Table 1.

Characteristics of Included Studies (N=31)

Author/Date	Sample Description	Design and Methods	Demographic Measures and Analysis	Aim and Mental Health Outcomes	Relevant Findings
Boyer et al. (2021)	Participants: Transgender compared to cisgender VHA users Sample total: 32,441 GM older adults: 961 (aged 65+) Overall sample age: 18–65+, M = NR	Scope/Setting: National (VHA database) Methodology: Quantitative Study design: Retrospective analysis of VHA records Sampling procedures: Algorithm based on gender identity-related diagnostic codes	Gender: Only measured sex; not examined Sexual orientation: NR Age: Measured; compared transgender and cisgender veterans within and across age groups (18–39, 40–64, 65+) Race/ethnicity: 66.5% NHW; not examined	Aim: Compare the prevalence of suicide, homicide, and all-cause mortality between transgender and cisgender veterans receiving care in the VHA. Outcomes: Suicide death (records in National Death Index)	Overall, transgender veterans had over twice the risk of suicide mortality as cisgender veterans. Transgender veterans aged 65+ had a suicide prevalence of 0.8% and over nine times the risk of suicide as cisgender veterans aged 65+. Among those aged 40–64, transgender veterans had a suicide prevalence of 0.8% and about twice the risk of suicide as cisgender veterans.
Brown & Patterson (2020)	Participants: SGM compared to non-SGM older adults Sample total: 36,734 GM older adults: 88 Overall sample age: 45–80+, M = NR	Scope/Setting: State (seven states with relevant BRFSS data) Methodology: Quantitative Study design: Cross-sectional analysis of BRFSS data Sampling procedures: Probability	Gender: Measured using options of male-to-female, female-to-male, or gender nonconforming; compared by sex for overall sample Sexual orientation: Measured separately from gender identity for all; only compared by “SGM” or “non-SGM” status Age: Measured; compared by age group (45–59, 60–69, 70–79, 80+) within overall sample only Race/ethnicity: 85.3% NHW; examined within overall sample only	Aim: Examine possible disparities in subjective cognitive decline and risk factors between SGM vs. non-SGM, transgender vs. non-transgender, and male vs. female older adults. Outcomes: Depression diagnosis (yes/no, self-report); subjective cognitive decline (worsened confusion or memory loss, self-report)	Transgender older adults were significantly more likely to report depression than non-transgender older adults (33.2 vs. 20.3%). After adjusting for depression and sociodemographic confounders, there was no significant association between transgender identity and subjective cognitive decline.
Carroll (2017)	Participants: Older transgender woman Sample total: 1 GM older adults: 1 Overall sample age: 58	Scope/Setting: Individual (clinic-based) Methodology: Qualitative Study design: Case vignette Sampling procedures: Purposive	Gender: Described participant as trans woman Sexual orientation: Described participant as bisexual Age: Described participant as aged 58 Race/ethnicity: Described participant as White	Aim: Describe therapeutic issues with transgender and nonconforming older adults, using a case vignette to illustrate the interplay between age, life phase, and sociocultural and historical contexts. Outcomes: Qualitative discussion of depression, trauma	Transition barriers such as discrimination and fears of family rejection contributed to the participant’s depression. Important aspects of her treatment included emphasizing resilience, connecting her to events and resources in the transgender community, addressing trauma, and exploring coming out.
Cortes et al. (2019)	Participants: LGBT veterans Sample total: 254 GM older adults: 46 Overall sample age: 19–78, M = 47.4	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience	Gender: Measured for all as man or woman; examined outcomes within groups of transgender men and transgender women Sexual orientation: Measured separately from gender identity for all; examined outcomes within mutually exclusive subgroups of lesbian woman, gay man, bisexual, transwoman, and transman Age: Measured; examined differences between younger (aged <50) and older (aged 50+) groups Race/ethnicity: 78.2% NHW; not examined	Aim: Examine differences in mental health and identity between older and younger LGBT veterans. Outcomes: Depression (Patient Health Questionnaire), anxiety (Overall Anxiety Severity and Impairment Scale), excessive alcohol use (Alcohol Use Disorders Identification Test-Consumption)	Transgender women aged 50 years and older had significantly lower mean alcohol use scores than younger transgender women (1.98 vs. 2.97), with no differences by age among transgender men. No age differences in anxiety or depression were found for any LGBT subgroups. Older LGBT veterans reported less harassment and rejection than their younger peers overall, although no age differences were found among transgender men or transgender women.
Dragon et al. (2017)	Participants: Transgender compared to cisgender Medicare beneficiaries Sample total: 39,143,683 GM older adults: 2,133 (aged 65+) Overall sample age: 18–85+, M (overall) = NR, M(transgender) = 53.1, M(cisgender) = 70.9	Scope/Setting: National (Medicare claims database) Methodology: Quantitative Study design: Cross-sectional analysis of Medicare claims data Sampling procedures: Algorithm based on gender identity-related diagnostic codes	Gender: Only measured sex; not examined Sexual orientation: NR Age: Measured; only compared transgender vs. cisgender beneficiaries within entitlement groups based on age (aged 65+) or disability (aged <65) Race/ethnicity: 76.8% NHW; not examined	Aim: Analyze differences in chronic conditions between transgender and cisgender Medicare beneficiaries, as well as within cohorts based on age and disability. Outcomes: Anxiety, bipolar disorder, depression, personality disorders, post-traumatic stress disorder, schizophrenia and other psychotic disorders, substance use disorders (diagnosis codes in claims)	Transgender vs. cisgender beneficiaries aged 65+ were significantly more likely to have diagnoses of anxiety (38.9 vs. 17.3%), bipolar disorder (12.4 vs. 2.4%), depression (45.6 vs. 19.1%), personality disorders (8.1 vs. 0.7%), post-traumatic stress disorder (6.2 vs. 0.6%), schizophrenia and other psychotic disorders (13.3 vs. 4.1%), and substance use disorders (8.44 vs. 2.0%).
Elder (2016)	Participants: Transgender and gender nonconforming older adults Sample total: 10 GM older adults: 10 Overall sample age: 60–83, M = NR	Scope/Setting: San Francisco Bay Area Methodology: Qualitative Study design: Semi-structured interviews Sampling procedures: Convenience	Gender: Measured using open-ended question; identities included female, transgender woman, “male-to-female and back,” trans man, and male Sexual orientation: Measured using separate open-ended question Age: Measured and reported in demographics Race/ethnicity: 80.0% White (ethnicity NR)	Aim: Offer perspectives that are often overlooked due to marginalization to improve the quality of psychotherapeutic care for gender-diverse people. Outcomes: Qualitative discussion of trauma, suicide, and various experiences of mental distress	Participants described healing experiences with knowledgeable therapists who affirmed their gender identities, as well as harmful experiences with distant, transphobic, and uninformed therapists. Sources of distress included the past pathologization and repression of transgender identities, discrimination, family rejection, and abuse. Involvement in the transgender community was a source of resilience.
Fabbre (2014)	Participants: Older transgender women Sample total: 22 GM older adults: 22 Overall sample age: 50–82, M = NR	Scope/Setting: Chicago metropolitan area; community-based conferences in multiple regions Methodology: Qualitative Study design: In-depth interviews and participant observation Sampling procedures: Purposive	Gender: Described all participants as transgender women Sexual orientation: Collected partnership status and partner gender Age: Measured and reported in demographics Race/ethnicity: 81.8% NHW	Aim: Describe the experiences of transgender women who pursued gender transitions later in life to develop queer conceptualizations of health and “successful aging.” Outcomes: Qualitative discussion of trauma, distress, substance abuse, suicidality	Participants experienced trauma, substance abuse, suicidality, and various mental health difficulties related to their sense of “failure” under oppressive gender expectations. Identity acceptance and transition processes in later life led participants to a sense of wellbeing and “success on new terms.”
Fabbre & Gaveras (2020) a	Participants: Transgender and gender nonconforming older adults Sample total: 88 GM older adults: 88 Overall sample age: 50–90, M = NR	Scope/Setting: National (community-based) Methodology: Qualitative Study design: Secondary content analysis of biographical interviews Sampling procedures: Purposive	Gender: Measured and described in demographics as trans woman, trans man, or non-binary Sexual orientation: NR Age: Measured and reported in demographics Race/ethnicity: 61.4% NHW	Aim: Examine experiences of multi-level (individual, interpersonal, and structural) stigma among transgender and gender nonconforming older adults. Outcomes: Qualitative discussion of substance abuse, depression, anxiety, suicidality	Participants described experiences of individual stigma (shame, self-isolation, fear), interpersonal stigma (familial rejection), and structural stigma (exclusion from “LGBT” spaces, health care discrimination), which they linked to substance abuse, depression, anxiety, and suicidality. Activism within the transgender community was a source of resilience.
Ferron et al. (2010)	Participants: Older transgender woman Sample total: 1 GM older adults: 1 Overall sample age: 68	Scope/Setting: Individual (clinic-based) Methodology: Qualitative Study design: Case study Sampling procedures: Purposive	Gender: Described participant as male-to-female transgender Sexual orientation: NR Age: Described participant as 68 years Race/ethnicity: Described participant as Hispanic	Aim: Present a case study of a 68-year-old transgender woman with HIV to provide a model of integrated mental and physical health care. Outcomes: Depression (diagnosis in clinical chart)	Transgender older adults with HIV may encounter intersecting challenges related to aging and physical conditions, depression and other mental health conditions, and social factors such as discrimination and stigma, creating complex health care needs.
Flatt et al. (2021)	Participants: SGM compared to non-SGM older adults Sample total: 119,128 GM older adults: 441 Overall sample age: 45–80+, M = 59.9	Scope/Setting: State (25 states with relevant BRFSS data) Methodology: Quantitative Study design: Cross-sectional analysis of BRFSS data Sampling procedures: Probability	Gender: Measured using options of male-to-female, female-to-male, or gender nonconforming; not examined Sexual orientation: Measured separately from gender identity for all; examined single transgender group and other mutually exclusive SGM subgroups (e.g., cisgender heterosexual women, cisgender gay men, cisgender lesbian women) Age: Measured; only compared subjective cognitive decline by older age (aged 60+) for overall sample Race/ethnicity: 71.8% NHW; not examined	Aim: Describe the prevalence of subjective cognitive decline among adults aged 45+ by SGM identity and examine the roles of demographics, chronic conditions, functional limitations, physical health, and depression as predictors. Outcomes: Depression diagnosis (yes/no, self-report); subjective cognitive decline (worsened confusion or memory loss, self-report)	SGM older adults overall were more likely than non-SGM older adults to report depression (28.0 vs. 17.4%) and subjective cognitive decline (15.7 vs. 10.5%), along with poor/fair health, diabetes, and functional limitations. Transgender older adults had the highest prevalence of subjective cognitive decline (17.3%) after cisgender bisexual older adults, but adjusting for depression attenuated differences in subjective cognitive decline.
Fredriksen-Goldsen et al. (2014) b	Participants: Transgender compared to cisgender LGB older adults Sample total: 2,546 GM older adults: 174 Overall sample age: 50+, M = 66.47	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured using options of man or woman for all; analyzed single transgender group Sexual orientation: NR; only described as transgender or cisgender LGB Age: Measured; not examined Race/ethnicity: 86.5% NHW; not examined	Aim: Compare differences among transgender and cisgender LGB older adults in physical health, disability, stress, and depression; explore the mediating role of various risk and protective factors. Outcomes: Depressive symptomatology (Center for Epidemiological Studies Depression Scale), stress (Perceived Stress Scale)	Compared to cisgender LGB older adults, transgender older adults had greater mean scores for depression (10.34 vs. 7.20) and stress (1.56 vs. 1.22), as well as worse physical health and greater disability. Victimization and discrimination, fear of accessing health services, identity concealment, physical inactivity, internalized stigma, lack of social support, and lower LGBT community belonging largely explained these worse outcomes among transgender older adults.
Fredriksen-Goldsen et al. (2015) b	Participants: LGBT older adults Sample total: 2,463 GM older adults: 101 Overall sample age: 50–80+, M = NR	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured for all using options of man or woman; analyzed single transgender group Sexual orientation: Measured separately from gender identity for all; examined as predictor within overall sample Age: Measured; compared by age group (50–64, 65–79, 80+) within overall sample Race/ethnicity: 86.9% NHW; compared by race only within overall sample	Aim: Investigate the relationship between physical and mental health-related quality of life and covariates (i.e., victimization, positive identity, identity disclosure, social resources, health-promoting behaviors, socioeconomic resources, background characteristics) among LGBT older adults by age group. Outcomes: Mental health quality of life (SF-8 Health Survey)	For LGBT older adults overall, victimization and discrimination were associated with poorer mental and physical health quality of life. These effects were strongest among the oldest LGBT adults, who also had the least social resources. Transgender compared to cisgender LGB older adults reported poorer mental health at the bivariate level but better mental health after controlling for risks and resources.
Fredriksen-Goldsen et al. (2017) b	Participants: LGBT older adults Sample total: 2,450 GM older adults: 411 Overall sample age: 50–80+, M = 61.41	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured for all using man, woman, and other; compared transgender men, transgender women, and other for life events only Sexual orientation: Measured separately from gender identity for all; examined in relation to life events for overall sample Age: Measured; compared life events by age group (50–64, 65–79, 80+) for overall sample Race/ethnicity: 77.6% NHW; examined in relation to life events for overall sample	Aim: Identify how patterns of key life events and transitions relate to mental health, physical health, and quality of life among LGBT older adults. Outcomes: Depressive symptomatology (Center for Epidemiological Studies Depression Scale), stress (Perceived Stress Scale), psychological quality of life (World Health Organization – BREF)	Of four identified clusters based on key life events, the cluster with the highest proportion of transgender older adults had relatively high levels of some social and socioeconomic resources compared to other clusters. However, this cluster did not have significant advantages in mental health outcomes, potentially related to the elevated risks (e.g., job discrimination) identified among transgender older adults.
Gaveras et al. (2021) a	Participants: Transgender older adults Sample total: 14 GM older adults: 14 Overall sample age: 50–70, M = NR	Scope/Setting: National (community-based) Methodology: Qualitative Study design: Content analysis of previously conducted biographical interviews Sampling procedures: Purposive	Gender: Described in demographics as trans woman, trans man, or nonbinary Sexual orientation: NR Age: Measured and reported in demographics Race/ethnicity: 85.7% NHW	Aim: Examine how transgender older adults describe and understand their past experiences of suicidal ideation and behavior, resilience, and recovery in biographical interviews. Outcomes: Suicidal ideation, suicide plans, suicide attempts (based on definitions from Center for Disease Control and Prevention)	Participants described recovery from suicidality in terms of impossible and possible paths. Impossible paths were shaped by oppressive societal gender expectations, trauma, and abuse. Support from friends, family, and accepting mental health providers facilitated possible paths toward gender affirmation and recovery.
Hillman (2021)	Participants: Transgender older adults Sample total: 3,462 GM older adults: 3,462 Overall sample age: 50–100, M = NR	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured using options of female, male, or nonbinary; not examined Sexual orientation: Measured separately from gender identity; not examined Age: Compared intimate partner violence but not health outcomes by age group (50–64 vs. 65–100) Race/ethnicity: 90.5% NHW; not examined	Aim: Examine the lifetime prevalence of intimate partner violence among transgender older adults, along with its relationship to mental and physical health outcomes. Outcomes: Lifetime attempted suicide (yes/no, self-report), severe mental distress (K6 Non-Specific Distress Scale), substance use (National Survey on Drug Use and Health items)	Over half of respondents used substances, 12% experienced severe mental distress, and 28% had a lifetime suicide attempt. Over half of respondents reported intimate partner violence, most commonly targeting gender identity. Intimate partner violence predicted greater smoking, drug use, psychological distress, suicide attempts, poor health, and disability. Gender identity-specific intimate partner violence accounted for additional risk.
Hoy-Ellis & Fredriksen-Goldsen (2017) b	Participants: Transgender older adults Sample total: 174 GM older adults: 174 Overall sample age: 50–86, M = 60.97	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured using options of woman or man; not examined Sexual orientation: Measured separately from gender identity; not examined Age: Measured; not examined Race/ethnicity: 82.4% NHW; not examined	Aim: Explore the relative contributions of general stress, internalized heterosexism, and identity disclosure to depression among transgender older adults. Outcomes: Depressive symptomatology (Center for Epidemiological Studies Depression Scale), stress (Perceived Stress Scale)	The prevalence of clinically significant depression scores was 47.9%. Internalized heterosexism predicted greater general stress, which predicted greater depression. Identity disclosure was not related to depression but predicted lower internalized heterosexism. General stress predicted depression independently from minority stressors.
Hoy-Ellis et al. (2017) b	Participants: Transgender older adults Sample total: 183 GM older adults: 183 Overall sample age: No range reported; M = 60.11	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured using options of women, men, or something else; examined as a moderator Sexual orientation: NR Age: Measured; not examined Race/ethnicity: 68.0% NHW; not examined	Aim: Examine the relationship between prior military service, identity stigma, psychological health-related quality of life, and depressive symptomatology among transgender older adults. Outcomes: Depressive symptomatology (Center for Epidemiological Studies Depression Scale), psychological quality of life (World Health Organization – BREF)	Transgender older adults overall had mean depression and psychological quality of life scores of 9.00 and 64.12, respectively. Veterans vs. non-veterans had lower depression (7.00 vs. 9.80) and higher psychological quality of life (70.30 vs. 61.82). Identity stigma was associated with greater depression and lower psychological QoL. The association between identity stigma and depression was weaker for veterans vs. non-veterans.
Johnson et al. (2018)	Participants: Older transgender woman Sample total: 1 GM older adults: 1 Overall sample age: 70	Scope/Setting: Individual (non-clinical) Methodology: Qualitative Study design: Interview and review Sampling procedures: Purposive	Gender: Described participant as trans woman Sexual orientation: Participant described her own experiences navigating sexual orientation Age: Described participant as 70 years Race/ethnicity: NR	Aim: Provide background information on the mental health of transgender older adults and a model of interdisciplinary care, along with an interview with an older transgender woman regarding her life journey and transition. Outcomes: Qualitative discussion of depression	The participant described how fears of discrimination while transitioning contributed to her depression. She stressed the importance of encouraging and accepting mental health care providers, in addition to access to transgender specific support groups.
Kim et al. (2017) b	Participants: LGBT older adults Sample total: 2,450 GM older adults: 206 Overall sample age: 50–98, M = 66.2	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured for all using options of male or female; examined in relation to social network types for overall sample Sexual orientation: Measured separately from gender identity; examined in relation to network types for overall sample Age: Measured; examined in relation to network types for overall sample Race/ethnicity: 77.6% NHW; examined in relation to network types for overall sample	Aim: Describe the social network types of LGBT older adults in terms of relationship status, number of close ties, and frequencies of contact with various types of individuals; examine the relationship between social network types and mental health. Outcomes: Mental health (psychological quality of life on the World Health Organization – BREF)	Social network types included: diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. Transgender participants were more likely to have the immediate family-focused and fully restricted network types, and the fully restricted network type was associated with the poorest mental health. Larger and more diverse networks predicted better mental health overall.
Pharr (2021)	Participants: LGBT and nonbinary older adults Sample total: 3,960 GM older adults: 421 Overall sample age: 50–80+; M = NR	Scope/Setting: State (31 states with relevant BRFSS data) Methodology: Quantitative Study design: Analysis of cross-sectional data from the BRFSS survey Sampling procedures: Probability	Gender: Measured and compared as transgender women, transgender men, or nonbinary Sexual orientation: Measured separately from gender identity; examined mutually exclusive subgroups (e.g., cisgender gay men, cisgender lesbian women, all transgender men, all transgender women) Age: Compared age groups of 50–64 vs. 65+ within each subgroup Race/ethnicity: 70.2% NHW; not examined	Aim: Examine disparities in health care access, disability, heath risk and healthy behaviors, general health, and chronic disease/conditions among LGBT and nonbinary adults aged 50 years and older. Outcomes: Depression diagnosis (self-report); heavy drinking (self-reported drinks per week); poor mental health (reported number of days that mental health was not good during the past 30 days)	Compared to other subgroups, nonbinary individuals had significantly higher levels of poor mental health days (32%) and depression (38%), as well as disability and poor physical health. Additionally, transgender women and nonbinary individuals were significantly more likely than other subgroups to not have a personal doctor and not have a recent medical checkup.
Progovac et al. (2018) c	Participants: GM compared to non-GM Medicare beneficiaries Sample total: Varied by year; ranged from 1,525,926–1,547,650 GM older adults: Ranged from 335–657 (aged 65+) Overall sample age: <65–85+, M = NR	Scope/Setting: National (Medicare claims database) Methodology: Quantitative Study design: Cross-sectional analysis of Medicare claims Sampling procedures: Algorithm based on gender identity-related diagnostic codes	Gender: Only measured sex; not examined Sexual orientation: NR Age: Measured; compared GM and non-GM groups within eligibility cohorts based on age (65+) or disability (under 65+) with no other comparison by age Race/ethnicity: Overall: NR; GM, disability: 73% NHW; GM, older age: 88% NHW; not examined	Aim: Compare chronic conditions and utilization rates of various health care services among GM and non-GM Medicare beneficiaries within eligibility cohorts based on disability or age. Outcomes: Outpatient mental health visits, inpatient mental health visits, psychotropic medications, (all from claims records); any mental health diagnoses (in beneficiary files)	GM older adults were more likely than non-GM older adults to report multiple chronic conditions (84 vs. 75%) and any mental health conditions (43 vs. 24%). GM older adults were also more likely to have any outpatient (10.3 vs. 3.7%) and inpatient mental health visits (0.15 vs. 0.09%) and psychotropic medication fills (23.2 vs. 18.6%). Similar patterns were found for GM vs. non-GM adults in the disability-eligible cohort.
Progovac et al. (2020) c	Participants: GM compared to non-GM Medicare beneficiaries Sample total: 2,244,505 GM older adults: 2,018 (aged 65+) Overall sample age: 18–85+, M = NR	Scope/Setting: National (Medicare claims database) Methodology: Quantitative Study design: Retrospective analysis of Medicare claims Sampling procedures: Algorithm based on gender identity-related diagnostic codes	Gender: Only measured sex; not examined Sexual orientation: NR Age: Measured; compared GM and non-GM groups within eligibility cohorts based on age (65+) or disability (under 65+); no other comparison by age Race/ethnicity: NR (referred to previous study for details); examined as a predictor for all groups except GM older adults (too small to report)	Aim: Compare the prevalence of suicidality among four cohorts of Medicare beneficiaries (GM older adults, GM disabled adults, non-GM older adults, non-GM disabled adults); determine significant predictors of suicidality for these groups. Outcomes: Suicide attempt, suicide ideation, potential suicide attempt (codes in claims records)	GM older adults were significantly more likely than non-GM older adults to have a suicide attempt (0.5 vs. 0.1%) and suicidal ideation (1.1 vs. 0.4%) but less likely to have a potential suicide attempt (1.7 vs. 3.1%). After adjusting for age and mental health, GM older adults had over twice the odds of any suicidality than non-GM older adults. Predictors of suicidality for GM older adults included Medicaid eligibility, depression, mental health conditions, avoidable hospitalizations, and violence victimization.
Puckett et al. (2022)	Participants: Transgender and gender diverse adults Sample total: 695 GM older adults: 27 (Boomers+, born before 1964) Overall sample age: 16–73, M = 25.52	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience	Gender: Measured using a list with several options, including a write-in; compared subgroups of transgender man, transgender woman, genderqueer, nonbinary, agender, and not listed Sexual orientation: Measured separately from gender identity; not examined Age: Measured; compared generations (Generation Z, Millennials, Generation X, and Boomers+) Race/ethnicity: 75.7% NHW; not examined	Aim: Examine differences among transgender and gender diverse individuals by gender identity and generation with respect to the timing of identity-related milestones; explore how gender identity, generation, and identity milestones relate to mental health and minority stress. Outcomes: Anxiety (Patient-Reported Outcomes Measurement Information System-Anxiety Scale), depression (Patient-Reported Outcomes Measurement Information System-Depression Scale)	The Boomers+ group had mean anxiety and depression scores of 53.91 and 50.43, respectively, which were near national averages. Younger generations reported greater internalized stigma, anxiety, and depression than older generations. While older generations attained milestones at older ages than younger generations, living full time in one’s affirmed gender and receiving transition-related medical care predicted lower levels of depression and anxiety overall and within each generation.
Putney et al. (2018)	Participants: LGBT older adults Sample total: 50 GM older adults: 3 Overall sample age: 55–87, M = 67	Scope/Setting: Multiple communities across one state in the Northeast Methodology: Qualitative Study design: Focus groups Sampling procedures: Convenience, snowball	Gender: Described as male, female, and transgender Sexual orientation: Measured separately from gender identity Age: Measured and reported in demographics Race/ethnicity: 78% White, 96% non-Hispanic	Aim: Identify the anticipated needs and fears of LGBT older adults with respect to aging and long-term care facilities. Outcomes: Qualitative discussion of suicidal ideation, fear, distress	Focus groups expressed concerns about the cost of long-term care, dementia, discrimination, and isolation. They also discussed needs for LGBT-friendly care environments. Transgender participants described fears of anti-transgender bias, suicide ideation due to gender discrimination, and a need for staff trained in transgender-specific care.
Rosenwohl-Mack et al. (2022)	Participants: Residents of an LGBTQIA-friendly housing program for older adults Sample total: 21 GM older adults: 3 Overall sample age: 55+; M = 61	Scope/Setting: Housing development in a Western U.S. metropolitan area Methodology: Qualitative Study design: Focus groups Sampling procedures: Convenience	Gender: Described as female, male, and transgender female Sexual orientation: Measured separately from gender identity Age: Measured and reported in demographics Race/ethnicity: 48% White (plurality)	Aim: Examine the experiences of older adults living in an LGBTQIA+ welcoming and affordable senior housing development, especially in relation to health outcomes. Outcomes: Qualitative discussion of general mental well-being, stress	Participants overall and transgender participants specifically described the development as improving their mental well-being and decreasing their stress through housing stability, a sense of safety, protection from discrimination, access to health services, and a sense of community.
Stanton et al. (2016)	Participants: Transgender and gender nonconforming adults Sample total: 402 GM older adults: 54 Overall sample age: 18–50+, M = NR	Scope/Setting: National (community-based) Methodology: Quantitative Study design: Analysis of cross-sectional data from U.S. Social Justice Sexuality Survey Sampling procedures: Respondent-driven, snowball, convenience	Gender: Measured using options of male, female, male-to-female transgender, female-to-male transgender, and other; not examined Sexual orientation: Measured separately from gender identity; not examined Age: Measured; examined age group (18–24, 25–49, 50+) as a predictor Race/ethnicity: 23% NHW; examined as a predictor	Aim: Examine good health, gender affirming health care, family support, and LGBT community connectedness and participation as predictors of well-being among transgender and gender nonconforming individuals. Outcomes: Well-being (composite self-reported frequency of feeling as good as other people, hopeful for the future, happy, and enjoying life in the past week)	Within the overall sample, 63% reported high levels of well-being, which was predicted by LGBT community connection, better general health, family support, and perceiving one’s health care provider to be comfortable with one’s identity. Exact well-being scores were not reported within age groups, but being aged 18–24 predicted lower well-being, and being aged 50 years and older predicted higher well-being.
Wang et al. (2021)	Participants: Transgender compared to non-transgender VHA users Sample total: 11,560 GM older adults: 1,403 Overall sample age: 18–71+, no mean reported	Scope/Setting: National (VHA database) Methodology: Quantitative Study design: Retrospective analysis of VHA records Sampling procedures: Algorithm based on gender identity-related diagnostic codes, using a pre-established patient cohort	Gender: Only measured sex; not examined Sexual orientation: NR Age: Measured; compared health care mobility by age group (18–25, 26–40, 41–50, 51–60, 61–70, and 71+) Race/ethnicity: 84.5% NHW; examined as a predictor of health care mobility for overall sample	Aim: Determine whether transgender veterans show greater health care mobility within the VHA network than non-transgender veterans; describe demographic and clinical predictors of health care mobility. Outcomes: Depression and post-traumatic stress disorder diagnoses (codes in electronic health records)	Overall, transgender veterans were more likely than non-transgender veterans to be health care mobile and to travel across states for care. They also had greater diagnoses of depression, post-traumatic stress disorder, and other chronic conditions, which predicted greater mobility. Those aged 61 and older showed less health care mobility compared to younger veterans.
White Hughto & Reisner (2018)	Participants: Transgender older adults Sample total: 61 GM older adults: 61 Overall sample age: 50–75, M = 57.7	Scope/Setting: State (Massachusetts) Methodology: Quantitative Study design: Cross-sectional survey Sampling procedures: Convenience	Gender: Measured using several response options; recategorized and compared using “male-to-female” and “female-to-male” spectrum subgroups Sexual orientation: NR Age: Measured; examined age group (50–54, 55–59, 60–64, 65–69, 70–75) as a predictor at bivariate level Race/ethnicity: 78.7% NHW; examined as a predictor at bivariate level	Aim: Examine the relationship between gender- and age-related discrimination and depressive distress among transgender older adults. Outcomes: Depressive distress (Center for Epidemiological Studies Depression Scale)	Over half (55.5%) of participants met criteria for past-week depressive distress. Controlling for demographics and number of discrimination experiences unrelated to gender or age, a greater number of discrimination experiences and experiencing gender-based discrimination predicted greater depressive distress. Having a larger number of close friends was protective against depression.
White Hughto et al. (2021)	Participants: Transgender compared to cisgender adults Sample total: 62,548 GM older adults: 4,541 Overall sample age: 18–61+, M = NR	Scope/Setting: National (private insurance claims data warehouse) Methodology: Quantitative Study design: Cross-sectional analysis of insurance claims data Sampling procedures: Algorithm based on gender identity-related diagnostic codes, surgical procedures, and hormone prescriptions	Gender: Categorized transgender participants as transfeminine, transmasculine, or unknown; compared by gender within overall GM sample only Sexual orientation: NR Age: Measured; stratified comparisons by age groups (18–25, 26–30, 31–35, 36–40, 41–45, 46–50, 51–55, 56–60, 61+) Race/ethnicity: NR	Aim: Identify the prevalence of substance use disorders among transgender vs. cisgender adults, comparing differences by age, gender, and geographic location. Outcomes: Substance use disorder diagnoses, including alcohol, nicotine, cannabis, cocaine, and opioids (codes in claims records)	In every age category, transgender adults had significantly higher rates of every substance use disorder than cisgender adults. Nicotine-related disorders were especially prevalent among transgender adults aged 61+ (27%). Overall, transfeminine adults had significantly higher rates of every substance use disorder than transmasculine adults.
Witten (2014)	Participants: Transgender adults Sample total: 1,963 GM older adults: 922 Overall sample age: 18–70+, M = NR	Scope/Setting: National (community-based) Methodology: Mixed methods Study design: Cross-sectional analysis of survey data Sampling procedures: Convenience, snowball	Gender: Measured and reported using list of 14 options (e.g., transgender, transman, gender queer) Sexual orientation: Measured and reported separately from gender identity Age: Measured and reported in demographics Race/ethnicity: 85.0% NHW	Aim: Provide relevant results from the Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals while summarizing literature on transgender aging. Outcomes: Qualitative discussion of anxiety, suicide ideation	Qualitative responses from transgender older adults revealed worries about aging and end-of-life care as related to their transgender identity. Some revealed thoughts of de-transitioning or suicide due to anxiety about discrimination or victimization in health care settings. They also described fears of discrimination related to ageism, disability, and other prejudices.
Yang et al. (2017)	Participants: LGBT older adults Sample total: 222 GM older adults: 17 Overall sample age: 45–65+, M = NR	Scope/Setting: Metropolitan area in North Carolina Methodology: Quantitative Study design: Cross-sectional survey Sampling procedures: Convenience	Gender: NR Sexual orientation: Measured and examined only using a mutually exclusive measure of “LGBT identity” (lesbian, gay, bisexual, transgender, or other) Age: Measured; examined age group (45–54, 55–64, and 65+) as a predictor for overall sample Race/ethnicity: 93% White and 96% non-Hispanic; not examined	Aim: Examine whether experiences with LGBT-welcoming aging service providers are associated with lower levels of perceived isolation among LGBT midlife and older adults and whether these experiences moderate the effects of living alone. Outcomes: Perceived isolation (self-reported feeling of being isolated, somewhat isolated, or not isolated)	There was no significant difference in perceived isolation between transgender and other subgroups, likely due to an underpowered sample size. For the overall sample, having experiences with welcoming aging service providers both predicted lower perceived isolation and buffered the negative effects of living alone on perceived isolation.

Note. The use of terms such as “transgender” and “gender minority” in this table reflect the language used in each source. Under “Sample Description,” “GM older adults” represents the number of GM participants aged 50 years or older, or if not reported exactly, the closest available reports using other age groups (e.g., aged 65 and older). Under “Demographic Measures and Analysis,” “Gender” describes whether studies measured gender identity among GM participants, the gender identities represented within these measures, and whether studies (if quantitative) compared differences in relevant outcomes by gender identity. “Sexual Orientation,” “Age,” and “Race/ethnicity” similarly describe whether these characteristics were measured and whether studies (if quantitative) compared differences in relevant outcomes by these characteristics. BRFSS = Behavioral Risk Factor Surveillance System. GM = gender minority. LGBT = lesbian, gay, bisexual, and transgender. NHW = non-Hispanic White. NR = not reported. SGM = sexual and gender minority. VHA = Veterans Health Administration.

^aStudies are from the To Survive on This Shore project.

^bStudies are from the Aging with Pride: National Health, Aging, and Sexuality/Gender Study.

^cStudies are from the same sample of Medicare beneficiaries.