Gender affirmation among transgender and gender-diverse people in middle age and late life: a scoping review

Although gender affirmation is a social determinant of health for transgender and gender-diverse people, reviews have predominantly focused on the medical domain and on younger populations. We conducted a scoping review by mapping peer-reviewed studies on 4 domains of gender affirmation among transgender and gender-diverse people in middle age and late life.

Using the Joanna Briggs Institute's scoping review methodology and PRISMA-ScR reporting guidelines, we conducted a literature search of the following databases: MEDLINE, Social Work Abstracts, CINAHL PLUS from EBSCOhost, APA PsycINFO, ASSIA, Sociological Abstracts from ProQuest, and SCOPUS. Of the 1,339 studies identified, 58 were included in this review. We used a hybrid thematic content analysis to synthesize the key findings.

The participants reported both gender-affirming and non-affirming experiences in (a) the psychological domain, which includes identity confusion, dysphoria, internalized stigma, and self-acceptance and identity realization in later life; (b) the social domain, which encapsulates decisions to conceal or disclose their gender identity, experiences of rejection or support, and community engagement and advocacy actions; (c) the medical domain, which concerns access to and experiences with gender-affirming care and non-affirming services in healthcare; and (d) the legal domain, which involves pursuing gender recognition, navigating legal documentation, and facing systemic barriers in end-of-life planning.

This review highlights the multi-dimensional needs associated with gender affirmation and the systemic barriers faced by transgender and gender-diverse adults in middle age and late life. It provides insight into gender-affirming experiences that can inform more age-friendly and gender-affirming care.