Transgender people, especially transgender women, are disproportionately affected by HIV. Yet there is little research on how HIV impacts transgender people as they age. For example, as someone ages, their hormone levels change. Transgender people who are aging with HIV and on hormone therapy should work carefully with their provider(s) to monitor their hormone levels. Some HIV medications may affect hormone levels. Irregular hormone levels may lead to decreased bone density, changes in mood or sex drive, and vaginal dryness, among other symptoms. Additionally, it is possible for people living with HIV to safely undergo gender confirmation surgery. Many surgeons have in depth experience successfully operating on people living with HIV of all ages.
The U.S. Transgender Survey has consistently found that transgender older adults, regardless of HIV status, have poorer mental health compared to older cisgender (i.e., non-transgender) adults. It is important for providers who work with transgender older adults, to recognize that this is not solely a function of being transgender. Their mental health status is also impacted by the stigma and prejudices that transgender people face. Many transgender people avoid health care due to these stigmas and prejudices encountered from health care providers at every level. It is crucial for care providers to make certain that their services are affirming. Both care providers and their trans patients should make efforts to stay current on the most recent findings.
Additionally, providers should understand how social determinants of health such as housing status and food security impact this population. Transgender people are more likely to have lower incomes as well as be housing and or food insecure. These factors and others may affect health outcomes for older transgender people with HIV differently or to a greater degree. Providers should consider building relationships with local organizations led by transgender people and their allies in order to provide the best health management possible.