Early in October, Ruth Rose went on holiday to Corfu with a group of female friends she had known for years. They swam in the sea every day, making the most of the late summer sunshine. On the last morning before flying home to England, the women took one last swim and skinny-dipped so as not to have to pack their costumes away wet.
Such adventures would once have been unthinkable for Rose. But the surgery she underwent at the age of 81 has opened doors she would never have thought possible. “In some ways it’s like having new hips after being told you would be condemned to arthritis for the rest of your life,” she says. “You do it, and life begins again. And that’s what happened to me. Age has nothing to do with it.”
When we read about people transitioning gender, the focus is often on teenagers; in an emotive debate about access to school changing rooms and Guides camping trips, older trans people are rendered almost invisible. Yet there are more than five times as many adult as child gender identity patients in the UK. Some are now having gender reassignment surgery not just in late middle age, but well into retirement.
The numbers remain tiny, but they are rising; according to the NHS, 75 people aged between 61 and 71 had gender reassignment operations in the seven years to 2015-16, and that’s not counting people who quietly transition without surgery. These trans baby boomers are now beginning to challenge received ideas not just about gender but age, and the capacity of older people to live bold, adventurous lives. “I think people need to learn quite fast that older people no longer all fit the white-haired granny stereotype,” says Jane Vass, the head of public policy at Age UK. The charity recently published advice to older people who are transitioning, covering everything from the impact on state pension ages to what to write on death certificates.
“If it was ever true that older people were all the same, it’s certainly not now. And yet we still seem to respond as a society to a very narrow view of what ageing is,” adds Vass. Later life is full of changes, she points out, from the end of a career to the death of a spouse. Why wouldn’t it also be a time in which people embrace opportunities denied them in the past, before it’s too late?
I just look upon it as a bit of history in my life, like having owned a certain car for a while and decided to change it
It’s perhaps only now that many older people feel comfortable coming out, having grown up in a time when being trans was so steeped in shame and silence that many couldn’t even put a name to what they felt. “I remember as a child thinking, am I unique? Am I strangely perverted?” says Christine Burns, the 64-year-old trans activist and author of the social history Trans Britain: Our Journey From The Shadows. It was only in the 1960s, when the Sunday People newspaper began salaciously to out trans people – most famously the Vogue model April Ashley – that she understood she was not alone. “To see those stories, egregious as they were, helped in a sense. I always say that, on that Sunday morning, I learned there was a name for people like me, but also that it was worse than I feared.”
Half a century on, trans people undoubtedly still experience stigma and discrimination. Fierce debate about proposed changes to the Gender Recognition Act, which could enable people to identify themselves as trans rather than going through a drawn-out process of medical and psychiatric assessment, has turned trans acceptance into a political football. But for those raised in an era when men could be arrested just for wearing women’s clothes in public, the thaw in public attitudes is still striking. “When I first came out [in the 1970s], I got reported to the police and my employer, for being in charge of a company vehicle dressed as a woman,” recalls Jenny-Anne Bishop, the chair of the support group Trans Forum, who had gender reassignment surgery at the age of 59. “Now I’m as likely to have lunch with the chief constable to discuss hate crime reporting. It’s changed that much.”
Ruth Rose was around nine when she realised she had what she thought must be “some sort of sexual aberration”. Hoping it would go away, she went through an all-boys public school, did national service in the Royal Air Force, began a career in mechanical engineering, married and had three children. It was only in her 30s that she began to hear about sex-change operations, as they were known, but even then the idea seemed fantastical.
She eventually met others in the same situation via the Beaumont Society, a support group set up in 1966 for cross-dressers, which also attracted trans people. Once a month, they would meet for dinner in a restaurant in Fulham, London. “There was one young man whose sister dressed him and made him up, who went out with no fear at all, travelling on the tube and things. There were others who crept from their cars in the next side street,” she recalls. “There were two little old ladies who brought their knitting and had the most amazing adventures.”
By this time, Rose’s wife had discovered her secret, and was “just about tolerant” of her dressing as a woman occasionally and discreetly. But permanent transition did not feel like an option. “I thought, it must cost thousands of pounds and I can’t do it – I’ve got responsibilities to my family.”
It was only after the children were grown up and the couple amicably divorced that Rose, now in her 60s, moved to a new town and began, increasingly, to live as a woman. At first, she still wore a suit for the voluntary work she did, although gradually that, too, began to change. For a while she kept male clothes for hospital appointments for her arthritis. She last dressed as a man when her former wife was ill; Rose went to make dinner for her every night in male clothes because, even though they were on reasonably friendly terms, her ex-wife didn’t like seeing her dressed as a woman.
Rose was in her 70s when her doctor finally suggested surgery. “At my age I wouldn’t have considered it, but when I went to the clinic at Charing Cross, you have to see two psychiatrists and the first one, after 10 minutes, said: ‘As far as I’m concerned, you are absolutely right for it.’”
Having lived comfortably as a woman for so long without it, Rose was surprised by how much the surgery meant to her. “It stopped the feeling that I was living a life of pretence, and that really made a difference. Also I had a lot of lady friends in their 50s and 60s, most of whom I swim with, and their attitude to me, without them realising it, changed that little bit – but that little bit was important, it was the last little bit of acceptance.”
Her children found out she had begun to transition only when a short article about her, in a women’s magazine that she hadn’t expected anyone to notice, was picked up by the News of the World; but she says the shock was short-lived. “Within a week, all the recriminations, the ‘why didn’t you tell us earlier’s were over and they’re marvellous now.”
She babysits regularly for her grandsons, goes to all the family weddings and christenings, and happily attended a school reunion a couple of years ago. “People were so, so nice; they accepted it absolutely. If you go along with fear and trepidation and don’t look people in the eye, you can expect to get a feeling of non-acceptance. Whereas it’s different if you meet the challenge and smile at everybody, and don’t even consider that they might look askance at you.”
It’s wrong when people say, oh, you’ve always wanted to be female. I’ve spent my life wanting and trying to be male
If anything, Rose finds it faintly absurd that people are still interested in her previous life. “It’s my past and, as far as I’m concerned, it’s over. I have changed emotionally in many ways – I can’t even recall the sort of emotions I had as a male. So I just look upon it as a bit of history in my life, like having owned a certain car for a while and decided to change it.”
It’s impossible to know how Rose’s life would have turned out had she transitioned earlier. But when she was collecting stories of trans pioneers for her book, Burns was struck by how many were wealthy or well-connected, often with independent incomes that meant they didn’t have to fear losing their jobs. (Until a 1996 test case, the law gave trans people little protection against employment discrimination.) Those seeking surgery in Britain were commonly told they had first to get divorced – which is why the travel writer Jan Morris travelled to Casablanca for the surgery she describes in her 1974 autobiography, Conundrum – or to renounce contact with children.
It was only when the BBC screened a primetime documentary, A Change Of Sex, in 1979, featuring the Charing Cross gender identity clinic run by the pioneering surgeon John Randall, that a route to treatment in this country became clear for many Britons; even then, four out of five people who approached him were turned down. Patients won the universal right to free gender reassignment surgery on the NHS only in 1999.
Yet for some, the greater openness about transitioning may have come too late. “There’s a group of people who were perhaps in their 20s and 30s in the 1960s – by the time there was a lot of public knowledge about trans, they would be in their 50s and locked in,” says Burns. “They would have tried to make their peace with life and everybody would have said, ‘What you need is to get married, have kids – that’ll cure you.’ Then you have got the children and it becomes a matter of duty. Some recent cases of people transitioning in their 80s have been people who waited until their partners died and they finally felt like free agents; they wanted to die being true to themselves.”
Transitioning in later years is not, however, always medically straightforward. Dr Paul Willis leads the Centre for Trans Ageing research project at the University of Swansea, examining older trans people’s experience of health and social care in Wales, and says some report having to jump hurdles to get treatment. “One trans woman’s GP grudgingly allowed the patient to have a prescription for hormones but insisted that she had to pay for it, even though prescriptions are free in Wales. The pharmacist would say, ‘Why are you paying for this?’ but they just accepted it as what they had to put up with,” he says. There are, he adds, still “a lot of unknowns” about the long-term effects of hormone treatment in old age, as doctors are only now seeing the first cohort to have taken them for decades.
Perhaps more surprising are the challenges facing older people who want to transition without having gender reassignment surgery. Any major operation can be risky for older people with serious conditions such as heart disease or diabetes, and Age UK’s advice is for individuals to consider whether it’s right for them. But that can be a difficult choice, given the common misconception that a “real” transition must involve surgery. “The barrier most people faced until quite recently was that people weren’t validated if they weren’t – as my GP put it when I asked for a referral – ‘going all the way’,” says Jenny-Anne Bishop, who worked with Willis on the research. “If you weren’t aiming to have hormones and/or surgery, then there was a sense you could get on with it without medical support.” (Surgery isn’t compulsory in order to get a gender recognition certificate or legal confirmation of an acquired gender, but medical diagnosis of gender dysphoria is.)
Bishop, now 72, chose to have only what she calls cosmetic surgery when she transitioned 13 years ago, because at that age she felt “the creation of a new vagina was just too invasive. There’s more risk as you get older.”
No matter when or how they transitioned, however, a common fear identified in Willis’s research among older trans people was of losing mental capacity in old age. “If you’re reliant on other people to make decisions over what you are going to wear, or what your hair looks like, and whether you have access to routines that are important to you, such as shaving – that can really impact on people’s sense of identity,” he says. The prospect of becoming vulnerable and dependent on strangers in a nursing home may be unusually alarming for people who have been stigmatised or threatened with violence for being trans. “If you are living in a world you feel to be hostile, you live your entire life defensively and expend a lot of energy making sure you are safe,” says Burns. “But what if you start getting confused?”
Ramses Underhill-Smith is the founder of Alternative Care Services, an agency providing home helps and social care for older LGBT people. He set up the agency after seeing an HIV-positive friend risk his health by rejecting care in his own home, over concern that the care workers might be homophobic. Some of the Alternative Care Services’ workers are trans themselves, some aren’t, but all get training in treating patients with dignity.
Underhill-Smith, who is trans himself, recently handled a case in which someone with dementia had begun to forget they had transitioned, leaving nursing home staff unsure about whether to treat them as male or female. The right answer, he says, is both. “If today they want to be this, that’s how you treat them. If tomorrow it’s something else, you treat them as something else.” What matters, he says, is that people who may have been made to feel shame all their lives are not treated judgmentally while at their most vulnerable.
A friend said, you idiot, doing it at this time in your life, and I was shocked, but that’s what people secretly think
“If you’ve had surgery and you’ve got scars, you don’t want people looking at them in a certain way. We’re so used to it in the LGBT community – it’s not even the words people say, but the fact that everybody stares. You don’t want to have to explain when you get undressed for personal care. It’s about knowing that whoever comes to your door is going to understand who you are, that in conversation you’re going to be able to say things openly.” Some frail older people, he points out, barely see anyone but health professionals; if they can’t talk to them honestly, they are completely isolated.
For some, transitioning later in life can be a lonely business. “People refuse to accept it when you’re older,” says Underhill-Smith, who was in his late 40s when he transitioned. “They’ll say, ‘But I’ve known you like this all my life.’ A friend said to me, ‘You fucking idiot, doing it at this time in your life’ and I was completely shocked, but that’s what people secretly think. They’re thinking, ‘Why are you putting us all through this change?’” He tends to avoid social events in his old circle. “I don’t go back into my community, I don’t go to functions, I don’t go to funerals. I used to go because I wanted youngsters to see me, but it gets so tiring because it’s isolating. People will say hello but they walk on.”
While fear of rejection by family can be a significant obstacle to coming out, it isn’t always well-founded. One recent study found around half of newly trans men maintained their previous relationships. “I thought I’d lose my whole life,” says Bethan Henshaw, a warehouse worker from Coventry, who at the age of 57 is shortly to have gender reassignment surgery. Like Ruth Rose, Henshaw has known she was trans since childhood, but for almost half a century forced herself to live a man’s life. “I think it’s wrong, sometimes, when people say, ‘Oh, you’ve always wanted to be female.’ I’ve spent most of my life wanting to be male, and trying to be male, and not being very good at it. A lot of trans people overcompensate – there’s a higher percentage of us in the armed forces before we come out. People try to do hyper-masculine things, just to force themselves into a role.”
Henshaw fell in love, settled down with her partner and kept up a male front, but as time went on she began to feel suicidal. Eventually her partner confronted her, asking what was wrong, and Henshaw blurted out her secret. “I did say to my partner, ‘If you want me to go, I’ll give you the house, the savings, everything’ because I felt like I was to blame, even though it’s the way I was born. But she just said, ‘Don’t be stupid’ and we carried on with our lives.” They are still together and, while Henshaw says she lost some friends during the process, most have rallied round; her family was supportive and her employers at Asda were “absolutely faultless” when she first came out. “They explained the situation to other people and, obviously, a lot of people were shocked. Some of them didn’t like it, some were very supportive, some people weren’t sure how to react because they hadn’t come across it before. But with time it has just faded into the background.”
Half a century ago, she might have struggled to find others going through the same process, but the internet has created a ready-made trans community to tap into. “The first person I ever saw who was trans was an American woman on YouTube,” recalls Henshaw. “She’d have been inspirational for anybody. When she started putting her views out, she was on her own, without a family, trying to survive in New York, working in a shop. Then she got a scholarship and went to college.” It’s a world away from the underground dinners Rose recalls in Fulham, whose guests attended at considerable personal risk. If acceptance continues to grow, then the wave of older people who transition may turn out to be something of a historical blip. The easier it becomes for young people to question their gender identity openly, the less need there might be for anyone to spend decades struggling with one that doesn’t feel right.
But if this is a phenomenon strictly of its time, then it’s all the more important to record their stories now. As Jane Vass puts it, “These people have probably felt like square pegs in round holes for years and years. They want their voices to be heard.”