Supporting gender-diverse individuals across the lifespan
Life can be challenging for those seeking to understand or express a gender identity different from the one assigned to them at birth. Fortunately, the UCLA Gender Health Program is designed to meet the needs of individuals across the lifespan, whether they are a child or adolescent beginning to explore their gender identity or an older adult who has been living in their gender identity for many years.
Rather than a one-size fits all approach, gender-affirming care at UCLA Health is unique in that it is interdisciplinary, and it is tailored to the individual.
“Which means we’re really trying to understand each person’s experience and help them plan how to live their best lives,” says Amy Weimer, MD, co-founder of the Gender Health Program.
Dr. Weimer notes that people across the lifespan have different needs, and UCLA Health is positioned to offer gender-affirming care to all age groups. The Gender Health Program comprises a team of specialty physicians from primary care, urology, plastic surgery, endocrinology, gynecology, otolaryngology, pediatrics, psychiatry and behavioral health.
“Most other programs don’t offer the breadth of services or have the collaboration across specialties that UCLA Health does,” she says.
Gender-diverse pediatric patients and their families meet with a dedicated care coordinator and with a psychologist prior to the first medical visit to ensure they have support lined up, and the patient and family are connected with resources as they’re navigating the process.
The care coordinator will make an initial intake assessment to understand the patient’s health care needs and goals. They also can assist with navigating the UCLA Health system, identifying appropriate providers and assisting with referrals, coordinating insurance and benefits coverage, and providing information on UCLA and community-based resources, including youth and family support groups.
The Gender Health Program also provides young people with primary care, gender-affirming medical care and behavioral health services.
“Our interdisciplinary approach is of real benefit to our young people and their families,” Dr. Weimer says. “We work together as a team to ensure everyone is well-supported.”
Seniors bring to the program a variety of life experiences, health histories and treatment goals, which will inform their choices for gender-affirming care, Dr. Weimer says.
“Sometimes, our patients have been living in their affirmed identities for many years and may be looking for a place where we understand their unique experiences,” she says. “We also have people coming in to start treatment in their senior years. They may have suppressed it their whole life, and they are now in a place where they finally feel ready to live authentically. In both circumstances, it can be very freeing to live one’s true experience, so we really help each person figure out all of the tools we have available and which ones will best help them to live their best life.”
Services for older adults may include primary care and routine screenings, hormone therapy, reconstructive surgery, voice therapy and voice surgery, and referrals to specialty physicians.
The program also helps seniors navigate how different gender-affirming treatments interact with other medical care so their physicians can provide a safe and effective treatment plan that aligns with a person’s unique goals, Dr. Weimer says.
“Older adults have very varied goals for their care,” says Dr. Weimer. “As with all of our patients, we work to understand each person’s experience and needs in order to provide the most meaningful care we can deliver.”
Darya is a 71-year-old transgender woman who didn’t begin addressing her gender dysphoria until her mid-40s, at which time she says she came out to her wife and started cross-dressing and visiting cross-dressing venues.
In 1998, she began working at a store that catered to cross-dressers. There, she was introduced to Premarin, a powerful estrogen supplement.
“It was wildly effective,” she says. “The craziest thing happened about a week or two after I started taking it. I noticed that I had a sense of well-being come over me. I felt calmer, clearer and at ease with myself.”
Darya continued to take Premarin, which was prescribed by a transgender doctor she knew. At that time, gender diversity was controversial, and it was difficult to find a physician that understood her or accepted her situation, she said.
Desperate to find good medical care, Darya was searching the internet when she came across the UCLA Gender Health Program. That was in 2017, the year after the program was founded.
“The minute I called, I talked to a very calm person who said, ‘Hi, what are your pronouns and what do you prefer to be called?’ I went, ‘Oh, what a relief!’ ” she says.
Darya started seeing Dr. Weimer, who put her on a hormone blocker — used by transgender adults to reduce the effect of the hormone produced by their body — and kept her on the same dose of estrogen. She also underwent routine tests to check for prostate cancer. Because she has been taking estrogen for nearly 25 years, she also has regular mammograms.
“Honestly, those services were the only ones I utilized,” she says. “They were enough for me.”
Darya has now switched to a different health care system closer to her home.
“They’re trying, but they don’t quite have the same commitment that UCLA does,” she says. “That’s the model the rest of the country should use.”
Despite some progress made in recognizing and accepting gender diversity, navigating the health care system still is complicated, she says. For instance, although she had a doctor’s referral, her insurance provider recently denied coverage for a mammogram because the procedure didn’t match her gender assigned at birth.
“It just shows you, there are still these stumbling blocks, and the system isn’t really set up for us,” she says. “As someone who benefitted from male privilege, I get it on one level, but on another level, as someone hoping to be seen or understood, it’s a little annoying and discouraging.”
Other health concerns
Transgender youth are more likely to experience poorer health, fewer wellness visits, more school nurse visits and increased substance use than their cisgender peers, Dr. Weimer told an audience gathered, recently, at the UCLA Meyer and Renee Luskin Conference Center for the “Contemporary Considerations in Gender-Affirming Care” conference.
In addition, they are more likely to experience depression, with 31% to 35% attempting suicide and 54.8% self-harming, she says.
“This is what we’re trying to improve, and we need to remember we have the means to do so,” she told conference-goers. Gender-affirming medical care has been shown repeatedly to improve mental health and reduce the risk of suicide in youth and adults, she noted.
Transgender seniors face their own set of problems, said Dr. Carl Burton, MD, a geriatrician and co-presenter at the conference: They may have been ostracized from their family of origin or their social communities, and they may experience social isolation and loneliness. They may be unaware of the availability of social services resources. They might have been dishonorably discharged from military service or not able to serve in their gender identity, ostracized by their faith community, or evicted from their home based on identity.
Dr. Weimer notes that overcoming the challenges of having to suppress one’s gender because of fear of consequences or deciding to transition and dealing with social responses to that are difficult experiences, no matter what your age.
UCLA’s Gender Health Program offers individuals help in navigating those barriers they may face and offers programs specifically designed to help people build resiliency skills, she says.
“We definitely see the effects of long-term trauma affecting people,” Dr. Weimer says. “Over time, if you can successfully navigate these difficulties, you can build resiliency.”
Luke Swanson is a 19-year-old who identifies as transmasculine and uses the pronouns he/him or they/them. Swanson came out to his parents when he was in eighth grade.
“It was a very rough path from that point on until I started going to UCLA,” Swanson recalls. “I did not have any support in my transition before UCLA.”
Swanson was introduced to Dr. Weimer shortly before he was admitted to a psychiatric hospital. “I was in a depressive, suicidal state because of everything I was dealing with, not only as a student but as someone who had no one to look up to, no one who understood and constantly battling to prove myself to everyone,” he says.
Swanson says Dr. Weimer was the first person who could see what he was going through, mentally and physically, and she advocated for him with his parents in terms of his medical transition.
“When I came out of the hospital, I think it changed my parents’ minds about the situation and how important it was to me. She really helped me verbalize that to them,” he says. “I think transitioning at an early age is controversial, but it was something that I really needed at that point in my life, and I could not imagine having any other doctor help me go through this.”
Swanson received psychiatric treatment, hormone therapy and, later, reconstructive top surgery through UCLA Health. Today, he says, his life is the “polar opposite” of what it was when he first transitioned.
“It’s something that, on a majority of days, I don’t even have to think about being trans,” he says. “It comes up, but it’s not in the forefront of my mind anymore, and that’s been a huge improvement.”
Importance of family support
While challenges are common, there also are plenty of people across all age groups that are well-supported by their families, friends and long-term partners, Dr. Weimer says.
How can loved ones demonstrate support?
Show you’re still there, show that you still love them, and show that you support them as they navigate their journey, she says.
“It’s very clear that people do better when they are supported in expressing and being recognized as their authentic gender,” Dr. Weimer says. “So, if a person asks somebody to use different terminology to refer to them, it is really important to do so. Some people may want to first explore this only in their home environment, or only with friends. And loved ones can help them explore how this feels.”
This same advice is true for people across all ages, from young children to older adults, she says.
Dr. Weimer wants families to know that it is common for a young person’s understanding of their gender to evolve over time. They may use certain terms to describe their identity, but then, over time, may understand their gender differently.
“Allowing people to take the time to understand their experience and not worry if it seems to be evolving is really important,” she says. “It’s a natural part of the process for most people.”
She notes families are on a unique journey that can be challenging as well, and the Gender Health Program supports them with the help and resources they need.
“Kids do better when parents do better,” she says. “We want to help parents and caregivers be as comfortable as we can.”
Learn more about UCLA’s Gender Health Program.
Jennifer Karmarkar is the author of this article.