Legal and public policy issues for transgender elders.

Alejandro is a 72 year old female-to-male transsexual (FTM). After suffering a number of serious health problems, Alejandro no longer felt safe living alone and moved into an assisted living facility. Within a few days of his arrival, some of the other residents discovered that Alejandro was transsexual and demanded that he be asked to leave. A month later, the facility informed him that his presence was upsetting to the other residents and that his tenancy was being terminated. Alejandro contacted several public agencies for assistance, but was told that discrimination against transgender people is not prohibited under federal, state or local law.

Lisa is a 60 year old male-to-female transsexual (MTF) who lost her career as a corporate manager when she transitioned at the age of 41. She has been unable to obtain any lawful employment since that time and cannot afford sex reassignment surgery. She has no permanent residence and is frequently homeless. On nights that she has nowhere else to stay, Lisa would like to be able to sleep in the local homeless women's shelter. She is unable to do so, however, because the shelter will not accept transsexual women who have not undergone genital surgery.

Mack is a 68 year old transgender person. Mack is biologically female and has never undergone any form of medical treatment, but considers himself to be male and lives his life as a man. When Mack suffered an incapacitating stroke, his adult sister was appointed to be his legal guardian. The sister placed Mack in a nursing home. She also insisted on dressing him in frilly female nightgowns and referring to him by a female name and female pronouns. When Mack recovered enough to make his wishes about clothing and pronouns known to the facility staff, the staff concluded that he was "confused." Mack became increasingly withdrawn and depressed. He no longer speaks or interacts with other residents.

As these stories show, transgender elders face unique and often extreme forms of discrimination. They are denied medical care, excluded from housing and social services, and despised simply for being who they are.

Housing and public accommodations discrimination. Laws protecting transgender elders are virtually non-existent. There is no federal law that prohibits discrimination against transgender individuals, and Minnesota and Rhode Island are currently the only states with such laws. Outside of these states and the approximately 50 cities and counties that have enacted local non-discrimination statutes, there is generally no established legal recourse for anti-transgender discrimination in employment, housing or public accommodations. As a result, homeless shelters, retirement communities, nursing homes, assisted living facilities, and other services for elderly people can and do discriminate against transgender elders with impunity. And despite a dramatic increase in the number of attorneys and legal organizations serving older Americans in recent years, very few are willing to represent transgender clients.

Medical discrimination. Although transgender people have existed throughout human history, the contemporary medical treatments that comprise sex reassignment, which are primarily hormone therapy and surgeries, have only existed for about forty years. Transsexual people have a gender identity--an internal sense of being a man or a woman--that differs from their anatomical sex. The resulting clash between one's external anatomy and one's internal sense of self is termed "gender dysphoria" or "gender identity disorder." Despite being classified by the American Psychiatric Association as a mental disorder, transsexuality cannot be "cured" by therapy, and attempts to do so have caused profound harm. Although misguided and damaging efforts to "cure" ...