title: Sociodemographic Variables, Clinical Features, and the Role of Preassessment Cross-Sex Hormones in Older Trans People.
abstract: BACKGROUND
  As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available.
  
  
  OBJECTIVE
  The aim of this study was to investigate the sociodemographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology.
  
  
  METHODS
  Individuals over the age of 50 years old referred to a national gender identity clinic during a 30-month period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross-sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology.
  
  
  METHODS
  Sociodemographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and nonsuicidal self-injury (Self-Injury Questionnaire).
  
  
  RESULTS
  The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n = 3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, and divorced and had children. Trans females on CHT who came out as trans and transitioned at an earlier age were significantly less anxious, reported higher levels of self-esteem, and presented with fewer socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem remained.
  
  
  CONCLUSIONS
  The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined.
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom. Electronic address: walterbouman@doctors.org.uk.
authors.forename: Walter Pierre
authors.initials: WP
authors.lastname: Bouman
authors.affiliation: Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Claes
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom; School of Sport, Exercise, and Health Sciences, Loughborough University, United Kingdom.
authors.forename: Ellen
authors.initials: E
authors.lastname: Marshall
authors.affiliation: Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Gill T
authors.initials: GT
authors.lastname: Pinner
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Longworth
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Maddox
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom; School of Sport, Exercise, and Health Sciences, Loughborough University, United Kingdom.
authors.forename: Gemma
authors.initials: G
authors.lastname: Witcomb
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Jimenez-Murcia
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Aranda
authors.affiliation: Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom; Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Arcelus
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010555:Personality Inventory; D015995:Prevalence; D012307:Risk Factors; D012649:Self Concept; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology; D012944:Social Support; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000523:psychology
chemical_list: D012739:Gonadal Steroid Hormones
keywords: Aging; Gender Dysphoria; Hormone Treatment; Mental Health; Midlife and Beyond; Self-Esteem; Social Support; Transsexualism