Agency and Social Forces in the Life Course: The Case of Gender Transitions in Later Life

Abstract

Objectives:

In order to bolster gerontology’s knowledge base about transgender issues and advance conceptualizations of agency and social forces in life course scholarship, this study explores the conditions under which people contemplate or pursue a gender transition in later life.

Methods:

In-depth interviews were conducted with male-to-female identified persons (N = 22) who have seriously contemplated or pursued a gender transition after the age of 50 years. Participant observation was also carried out at three national transgender conferences (N = 170 hours). Interpretive analyses utilized open and focused coding, analytical memo writing, and an iterative process of theory development.

Results:

Participants in this study faced unrelenting social pressures to conform to normative gender expectations throughout their lives, which were often internalized and experienced as part of themselves. Confronting these internalized forces often took the form of a “dam bursting,” an intense emotional process through which participants asserted agency in the face of constraining social forces in order to pursue a gender transition in later life.

Discussion:

The findings in this paper are used to extend the life course concept of agency within structure, which has implications for future life course research in aging, especially with respect to socially marginalized and oppressed minority groups.

The importance of understanding variations in human development within social and historical contexts laid the foundation for early conceptualizations of the life course perspective in social sciences (Cain, 1964; Elder, 1974; Riley, Johnson, & Foner, 1972). In gerontology, scholars have used this perspective extensively to guide investigations of aging and experiences in later life, leading to its paradigmatic influence in the field (Silverstein, 2012). Yet, although the widespread use of the life course perspective in aging-related studies has led to a broad range of scholarship, there are still gaps in the heterogeneity of life experiences and social environments accounted for within this perspective (Dannefer, 2003; Kelley-Moore & Lin, 2011). This study explores the experiences of transgender older adults who contemplate or pursue a gender transition in later life in order to expand the diversity of human aging experiences considered within life course scholarship. In addition, these experiences are analyzed in order to expand life course conceptualizations of agency to account for the ways in which transgender adults engage with social forces that influence their lives as they age.

The Case of Gender Transitions in Later Life

Gender transitions in later life have become a hot topic in contemporary popular culture. The 17-million-person television audience for Diane Sawyer’s interview with the former Olympian Bruce Jenner about his gender identity (American Broadcasting Company, 2014) along with the airing of Caitlyn Jenner’s reality television show about her life as a transgender woman (Entertainment Television, 2015), as well as recent acclaim for the Amazon series “Transparent” (Amazon, 2014), have drawn unprecedented attention to this phenomenon in mainstream media. Similarly, social service providers and researchers in LGBTQ (lesbian, gay, bisexual, transgender, and queer) aging have begun to note that many male-to-female identified people, often the oldest of the Baby Boomers, are seriously contemplating gender transitions in their later years (Witten & Eyler, 2012). The term transgender is an umbrella term used to describe people whose gender identity and/or gender expression differs from the sex they were assigned at birth. For some people, a transition may mean pursuing hormone therapy or surgical modifications of their bodies. For many, it means re-negotiating their social and familial relationships in relation to their gender identity. Transgender people may identify with a range of descriptive terms and conceive of gender transitions differently. For a comprehensive review of LGBTQ terminology, I direct readers to the Safe Zone Project (2015) and the National Center for Transgender Equality (2016).

Several advocates and scholars concerned with transgender identities and experiences have begun to consider why many male-to-female identified people have waited until later life to transition. Cook-Daniels (2006, 2015) notes that transgender older adults often wait to transition until they have retired or their children have moved out of the home and argues that these decisions reflect efforts to avoid uncomfortable responses from work colleagues and/or children. Rosenfeld (2010) suggests that these decisions may also reflect that information about transgender issues and resources is becoming increasingly available along with web-based supports. Similarly, Valentine (2007) argues that a contemporary societal context (post-1990s) in which the category of “transgender” has been rapidly adopted influences the social opportunities for those who take on this collective identity. Writing during this post-1990s shift, Gagné, Tewksbury, and McGaughey (1997) note that the process of coming out as transgender is inextricably linked to community relationships and socially constructed options for transgender identity.

We also know from gay, lesbian, and bisexual adults who come out later in life that this decision is often driven both by individual maturational factors as well as reactions to the constraints of heteronormativity in a changing society (Floyd & Bakeman, 2006; Orel, 2004). Research on gay and lesbians’ identity narratives demonstrates how heteronormative constraints cause psychological distress. This same research shows, however, that individuals also develop narratives of resistance with respect to these constraining forces (Hammock & Cohler, 2011). Queer perspectives on gender transitions in later life (which challenge heteronormative constructions of gender and sexuality) have shed light on transgender older adults’ sense of time and its role in later life development (Fabbre, 2014) and helped to re-conceptualize the meaning of successful aging (Fabbre, 2015). Yet, despite this awareness in the literature of the relationship between social context and gender and sexual minorities’ life experiences, the case of gender transitions in later life has yet to be examined explicitly from a life course perspective. Further, little is known about the health and mental health challenges generated by late life transitions and how transgender adults’ growth and development may be bolstered or hindered by this process (Bernstein, 2015; Fredricksen-Goldsen et al., 2013).

The Agency/Structure Dynamic in Life Course Scholarship

At its core, the life course perspective emphasizes the study of human development at all stages of the life span and with respect to the timing of key events and experiences, the interdependence of human lives, and the nature of human agency within sociohistorical contexts (Elder & Shanahan, 2006). Two dominant perspectives are evident in the field: what Dannefer and Settersten refer to as “personological” and “institutional” paradigms; the former focuses on the role of early life experience in shaping later life outcomes whereas the latter emphasizes the social construction of life stages by social policy and cultural context (Dannefer and Settersten, 2010). Thus, one of the most salient tensions in the field focuses on the role of human agency and social structure in shaping individual and collective variations in aging (Marshall & Bengtson, 2012; Marshall & Clarke, 2010; Settersten, 2003). Although myriad definitions, conceptualizations, and debates about the nature of agency and structure exist in life course discourse, this tension maintains two ostensibly opposing propositions: one that emphasizes individual capacities and effort and the other that emphasizes an individual’s life course as a product of social forces (Settersten & Gannon, 2005). Between the two extremes of these positions, Settersten and Gannon argue that a third model—agency within structure—holds the potential to bridge under-structured and over-structured views of the life course. The model of agency within structure seeks to illuminate “how individuals set goals, take action, and create meanings within – and often despite – the parameters of social settings, and even how individuals may change those parameters through their own actions” (p. 36).

The agency within structure model also echoes what Dale Dannefer has called the “missing middle” in life course scholarship, referring to the proximal social dynamics, relations, and settings that impact aging (2008). Although many fields in the study of aging seek to study aging-in-context (e.g., life span psychology and life course sociology), Dannefer argues that life course research has focused on understanding context through modes that privilege demographic analyses, historical scholarship, cross-cultural comparisons, policy initiatives, or longitudinal studies that track individual lives on repeated measures of “snapshot” characteristics (p. 11). These approaches to life course research create a conceptual distance between microlevel and macrolevel issues, often neglecting the ways in which relational dynamics have the potential to shape proximal influences on human development and aging.

Settersten and Gannon similarly argue that modes of agency within structure cannot be general and that they must be understood within particular domains of functioning and particular environments. They also propose that agency should not be considered an individual phenomenon, but a collective one in which “individuals who dare to make innovative life decisions end up creating new options for others” (p. 43). In light of critiques that life course scholarship overemphasizes average trends in aging and limits the degree of heterogeneity explored in aging experiences (Dannefer, 2003; Kelley-Moore & Lin, 2011), the case of gender transitions in later life has the potential to help conceptualize the ways in which gender-variant older adults grow and develop with respect to their social environment (Witten, 2008, 2009). Further, this case may help advance conceptualizations of social environment as a dynamic construction shaped by the interdependence of human lives and the timing of key events and experiences in the life course. In order to expand Settersten and Gannon’s model of agency within structure, this study asks: What are the conditions under which people contemplate or pursue a gender transition in later life? Stemming from the agency/structure dynamic in life course scholarship, this study also poses the analytical question: What facilitates or constrains “choice” in these decisions?

Method

The data generated and analyzed in this paper are part of an extended case method (ECM) study that seeks to refine existing theory or concepts by exploring macrolevel social forces through analyses of microlevel experiences and social settings (Burawoy, 1998; Burawoy et al., 1991; Small, 2009; Samuels, 2009). I carried out ECM in three stages, reflecting recent articulations of this method by Wadham and Warren (2013). First, I identified the life course perspective as a conceptual framework ideally suited to extension and refinement; second, I identified gender transitions in later life as a case that illuminated a unique aging experience to which life course concepts could be applied and critiqued; and third, I generated ethnographic data from in-depth interviews and participation observation and analyzed them in order to expand the life course model of agency within structure to account for the experiences of transgender older adults. I combined the use of interviews and observation in this study in order to broaden the empirical means through which I could understand an experience that is at once highly personal and also inherently social. Interviews facilitated interpersonal knowledge of study participants’ thoughts and emotions whereas observation facilitated an experiential knowledge of relevant social contexts.

Data Generation

Interviews

I employed purposive sampling (Mason, 2002) to recruit persons 50 years of age or older who have seriously contemplated or have pursued a gender transition. I intentionally recruited male-to-female identified persons because social service providers and community advocates have noted that they tend to come out and/or transition later in life than female-to-male identified persons (Cook-Daniels, 2006). I recruited 22 interview participants through flyers, word of mouth, and snowball sampling. These participants met the primary criteria while also offering some variance of lived experience with respect to other social characteristics such as racial and ethnic identity, socioeconomic status, age, and relationship status. Of the 22 participants, 18 were European American, 3 were African American, and 1 was Asian American. Based on information shared during the interviews, 5 expressed ongoing socioeconomic challenges, 6 expressed a sense of socioeconomic stability, and 11 shared that their socioeconomic position afforded stability and some luxury. Twelve participants were between 50 and 60 years of age, seven were between 61 and 70 years of age, two were between 71 and 80 years of age, and one participant was 82 years old. Seven participants were currently married, eleven were previously married and divorced, two were partnered, and two were never married or partnered.

Conceptualizing adults’ gender identities is complex and can be understood from diverse perspectives. For this study, I use the language of the participants themselves to illustrate how they contemplate and pursue transitions. Therefore, I use the word transition to reference the process through which a person may decide to change from living part-time (a term often used by participants to describe expressing their preferred gender identity in private or only in some aspects of their lives) to full-time (a term used to describe living in and expressing their preferred gender 100% of the time). At the time of my interviews, 15 participants were living full-time, 3 were living part-time and were not sure about transitioning, 3 were living part-time and had decided not to transition, and 1 person was living part-time and considered herself in preparation for transition. In-depth biographical interviews focused on participants’ gender expression and identity over time, experiences in families of origin, work trajectories, significant relationships, and their contemplation or pursuit of a gender transition. I conducted interviews in participants’ homes and, in a few cases, at public locations such as coffee shops or parks and they lasted from 1.5 to 2.5 hours. Eighteen interviews were audio recorded and transcribed verbatim and four were recorded with hand-written notes at the request of participants.

Participant observation

In order to generate additional data that would aid in developing a socially and historically contextualized analysis, I carried out participant observation (Burawoy et al., 1991; Emerson, 2001) with the permission of organizers at three national transgender conferences in the Southeast, Midwest, and Northwest of the United States. These three conferences were selected as field sites because they have been widely influential in transgender community circles, especially among older transgender women (Sosin, 2012). The majority of the interview participants attended or knew about these conferences: 12 of the interview participants have attended one of these conferences and 10 interview participants had learned about them through friends and involvement in social groups. I participated in the full range of activities at conferences, which included attending seminars, discussion groups, meals, and social outings. In all settings, I introduced myself as a researcher while also contributing personal reflections in conversations and at times disclosing aspects of my own identity. Balancing both roles—researcher and participant—aided in developing alliances with fellow participants and generating in-depth field data. I took extensive field notes about these experiences (Emerson, Fretz, & Shaw, 2011) that focused on issues of aging, later life transitions, and the history of the conferences themselves. Each conference lasted approximately 1 week; I spent 170 hours in the field.

Data Analysis

The data analysis carried out in this study was guided by interpretive research principles that emphasize an iterative process of meaning making and developing insight into social phenomena (Schwartz-Shea & Yanow, 2012). I used NVivo 9 qualitative data analysis software (QSR International, 2012) to organize the interview and field data and to develop a set of open and focused codes on a wide range of descriptive topics evident in the transcripts and notes (Padgett, 2008). Some of the open codes captured significant domains of life experience described by participants, such as childhood experiences, marriage and family relationships, and work life. I then developed a range of focused codes on topics related to gender identity over time such as first memories of gender awareness, connecting to transgender communities, and coming out to family members. I then used extensive analytical memo writing (Auerbach & Silverstein, 2003; Emerson, Fretz & Shaw, 2011) to make conceptual connections between these coded data in the form of themes. Early on, this memo writing process aided in identifying the notion of the “dam bursting,” language used often by participants and the central concept in this paper’s findings. I used these themes as a foundation for further abstraction and interpretation of the data with respect to life course principles and the agency within structure model proposed by Settersten and Gannon (2005). The process of analyzing the data was an iterative one that included presenting raw data for discussion with colleagues in a qualitative methods working group, extensive use of analytical memos, and the articulation and refinement of conceptual findings with an interpretive methods advisor. I used member checking (Padgett, 2008) to enhance the credibility and trustworthiness of my analytical process. I published early findings in community-based newsletters, gave presentations and elicited participant feedback at original field sites, and had ongoing discussions with members of transgender community groups about the relevance of this study’s findings to their lived experiences. For additional rationale and specificity with respect to the methodology employed in this study, see Supplementary Appendix.

Results

Participants in this study followed unique paths to contemplating and/or pursuing a gender transition, but their experiences suggest a common condition under which they made this decision. They felt unrelenting social pressures to conform their gender identities and expressions to normative expectations throughout their lives, which often led to a desperate psychological and emotional breaking point later in life. This breaking point, what many described as the “dam bursting,” reflects how transgender adults often internalize, but then find ways to resist, the constraining social forces in their lives. In addition, these social forces are often negotiated through interpersonal relationships, and thus, these relationships play central roles when transgender adults contemplate and/or pursue a transition later in life.

The Dam Bursting

Societal expectations of manhood and masculinity had constraining effects for study participants that began very early in life and worsened over time, limiting their opportunities to explore their female-identified and feminine selves. This process often began with early childhood memories of feeling different, confused, or yearning for a sense of belonging with others that never quite took hold. Their attempts to conform to these expectations in early and mid life often resulted in significant mental health consequences. In fact, a common feeling shared by participants was experiencing years of pent up anger and severe depression, often to the point of suicidality. Eventually, participants described a process through which they came to see that this way of living was not endurable and that their only real choice, short of taking their own lives, was to break through the “dam” and express themselves freely, regardless of the social consequences.

Carly (All names in this paper are pseudonyms to protect the confidentiality of study participants.), a European American woman who recently retired and transitioned to living full-time at the age of 62 years, shares the beginning of a life-long frustration with having to maintain relationships with her parents, spouse, and children in which her full identity was not acknowledged. She reflects on an early memory of needing respite from this sense of disconnectedness but also yearning to be known in an authentic way:

One of my favorite times when I was a kid was being outside during a thunderstorm, or during rain…I would just be out there for – for two or three hours, reflecting and thinking about my life. And so, I was trying to figure myself out….but I knew who – who I was. And I always was trying to gain the strength to tell my mom or tell my dad who I was.

For Carly, and many transgender women, her parents exerted the earliest and most salient social forces that constrained her gender variance. The influence of these familial experiences had lasting effects, often in the form of internal conflict. In midlife, after marrying and having two children and securing a managerial position in a government agency, Carly remembers the increasingly complex and internal struggle to manage this conflict within herself:

I was still pushing it away. I was pushing reality away…let me think of the reasons why. One, it was my job. I’ve got a house, and children. I am – I am the provider there. And if I lost my job, what am I gonna do? I love my children. So, what am I gonna do? And – and then, I also believed I had some really strange disorder, that I could self correct this… I thought - I can destroy this thing. Grow a beard. Grow a mustache. I always had my hair cropped short. I always adopted super, super hyper masculine ways by emulation…I had a like John Wayne walk…when my kids were growing up, I acted like a drill sergeant, and I got that from the movies. And so…I tried to put all of it behind, but then it kept coming back and coming back. And each time it surfaced it came back stronger.

Carly’s attempts to “destroy this thing” reveal multiple aspects of herself, some that are grounded in mainstream notions of what a man should be, and others that push back against these notions. Her imitation of hypermasculine behaviors and personas, in addition to taking on a heteronormative male role in the family as father and provider, is typical of many of the participants in this study who remember elaborate and determined ways of projecting a masculine identity throughout childhood and middle adulthood. These efforts reflect the complexity and intensity with which heteronormative expectations for gender expression in society come to exert influence on individuals through relationships with others and a relationship with one’s self.

Over time, the pressure of feeling constrained, fighting with oneself, and feeling out of place in normative social life takes a psychological toll that significantly affects family and work life. Carly recounts the progression of these feelings and coping strategies:

So as long as I didn’t read about it, as long as I didn’t hear about it, I could keep…well, just putting things in a vault. I twist the combination, and I take the combination to it, and I put it away somewhere, and try to forget where it was at. And periodically, in my life, I would come across the combination and then go, “Oh, jeez. I gotta – I gotta look at this,” go through some pain and suffering for a few months and I go, “Okay. This is too, too much.” I have so much to lose in my life. My parents. My parents were alive. And I – I didn’t – I couldn’t do this to my parents. So, when my parents passed away, it was the final straw that said I – I – I’ve gotta do something.

The deaths of Carly’s parents had significant effects on her development as an older transgender person. The real absence of interpersonal relations with her parents eased some external pressure, which provided an opportunity for her to address the internal conflict she had battled for so long. In addition to relationships with one’s parents, many study participants recounted the intense conflict they felt while maintaining relationships with their partners and children as they contemplated a gender transition. On the first day of the Midwest transgender conference I attended as a participant observer, I arrived alone at an organized dinner and was invited by two other attendees to join their table. As we introduced ourselves, I came to learn that my fellow diners, Ginny and Micheala, were both married and open to their wives about engaging in cross-dressing and contemplating a transition. Ginny shared that she would love to live full-time, but feels conflicted about pursuing this, saying “but my kids need their father, so what I am gonna do?” Michaela nodded knowingly and said that for her, her contemplation was more about her wife’s level of tolerance. She feels fortunate that her wife is “okay” with her cross-dressing and identification as transgender, but also acknowledges that her wife “doesn’t really want to be around it.” For both Ginny and Michaela, these relational constraints put them in a bind about how to move forward in their lives. Ginny’s concern for her children and Michaela’s concern for her relationship with her wife exemplify how normative expectations for gender identity and social roles are experienced and negotiated through interpersonal relationships.

The pressure of feeling out of sync within family and work life often led to marital struggles for those interviewed, which caused significant distress and produced psychological defenses that served to manage this conflict over many years. Samantha, a 65-year-old European American woman whom I interviewed on the farm she shares with her female partner in the rural Midwest, shared an example of this experience. She recalls the painful time in which an affair she pursued while in her first marriage, as well as therapy at the urging of her wife, contributed to a breakthrough in awareness:

So the affair was crucial in a number of ways. It all came out – it came tumbling out when [my wife] wanted me to see a therapist…Up to that point, I had no emotional outlet of any sort. When I had that affair with the other woman, we bonded - and I could get in touch with my emotions a little bit…It was crucial in the fact that it broke through that barrier that I had and I could feel something in life...And when I went to the therapist, it was the first time I’d ever talked about it openly and it was the dam bursting. It really was…Then there was the epiphany, there was – I think perhaps everyone has this epiphany where everything in my life finally made sense…I couldn’t deny who I was - I finally could no longer deny it…it would occur to me and wherever I went from that point on I knew that life was over because I could never go back into denial.

The emotional outlets that an intimate affair and psychotherapy provided for Samantha in this case facilitated a breakdown of psychological denial that had served to reinforce constraining social forces in her life. For Samantha, as well as Carly, she was aware of feeling out of place from an early age. Although not all transgender women have memories of gender conflict in childhood, many do, and many recount the struggle to suppress these feelings for decades. This suppression causes significant anguish and distress, especially when people feel that embracing their nonnormative gender identities would put their family lives at risk. The point at which this suppression is overcome is significant because it demonstrates how transgender adults exert agency with respect to constraining social forces that have been imposed, in part, through close relationships with others.

This type of conflict developed for most participants in this study, including Elaine, a 57-year-old European Woman who recently transitioned while still working in the insurance industry. She remembers that in her mid-40s she “gave up fighting with myself” and that “the dam got significantly weaker, the feeling got stronger and I came to realize that after so many years I had to deal with this.” Elaine’s description of the dam getting weaker suggests that this was an internal construct that held back one part of herself (the part that had internalized constraining social forces in her life) from the other (the internal sense of her femaleness). It also suggests that the dam was subject to her increasing sense of self-efficacy as she aged. The process of coming to terms with conflicting parts of oneself was evident in the way many participants experienced the conferences I observed for this study. During a graduation ceremony at one such conference, first time attendees (many of whom were presenting as female in public for the first time in their lives) were celebrated. Midway through the ceremony an attendee, Cynthia, stood up to speak and turned sideways to show a freshly inked tattoo above her ankle and said, “I’d like to show you the new tattoo I got this week. It’s a blue rose with thorns. A blue rose exists in nature as a hybrid of other roses, and this symbolizes the parts of me coming together this week. And the thorns represent all the pain and challenges I’ve faced in my life.” Cynthia went on to thank her fellow attendees for helping her to take this big step in her life and sat back down teary-eyed and beaming. Cynthia’s tattoo captures the essence of what the dam bursting means for many transgender older adults: The blue rose represents the process of reconciling multiple and often conflicting parts of oneself, and its thorns represent how society’s constraints and the pain they cause become an integral part of the self.

Discussion

In her highly publicized Vanity Fair interview in 2015, Caitlyn Jenner said that “if I was lying on my deathbed and I had kept this secret and never ever did anything about it, I would be lying there saying, ‘You just blew your entire life. You never dealt with yourself,’ and I don’t want that to happen” (Bissinger, 2015, p. 53). By conceptualizing her struggle with gender identity as a matter of dealing with herself, Jenner echoes the experiences of many participants in this study wherein they often felt they were fighting with themselves for many years. The metaphor of a “dam bursting” helps illuminate how societal-level constraints on gender identity and expression are internalized, build up as part of oneself, and are confronted through the exertion of agency in later life for many who contemplate or pursue a gender transition. The point at which people think, like Jenner, “I don’t want that to happen” is where individual agency pushes back on social structure with life-changing potential. Further, the role of interpersonal relationships in this process exemplifies the life course principle of linked lives, of which scholars have called for increased exploration and understanding (Settersten, 2015), and draws our attention to the ways in which relational dynamics facilitate the expression of agency within structure in later life.

Contemplating or pursuing a gender transition in later life is an intensely personal yet inherently social experience. This study identifies a key social condition that plays a role in this decision. The findings presented in this paper demonstrate that for those whose core gender identities have been oppressed by heteronormative social forces, exerting agency often means addressing the ways in which constraining social forces are internalized and become part of one’s self. The experience of “the dam bursting” is significant because it is both shaped by and resistant to these forces. Transgender adults have also engaged in community organizing over several decades that led to the creation of many conferences and community spaces like the ones I observed for this study. This form of organizing has generated new social forces that facilitate, both directly and indirectly, real possibilities for embracing transgender identity and rejecting long-endured normative expectations and constraints (Fabbre & Siverskog, 2016). These findings and their link to community organizing offer a substantive contribution to the literature that has identified the role of social context in constructing transgender identities and making life choices (Floyd & Bakeman, 2006; Orel, 2004; Rosenfeld, 2010; Valentine, 2007). They also build upon research that has identified the psychological impact of and resistance to constraining social forces over time for gender and sexual minorities (Hammock & Cohler, 2011). Most importantly, the findings in this study extend the agency within structure model articulated by Settersten and Gannon (2005) by showing how agency within structure is enacted through the internalization and psychological resistance to structural forces that is facilitated by the interdependence of human lives.

Limitations

The interviews in this study were conducted only with male-to-female identified persons, which limits the relevance of these findings for many other members of the transgender community. One important consideration in the transferability of these findings is that male-to-female identified persons have experienced and benefited from male privilege prior to pursuing a gender transition. Those who navigated the world as men for decades of their lives experienced the benefits of this social position, regardless of the mental anguish and suffering many experienced. This form of privilege then shapes the ways they see the world and themselves and likely influences their decisions about transitioning in many ways. A limitation of this study is that I did not explicitly analyze the role that male privilege plays in gender transitions in later life, and this leaves a gap in my findings and limits their relevance for others in the transgender community who experience gender-based privilege and oppression in different ways.

In addition, although I interviewed people of different racial, ethnic, and class backgrounds, I did not foreground these social identities in my analyses. By prioritizing social forces and experiences around gender and sexuality without an intersectional framework, I limited the degree to which I have understood study participants and the conditions under which they contemplated or pursued a transition. This analytical choice also limits the degree to which my findings address multiple forms of privilege and oppression or speak to the full complexity of transgender identities and experiences across multiple identity domains and with respect to multiple social forces.

Implications

The findings presented in this paper have implications for future life course research in aging, especially with respect to socially marginalized and oppressed minority groups. The extension of the agency within structure model can be used to focus life course scholars’ attention to the ways in which microlevel expressions of agency are both shaped by and challenge macrolevel forces. Further, this agency may go beyond merely challenging them and holds the potential to create sustained changes in social structure with respect to gender and sexuality. We are seeing this impact already in transgender communities, where as more people claim these identities and become more visible, social opportunities increase for this group (Valentine, 2007). This dynamic view of agency and social structure also makes a conceptual contribution to efforts to fill in the “missing middle” in life course scholarship (Dannefer, 2008). The gap between the individual and society is filled with an understanding of how people engage with social forces through psychological and interpersonal means in order to enhance their own growth and development. Greater attention to these dynamics for socially oppressed groups can be used to design and develop life course research that explores multiple levels of diverse aging experiences. Future research in LGBTQ aging should conceptualize social structure as a dynamic and modifiable aspect of human development and aging experiences.

The agency within structure model extended to transgender aging experiences also has implications for mental health care for transgender older adults, as the role of social forces can be easily overlooked through individualized diagnosis and “treatment” of those who struggle with a gender conflict. As Samantha from this study reminds us, mental health professionals have the potential to facilitate breakthrough moments for those who have felt unrelenting pressure to conform to society throughout many decades of their lives. However, these opportunities can be easily missed if the role of social forces and linked lives are not taken into account. Medical providers who subscribe to standards of the World Professional Association for Transgender Health (WPATH, 2012) usually require that patients who wish to receive hormone or surgical treatments receive an assessment by a mental health professional and be diagnosed with gender dysphoria (American Psychiatric Association, 2014). The relationship between these health professionals and their transgender patients often focuses on individual-level identity, gender expression, and biomedical therapies and doesn’t necessarily mean that all providers understand the ways in which heteronormative social forces contribute to feelings of conflict, or how they might work collaboratively with patients and clients to push back against these forces. Mental health professionals, who often play gatekeeper roles for those who wish to pursue transition-related medical care, could enhance their practice by incorporating this knowledge into their therapeutic work in order to empower transgender clients to acknowledge the societal and collective dynamics that may both hinder and facilitate their decisions in later life. Greater attention to the role of agency and social forces in the lives of transgender adults has the potential to expand the way helping professionals join with their clients to promote individual and social change.

Supplementary Material

Supplementary material can be found at: http://psychsocgerontology.oxfordjournals.org/

Funding

This work was supported in part by the National Institute on Aging at the National Institutes of Health (T32 AG 243-17) through the Center on Aging at the University of Chicago. It was also supported in part by the Center for Health Administration Studies at the University of Chicago through a dissertation fellowship.