for older LGBT persons, quality of care received, and end-of-life issues (e.g., preparations, fears, and plans). Mental health, including depression and suicidality (about which little has been written), the effects of stigma and discrimination (over the course of a lifetime), and the experience of and preparations for late life among older LGBT persons. Physical health, including cancer rates, risks, and treatment (particularly for prostate cancer among older gay and bisexual men and transgender women and anal cancer among older men who have sex with men); the effects of long-term hormone use among older transgender persons; and the effects of disabilities among older LGBT persons. Sexual and reproductive health, including HIV rates and interventions (and the experience of aging with HIV) and sexual well-being and sexual dysfunction (particularly among older lesbians and transgender elders, about whom little is known). REFERENCES Adelman, M. 1990. Stigma, gay lifestyles, and adjustment to aging: A study of later-life gay men and lesbians. Journal of Homosexuality 20(3/4):7–32. Adelman, M., L. Gurevich, B. de Vries, and J. Blando. 2006. Openhouse: Community building and research in the LGBT aging population. In Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives, edited by D. Kimmel, T. Rose, and S. David. New York: Columbia University Press. Altekruse, S. F., C. L. Kosary, M. Krapcho, N. Neyman, R. Aminou, W. Waldron, J. Ruhl, N. Howlader, Z. Tatalovich, H. Cho, A. Mariotto, M. P. Eisner, D. R. Lewis, K. Cronin, H. S. Chen, E. J. Feuer, D. G. Stinchcomb, and B. K. Edwards. 2010. SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute. Asencio, M., T. Blank, L. Descartes, and A. Crawford. 2009. The prospect of prostate cancer: A challenge for gay men’s sexualities as they age. Sexuality Research & Social Policy: A Journal of the NSRC 6(4):38–51. Balsam, K. F., E. D. Rothblum, and T. P. Beauchaine. 2005. Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting & Clinical Psychology 73(3):477–487. Baltes, P. B., U. M. Staudinger, and U. Lindenberger. 1999. Lifespan psychology: Theory and application to intellectual functioning. Annual Review of Psychology 50:471–507.
OCR for page 285
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Barker, J. C. 2002. Neighbors, friends, and other nonkin caregivers of community-living dependent elders. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57(3):S158–S167. Barker, J. C., G. Herdt, and B. de Vries. 2006. Social support in the lives of lesbians and gay men at midlife and later. Sexuality Research & Social Policy: A Journal of the NSRC 3(2):1–23. Bayer, R. 1987. Homosexuality and American psychiatry: The politics of diagnosis (revised ed.). Princeton, NJ: Princeton University Press. Beeler, J. A., T. W. Rawls, G. Herdt, and B. J. Cohler. 1999. The needs of older lesbians and gay men in Chicago. Journal of Gay & Lesbian Social Services 9(1):31–49. Bergling, T. 2004. Reeling in the years: Gay men’s perspectives on age and ageism. New York: Harrington Park Press. Black, D., G. Gates, S. Sanders, and L. Taylor. 2000. Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography 37(2):139–154. Blanchard, R. 1989. The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease 177(10):616–623. Blank, T. O. 2008. The challenge of prostate cancer: ‘Half a man or a man and a half.’ Generations 32(1):68–72. Blank, T. O., M. Asencio, L. Descartes, and J. Griggs. 2009. Aging, health, and GLBTQ family and community life. Journal of GLBT Family Studies 5(1–2):9–34. Bockting, W., and E. Avery, eds. 2005. Transgender health and HIV prevention: Needs assessment studies from transgender communities across the United States. New York: Haworth Medical Press. Bockting, W. O., and E. Coleman. 2007. Developmental stages of the transgender coming out process: Toward an integrated identity. In Handbook of transgender medicine and surgery, edited by R. Ettner, S. Monstrey, and E. Evan. New York: Haworth Press. Bradford, J., C. Ryan, and E. D. Rothblum. 1993. National lesbian health care survey: Implications for mental health care. Journal of Consulting and Clinical Psychology 62(2): 228–242. Brotman, S., B. Ryan, and R. Cormier. 2003. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist 43(2):192–202. Brotman, S., B. Ryan, S. Collins, L. Chamberland, R. Cormier, D. Julien, E. Meyer, A. Peterkin, and B. Richard. 2007. Coming out to care: Caregivers of gay and lesbian seniors in Canada. Gerontologist 47(4):490–503. Brown, L. B., G. R. Alley, S. Sarosy, G. Quarto, and T. Cook. 2001. Gay men: Aging well! Journal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research 13(4):41–54. Buhrich, N., and N. McConaghy. 1978. Two clinically discrete forms of transsexualism. The British Journal of Psychiatry 133:73–76. Catania, J. A., D. Osmond, R. D. Stall, L. Pollack, J. P. Paul, S. Blower, D. Binson, J. A. Canchola, T. C. Mills, L. Fisher, K. H. Choi, T. Porco, C. Turner, J. Blair, J. Henne, L. L. Bye, and T. J. Coates. 2001. The continuing HIV epidemic among men who have sex with men. American Journal of Public Health 91(6):907–914. CDC (Centers for Disease Control and Prevention). 2007. Cases of HIV infection and AIDS in the United States and dependent areas, 2005. Atlanta, GA: CDC. CDC. 2010. HIV and AIDS among gay and bisexual men. Atlanta, GA: CDC. Chin-Hong, P. V., E. Vittinghoff, R. D. Cranston, S. Buchbinder, D. Cohen, G. Colfax, M. Da Costa, T. Darragh, E. Hess, F. Judson, B. Koblin, M. Madison, and J. M. Palefsky. 2004. Age-specific prevalence of anal human papillomavirus infection in HIV-negative sexually active men who have sex with men: The EXPLORE study. Journal of Infectious Diseases 190(12):2070–2076.
OCR for page 286
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Clements, K., K. Kitano, W. Wilkinson, and R. Marx. 1999. HIV prevention and health service needs of the transgender community in San Francisco. International Journal of Transgenderism 3(1/2):1. Clements-Nolle, K., R. Marx, R. Guzman, and M. Katz. 2001. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health 91(6):915–921. Clunis, D. M., K. Fredriksen-Goldsen, P. Freeman, and N. Nystrom. 2005. Lives of lesbian elders. New York: Haworth Press. Cochran, S. D., and V. M. Mays. 2006. Estimating prevalence of mental and substance-using disorders among lesbians and gay men from existing national health data. In Sexual orientation and mental health, edited by A. M. Omoto and H. S. Kurtzman. Washington, DC: American Psychological Association. Pp. 143–165. Comerford, S. A., M. M. Henson-Stroud, C. Sionainn, and E. Wheeler. 2004. Crone songs: Voices of lesbian elders on aging in a rural environment. Affilia-Journal of Women and Social Work 19(4):418–436. Conron, K. J., M. J. Mimiaga, and S. J. Landers. 2010. A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health 100(10):1953–1960. Cook-Daniels, L., and M. Munson. 2010. Sexual violence, elder abuse, and sexuality of transgender adults, age 50+: Results of three surveys. Journal of GLBT Family Studies 6(2):142–177. D’Augelli, A., and A. Grossman. 2001. Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. Journal of Interpersonal Violence 16(10):1008–1027. Dahl, M., J. L. Feldman, J. M. Goldberg, and A. Jaberi. 2006. Physical aspects of transgender endocrine therapy. International Journal of Transgenderism 9(3):111–134. David, S., and B. G. Knight. 2008. Stress and coping among gay men: Age and ethnic differences. Psychology and Aging 23(1):62–69. de Vries, B. 2006. Home at the end of the rainbow. Generations 29(4):64–69. de Vries, B. 2008. Lesbian, gay, bisexual and transgender persons in later life. In Encyclopedia of the life course and human development, edited by D. S. Carr. Farmington Hills, MI: Cengage Learning, Inc. Pp. 161–165. de Vries, B., and J. Blando. 2004. The study of gay and lesbian aging: Lessons for social gerontology. In Gay and lesbian aging: Research and future directions, edited by G. Herdt and B. de Vries. New York: Springer. de Vries, B., and P. Hoctel. 2006. The family-friends of older gay men and lesbians. In Sexual inequalities and social justice, edited by N. Teunis and G. Herdt. Berkeley, CA: University of California Press. Pp. 213–232. de Vries, B., and D. Megathlin. 2009. The meaning of friendship for gay men and lesbians in the second half of life. Journal of GLBT Family Studies 5(1):82–98. de Vries, B., A. M. Mason, J. Quam, and Aquaviva. 2009. State recognition of same-sex relationships and preparations for end of life among lesbian and gay boomers. Sexuality Research & Social Policy: A Journal of the NSRC 6(1):90–101. Department of Health and Human Services. 2010. Medical management of older patients with HIV/AIDS (R21). http://grants.nih.gov/grants/guide/pa-files/pa-09-019.html (accessed February 28, 2011). Doctor, R. F. 1988. Transvestites and transsexuals: Towards a theory of cross-gender behavior. New York: Plenum Press. Doorn, C. D., J. Poortinga, and A. M. Verschoor. 1994. Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior 23(2):185–201.
OCR for page 287
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Emerson, S. 1996. Stages of adjustment in family members of transgender individuals. Journal of Family Psychotherapy 7(3):1–12. Eyler, A. E. 2007. Primary care of the gender-variant patient. In Principles of transgender medicine and surgery, edited by R. Ettner, S. Monstrey, and A. E. Eyler. New York: Haworth Press. Pp. 15–31. Fairchild, S. K., G. E. Carrino, and M. Ramirez. 1996. Social workers’ perceptions of staff attitudes toward resident sexuality in a random sample of New York state nursing homes: A pilot study. Journal of Gerontological Social Work 26(1):153–169. Feldman, J. 2007. Preventive care of the transgendered patient: An evidence-based approach. In Principles of transgender medicine and surgery, edited by R. Ettner, S. Monstrey, and A. E. Eyler. New York: Haworth Press. Pp. 33–72. Feldman, J. L., and J. M. Goldberg. 2007. Transgender primary medical care. International Journal of Transgenderism 9(3–4):3–34. Fredriksen-Goldsen, K. I., and A. Muraco. 2010. Aging and sexual orientation: A 25-year review of the literature. Research on Aging 32(3):372–413. Fredriksen-Goldsen, K. I., H. J. Kim, A. Muraco, and S. Mincer. 2009. Chronically ill midlife and older lesbians, gay men, and bisexuals and their informal caregivers: The impact of the social context. Sexuality Research & Social Policy: A Journal of the NSRC 6(4):52–64. Fredriksen-Goldsen, K. I., H.-J. Kim, and J. Goldsen. 2011 (unpublished). Resilience and disparities among lesbian, gay, bisexual and transgender older adults. Institute for Multi-generational Health. Fruhauf, C. A., N. A. Orel, and D. A. Jenkins. 2009. The coming-out process of gay grandfathers: Perceptions of their adult children’s influence. Journal of GLBT Family Studies 5(1):99–118. Garnets, L. D., and L. A. Peplau. 2006. Sexuality in the lives of aging lesbian and bisexual women. In Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives, edited by D. Kimmel, T. Rose, and S. David. New York: Columbia University Press. Pp. 70–90. Goldberg, N. G. 2009. The impact of inequality for same-sex partners in employer-sponsored retirement plans. Los Angeles, CA: The Williams Institute. Grossman, A. H. 2006. Physical and mental health of older lesbian, gay, and bisexual adults. In Lesbian, gay, bisexual and transgender aging: Research and clinical perspectives, edited by D. Kimmel, T. Rose and S. David. New York: Columbia University Press. Pp. 53–69. Grossman, A. H., A. R. D’Augelli, and S. L. Hershberger. 2000. Social support networks of lesbian, gay, and bisexual adults 60 years of age and older. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences 3(3):171. Grossman, A. H., A. R. D’Augelli, and T. S. O’Connell. 2001. Being lesbian, gay, bisexual, and 60 or older in North America. Journal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research 13(4):23–40. Grov, C., D. S. Bimbi, J. E. Nanin, and J. T. Parsons. 2006. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2):105–123. Gruskin, E. P., G. L. Greenwood, M. Matevia, L. M. Pollack, and L. L. Bye. 2007. Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. American Journal of Public Health 97(8):1496–1502. Gutmann, D. 1985. The parental imperative revisited: Towards a developmental psychology of adulthood and later life. Contributions to Human Development 14:31–60. Harrison, A. E., and V. M. Silenzio. 1996. Comprehensive care of lesbian and gay patients and families. Primary Care; Clinics in Office Practice 23(1):31–46. Hartzell, E., M. S. Frazer, K. Wertz, and M. Davis. 2009. The state of transgender California: Results from the 2008 California Transgender Economic Health Survey. San Francisco, CA: Transgender Law Center.
OCR for page 288
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Herek, G. M., and L. D. Garnets. 2007. Sexual orientation and mental health. Annual Review of Clinical Psychology 3:353–375. High, K. P., R. B. Effros, C. V. Fletcher, K. Gebo, J. B. Halter, W. R. Hazzard, F. M. Horne, R. E. Huebner, E. N. Janoff, A. C. Justice, D. Kuritzkes, S. G. Nayfield, S. F. Plaeger, K. E. Schmader, J. R. Ashworth, C. Campanelli, C. P. Clayton, B. Rada, and N. F. Woolard. 2008. Workshop on HIV infection and aging: What is known and future research directions. Clinical Infectious Diseases 47(4):542–553. Hostetler, A. 2004. Old, gay and alone? The ecology of well-being among middle-aged and older single gay men. In Gay and lesbian aging: Research and future directions, edited by G. Herdt and B. de Vries. New York: Springer. Pp. 143–176. Hughes, T. L., S. C. Wilsnack, L. A. Szalacha, T. Johnson, W. B. Bostwick, R. Seymour, F. Aranda, P. Benson, and K. E. Kinnison. 2006. Age and racial/ethnic differences in drinking and drinking-related problems in a community sample of lesbians. Journal of Studies on Alcohol 67(4):579–590. Johnson, M. J., N. C. Jackson, J. K. Arnette, and S. D. Koffman. 2005. Gay and lesbian perceptions of discrimination in retirement care facilities. Journal of Homosexuality 49(2):83–102. Kammerer, N., T. Mason, and M. Connors. 1999. Transgender health and social service needs in the context of HIV risk. International Journal of Transgenderism 3(1/2):1. Karpiak, S. E., R. A. Shippy, and M. H. Cantor. 2006. Research on older adults with HIV. New York: AIDS Community Research Initiative of America. Kehoe, M. 1989. Lesbians over sixty speak for themselves. New York: Harrington Park Press. Kenagy, G. P. 2005. Transgender health: Findings from two needs assessment studies in Philadelphia. Health & Social Work 30(1):19–26. Kenagy, G. P., and C. M. Hsieh. 2005. The risk less known: Female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care 17(2):195–207. Kennamer, J. D., J. Honnold, J. Bradford, and M. Hendricks. 2000. Differences in disclosure of sexuality among African American and white gay/bisexual men: Implications for HIV/ AIDS prevention. AIDS Education & Prevention 12(6):519–531. Kertzner, R. M., I. H. Meyer, D. M. Frost, and M. J. Stirratt. 2009. Social and psychological well-being in lesbians, gay men, and bisexuals: The effects of race, gender, age, and sexual identity. American Journal of Orthopsychiatry 79(4):500–510. Kimmel, D. C. 1978. Adult development and aging: A gay perspective. Journal of Social Issues 34(3):113–130. King, M., J. Semlyen, S. S. Tai, H. Killaspy, D. Osborn, D. Popelyuk, and I. Nazareth. 2008. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8:70. King, S., and H. Dabelko-Schoeny. 2009. “Quite frankly, I have doubts about remaining”: Aging-in-place and health care access for rural midlife and older lesbian, gay, and bisexual individuals. Journal of LGBT Health Research 5(1):10–21. Landen, M., J. Walinder, and B. Lundstrom. 1998. Clinical characteristics of a total cohort of female and male applicants for sex reassignment: A descriptive study. Acta Psychiatrica Scandinavica 97(3):189–194. Lawrence, A. A. 2003. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior 32(4):299–315. Lawrence, A. A. 2010. Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Archives of Sexual Behavior 39(2):514–545. Lee, J. A. 1987. The invisible lives of Canada’s gray gays. In Aging in Canada: Social perspectives, edited by V. M. Marshall. Markham, Ontorio: Fitzhenry & Whitside. Pp. 138–155. Lev, A. I. 2004. Transgender emergence: Therapeutic guidelines for working with gender. New York: Haworth Press.
OCR for page 289
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Lindau, S. T., L. P. Schumm, E. O. Laumann, W. Levinson, C. A. O’Muircheartaigh, and L. J. Waite. 2007. A study of sexuality and health among older adults in the United States. New England Journal of Medicine 357(8):762–774. Lopata, H. Z. 1993. The support system of American urban widows. In Handbook of bereavement: Theory, research, and intervention, edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson. Cambridge, UK: Cambridge University Press. Pp. 381–396. Martin, J. L., and L. Dean. 1993. Bereavement following death from AIDS: Unique problems, reactions, and special needs. In Handbook of bereavement: Theory, research, and intervention, edited by M. S. Stroebe, W. Stroebe, and R. O. Hansson. New York: Columbia University Press. Pp. 315–330. Masini, B. E., and H. A. Barrett. 2008. Social support as a predictor of psychological and physical well-being and lifestyle in lesbian, gay, and bisexual adults aged 50 and over. Journal of Gay & Lesbian Social Services 20(1):91–110. Massachusetts Department of Public Health. 2009. The health of lesbian, gay, bisexual and transgender (LGBT) persons in Massachusetts: A survey of health issues comparing LGBT persons with their heterosexual and non-transgender counterparts. Boston, MA: Massachusetts Department of Public Health. McLaughlin, K. A., M. L. Hatzenbuehler, and K. M. Keyes. 2010. Responses to discrimination and psychiatric disorders among black, Hispanic, female, and lesbian, gay, and bisexual individuals. American Journal of Public Health 100(8):1477–1484. MetLife. 2006. Out and aging: The MetLife study of lesbian and gay baby boomers. Westport, CT: MetLife Mature Market Institute. MetLife. 2010. Still out, still aging: The MetLife study of lesbian, gay, bisexual, and transgender baby boomers. Westport, CT: MetLife Mature Market Institute. Mills, T. C., J. Paul, R. Stall, L. Pollack, J. Canchola, Y. J. Chang, J. T. Moskowitz, and J. A. Catania. 2004. Distress and depression in men who have sex with men: The Urban Men’s Health Study. American Journal of Psychiatry 161(2):278–285. Möller, B., H. Schreier, A. Li, and G. Romer. 2009. Gender identity disorder in children and adolescents. Current Problems in Pediatric & Adolescent Health Care 39: 117–143. Moore, E., A. Wisniewski, and A. Dobs. 2003. Endocrine treatment of transsexual people: A review of treatment regimens, outcomes, and adverse effects. Journal of Clinical Endocrinology & Metabolism 88(8):3467–3473. Movement Advancement Project and Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders. 2010. Improving the lives of LGBT older adults. http://www.sageusa.org/uploads/Advancing%20Equality%20for%20LGBT%20Elders%20%5BFINAL%20COMPRESSED%5D.pdf (accessed March 17, 2011). Mullan, J. T. 1998. Aging and informal caregiving to people with HIV/AIDS. Research on Aging 20(6):712. Nemoto, T., D. Operario, and J. G. Keatley. 2005. Health and social services for male-to-female transgender persons of color in San Francisco. International Journal of Transgenderism 8(2/3):5–19. NIMH (National Institute of Mental Health). 2007. Suicide in the U.S.: Statistics and prevention. http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml (accessed November 9, 2010). Nuttbrock, L., S. Hwahng, W. Bockting, A. Rosenblum, M. Mason, M. Macri, and J. Becker. 2010. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research 47(1):12–23. Office of the New York City Public Advocate. 2008. Improving lesbian, gay, bisexual and transgender access to healthcare at New York City health and hospitals corporation facilities. New York: Office of the New York City Public Advocate.
OCR for page 290
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Orel, N. 2006a. Community needs assessment: Documenting the need for affirmative services for LGB older adults. In Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives, edited by D. Kimmel, T. Rose, and S. David. New York: Columbia University Press. Pp. 227–246. Orel, N. 2006b. Lesbian and bisexual women as grandparents: The centrality of sexual orientation in the grandparent-grandchild relationship. In Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives, edited by D. Kimmel, T. Rose, and S. David. New York: Columbia University Press. Pp. 175–194. Paul, J. P., J. Catania, L. Pollack, J. Moskowitz, J. Canchola, T. Mills, D. Binson, and R. Stall. 2002. Suicide attempts among gay and bisexual men: Lifetime prevalence and antecedents. American Journal of Public Health 92(8):1338–1345. Person, E., and L. Ovesey. 1974. The transsexual syndrome in males. I. Primary transsexualism. American Journal of Psychotherapy 28(1):4–20. Price, J. H., A. N. Easton, S. K. Telljohann, and P. B. Wallace. 1996. Perceptions of cervical cancer and Pap smear screening behavior by women’s sexual orientation. Journal of Community Health 21(2):89–105. Qureshi, H., and A. Walker. 1989. The caring relationship: Elderly people and their families. Philadelphia, PA: Temple University Press. Rawls, T. W. 2004. Disclosure and depression among older gay and homosexual men: Findings from the Urban Men’s Health Study. In Gay and lesbian aging: Research and future directions, edited by G. Herdt and B. De Vries. New York: Springer. Pp. 117–141. Riggle, E. D., S. S. Rostosky, R. A. Prather, and R. Hamrin. 2005. The execution of legal documents by sexual minority individuals. Psychology, Public Policy, and Law 11(1):138–163. Roberts, S. A., S. L. Dibble, B. Nussey, and K. Casey. 2003. Cardiovascular disease risk in lesbian women. Womens Health Issues 13(4):167–174. Scherrer, K. S. 2009. Images of sexuality and aging in gerontological literature. Sexuality Research & Social Policy: A Journal of the NSRC 6(4):5–12. Schlesinger, B. 1996. The sexless years or sex rediscovered. Journal of Gerontological Social Work 26(1/2):117–131. Schwartzberg, S. 1992. AIDS-related bereavement among gay men: The inadequacy of current theories of grief. Psychotherapy 29(3):422–429. Shanas, E. 1980. Older people and their families: The new pioneers. Journal of Marriage and Family 42(1):9–15. Shernoff, M. 1998. Gay widowers: Grieving in relation to trauma and social supports. Journal of the Gay and Lesbian Medical Association 2(1):27–34. Shippy, R., M. H. Cantor, and M. Brennan. 2004. Social networks of aging gay men. The Journal of Men’s Studies 13(1):107–120. Statewide Office of Suicide Prevention. 2009. Suicide prevention. Tallahassee, FL: Statewide Office of Suicide Prevention. Tang, H., G. L. Greenwood, D. W. Cowling, J. C. Lloyd, A. G. Roeseler, and D. G. Bal. 2004. Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? (United States). Cancer Causes & Control 15(8):797–803. Valanis, B. G., D. J. Bowen, T. Bassford, E. Whitlock, P. Charney, and R. A. Carter. 2000. Sexual orientation and health: Comparisons in the women’s health initiative sample. Archives of Family Medicine 9(9):843–853. Van Kesteren, P. J. M., H. Asscheman, J. A. J. Megens, and L. J. G. Gooren. 1997. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clinical Endocrinology 47(3):337-343. Wahler, J. J., and S. G. Gabbay. 1997. Gay male aging. Journal of Gay and Lesbian Social Services 6(3):1-20.
OCR for page 291
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Wallien, M. S. C., and P. T. Cohen-Kettenis. 2008. Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry 47(12):1413–1423. Williams, M. E., and P. A. Freeman. 2005. Transgender health: Implications for aging and caregiving. Journal of Gay & Lesbian Social Services 18(3/4):93–108. Witten, T. M. 2002. Geriatric care and management issues for the transgender and intersex populations. Geriatric Care Management Journal 12(3):20–24. Witten, T. M. 2009. Graceful exits: Intersection of aging, transgender identities, and the family/community. Journal of GLBT Family Studies 5(1/2):35–61. Witten, T. M., and A. E. Eyler. 1999. Hate crimes and violence against the transgendered. Peace Review 11(3):461. Witten, T. M., and A. E. Eyler. 2007. Transgender aging and the care of the elderly transgendered patient. In Principles of transgender medicine and surgery, edited by R. Ettner, S. Monstrey, and A. E. Eyler. New York: Haworth Press. Pp. 285–309. Witten, T. M., and S. Whittle. 2004. Transpanthers: The graying of transgender and the law. Deakin Law Review 9(2):503–522. Xavier, J. M., J. Bradford, and J. Honnold. 2007. The health, health-related needs, and life-course experiences of transgender Virginians. Richmond, VA: Virginia Department of Health. Zaritsky, E., and S. L. Dibble. 2010. Risk factors for reproductive and breast cancers among older lesbians. Journal of Women’s Health 19(1):125–131.
OCR for page 292
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding This page intentionally left blank.