Factsheet 16

Trans issues and later life

July 2024

About this factsheet

This factsheet provides information about later life for trans people. It is
intended to provide information and advice and does not offer any
opinions or views on the subject matter. The focus is on growing older for
people who have transitioned and live permanently in their acquired
gender, or who are considering transitioning and gender reassignment.
The factsheet covers a range of legal, financial and social care
considerations and details of where to go for further information and
support.
Terminology used by trans people to describe their experiences and
identities is varied and changes over time and context. We are
committed to reflecting this diversity but recognise that terms used in this
factsheet may vary in their usage or become outdated.
The information in this factsheet is applicable to England and Wales. If
you are in Scotland or Northern Ireland, please contact Age Scotland or
Age NI for information and advice. Contact details are at the back of the
factsheet.
Contact details for any organisation mentioned in this factsheet can be
found in the Useful organisations section.

Page 1 of 30
Contents

1 Who is trans? 4

2 Trans and other identities 4

2.1 People who cross-dress 5

2.2 People who identify as non-binary 6

3 Transitioning in later life 6

4 The transitioning process 7

4.1 Transition and hormones 8

4.1.1 The trans man’s transition 9

4.1.2 The trans woman’s transition 9

4.1.3 Risks of hormone therapy 10

5 Surgical transitioning in later life 10

6 Getting older 11

6.1 Being a healthy older trans man 11

6.2 Being a healthy older trans woman 11

6.3 Looking after your mental wellbeing 12

6.4 Sexual health 12

7 Your rights 13

7.1 The Gender Recognition Act: the basics 13

7.2 If you are in an existing marriage or civil partnership 14

7.3 The Equality Act 2010 14

8 Hate crime 16

9 Financial issues 16

10 Care services 17

10.1 Seeking care and support 18

10.2 Sheltered housing and residential care 19

10.3 Making a complaint about your care 19

11 Mental capacity and making decisions 20

12 Wills and intestacy 21

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13 Bereavement and registration of death 21

14 Partners of trans people 22

15 Glossary 23

Useful organisations 25

Age UK 29

Support our work 29

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1 Who is trans?
Trans people are people whose gender identity differs from or does not
match or sit comfortably with their biological sex. Trans is an umbrella
term that embraces many different gender identities. Trans people may
describe themselves using one or more of a wide variety of terms
including, but not limited to transgender, transsexual, gender queer,
gender non-conforming and gender variant.
A trans person may or may not become fully bodily reassigned in their
acquired gender. They may or may not receive hormone therapy, have
gender related surgery, or obtain legal recognition of their change of
gender.
This factsheet focuses on trans people living permanently in their
acquired gender and those who are seeking to do so. Acquired gender is
a legal term used in the Gender Recognition Act 2004. It refers to the
gender which a person is living in and seeking legal recognition of.
There may be some specific considerations, for example in employment,
with family and friends, government bodies, and health and care
providers. Gender reassignment means you are protected by law under
the Equality Act 2010 against discrimination, harassment, and
victimisation.

Note
Affirmed gender–describes a person’s gender following transition -
the gender with which they identify has been affirmed. We use the
term ‘acquired gender’ to align with language used in the Gender
Recognition Act 2004.
Gender identity- your internal sense of being male or female, both
or neither.
Gender reassignment-describes the process a trans person
undertakes to transition socially and/or medically to live in their
acquired gender.

2 Trans and other identities

Many trans people report identifying as a member of the opposite sex
from an early age. At some time in their life, many seek professional
advice, perhaps after long periods of cross-dressing publicly or privately.
This may be influenced by their personal and social circumstances,
family support, and degree of motivation.
The medical term for discomfort or distress caused by a mismatch
between a person’s gender identity and biological sex is ‘gender
dysphoria’. Some trans people and organisations prefer the terms
‘gender incongruence’ or ‘gender variance’.

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 Transition
If you identify as trans, you may wish to consider if and how you want to
‘transition’. Transition is not a standard or pre-determined process.
People approach it in different ways depending on their individual
circumstances, needs and preferences.
Do you wish to have hormone therapy, surgery, or legal recognition of
your gender reassignment? None are a requirement for transition,
though many people proceed to pursue some, if not all, of the above.
The term trans man is used to describe a person whose biological sex is
female but who identifies and lives as a male. They may refer to
themselves as a man with a trans history. Similarly, a person whose
biological sex is male but who identifies as a female may refer to
themselves as a trans woman or a woman with a trans history.
You may also see the abbreviations FtM (female to male) and MtF (male
to female), but these can be questionable as for example, a trans woman
may never have identified as male in the first place.
It is important to recognise that having taken steps to live a life that
aligns with their gender identity, people with a trans history may not wish
to be referred to as trans, transgender, or transsexual. They may simply
wish to be referred to as men or women.

Sexual orientation of trans people

Sexual orientation describes a person’s sexual attraction to another
person. Being trans does not imply any specific orientation. Trans
people, like everyone else, may be heterosexual, lesbian, gay, bisexual,
asexual or pansexual etc.
Sexual orientation may change, particularly after a process of transition
or transition events. It may also remain unchanged or be fluid. This
varies from person to person and the sexual orientation of many trans
people does not change.

2.1 People who cross-dress

People who cross-dress enjoy wearing clothes associated with the
opposite sex, often for relatively short periods of time, for personal
comfort and pleasure.
People who cross-dress are usually comfortable with their gender
identity and do not wish to change it. However, for some people, cross-
dressing may be carried out as part of a wish to subvert gender norms
and as an exploration of their gender identity. This exploration may
support them to go on to live permanently in their acquired gender.
You may hear the term ‘transvestite’ used to describe a person who
cross-dresses. Some people consider this term as being outdated or
derogatory, whilst others may still be happy with it. Trans communities
generally prefer the term ‘cross-dresser’.

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2.2 People who identify as non-binary
Non-binary describes gender identities that are not exclusively masculine
or feminine and therefore outside the ‘gender binary’ of male and female.
It may mean you feel you have no gender.
You may come across other terms such as gender variance or gender
fluid to describe variations in non-binary identities.
People who identify as non-binary may experience gender variance and
wish to pursue the transition route, but equally they may just want to
focus on ‘being themselves’.
One of the most important ways others can acknowledge and respect
non-binary identities is to use the personal pronoun a non-binary person
chooses. If you are unsure, ask them.

3 Transitioning in later life

Some trans people have an inkling early in their life that their gender
identity differs from or does not sit comfortably with their biological sex.
For other people, it may not be something they fully understand about
themselves or are able to explore until later in life. Retirement or the
death of a partner may provide the first real opportunity to think about
and act on this.
Many older people have successfully transitioned and are living in their
acquired gender. Transitioning in later life can be an opportunity to
resolve long standing conflicts and uncertainties that impact your mental
health and wellbeing. There may be fewer social and economic impacts
to transitioning when work or social responsibilities change in later life.
However, there may be financial implications (see section 9).
Achieving surgical reassignment is not often easy. Psychological
implications should not be underestimated and are always addressed as
part of your assessment.
The process can take several years, involve several doctors, and
probably involve more than one operation. After having surgery available
to you (not everyone is able to have all possible operations), you will
likely continue long term hormone therapy and regular monitoring for
possible side effects.

Note
In England, there is information on gender dysphoria and the
transition process at www.nhs.uk/conditions/gender-dysphoria
In Wales, visit Gender Wales website at www.gender.wales

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4 The transitioning process
Gender transition describes the process of social and medical changes
that you can take to live comfortably in your gender identity. Transition is
not necessarily a linear or fixed process, as it is shaped by your needs
and preferences and your access to resources including specialist care
and it can take several years.
If you are considering transitioning, you usually start by seeking a
diagnosis of gender dysphoria. When you receive a diagnosis, you can
discuss its implications and agree a treatment plan. You should think
about the physical, social, psychological and emotional changes
involved. This includes making decisions about whether you want to
commence hormone therapy or be considered for surgery.
Social transitioning involves social, cosmetic, and legal changes without
regard to medical interventions. For example, changes to your name and
sex marker on documentation.
The two most commonly used methods to change your name are by
deed poll or statutory declaration. The law resources section of the
GIRES website has information about changing your name and lists the
documents you need.
The Tranzwiki directory lists organisations offering information and
support for trans and non-binary people and their families.

Assessment
A visit to your GP is usually the first step, though they may not have
experience of supporting or providing medical care to trans patients.
Most GPs are unlikely to have seen many trans people during their
medical career.
Your GP can refer you to a specialist team at an NHS Gender Dysphoria
Clinic (GDC). These clinics offer expert support and help, as well as
assessment and diagnosis, for people with gender incongruence.
However, waiting lists are long.
You can self-refer, or other healthcare professionals can refer you to a
GDC or other local gender dysphoria services (if available), but this still
requires your GP’s involvement. Alternatively, you can seek private
consultation and assessment.
A diagnosis of gender dysphoria is usually made after an in-depth
assessment by two or more specialists and may require several
sessions, a few months apart. It may involve discussions with people you
are close to, for example members of your family or your partner.
The assessment assists you to determine whether you have gender
dysphoria and how you wish to proceed. It may involve a more general
assessment of your physical and psychological health.

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 Developing a treatment plan
If the assessment suggests you have gender dysphoria, GDC staff work
with you to agree an individual treatment plan. This aims to remove or
reduce any distressing feelings you experience due to the mismatch
between your gender identity and biological sex, and to help you live in
your acquired gender.
It can involve discussing psychological support, the risks and benefits of
hormone treatment or any surgical treatment you may want to consider,
and a likely preliminary timescale for treatment you choose to have.
If you choose to take hormones, you will need regular blood tests and
check-ups to make sure the treatment is working and to identify any
signs of associated health problems.
Genital reconstructive surgery (but not hormone therapy) is subject to
completion of ‘social gender role transition’ (sometimes called ‘real life
experience’).
This involves living in your acquired gender for at least one to two years
– enough time for you to have a range of experiences, such as work,
holidays and family events, face challenges to your self-confidence, and
build self-esteem in your gender identity.
This may seem arduous but a period of psychological adjustment is
currently thought to be integral to success in your new identity.
Following a diagnosis of gender dysphoria, either by a GDC or privately,
you can choose to proceed privately or within the NHS with care
delivered through your GP. It is possible to pursue medical transition
(consisting of hormone therapy and regular blood tests) using a
combination of private and NHS healthcare, but only with the consent of
your GP.
The only way to access gender surgery funded by the NHS is via a
referral from the GDC which undertook your original assessment and
made a diagnosis of gender dysphoria.
The NHS route is free, but demand is high and capacity limited by the
number and location of GDCs - there are currently seven in England and
one in Wales. There may be additional capacity in some areas as local
services develop.

4.1 Transition and hormones

Hormone therapy means taking hormones of the sex you identify with.
The type, intensity, and rate of reaction to hormone therapy varies from
person to person and depends on the type of medication taken.
In the long term, your hormone levels will continue to be monitored by
your GP.

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4.1.1 The trans man’s transition
A trans man may undergo masculinising hormone therapy by taking the
hormone testosterone. Masculinising hormone therapy can be done
alone or along with masculinising surgery.
When taking masculinising hormones, physical and emotional changes
you may experience include:
⚫ beard and body hair growth
⚫ development of male pattern baldness
⚫ slight increase in the size of your clitoris
⚫ heightened libido
⚫ increased muscle mass
⚫ deepening of your voice, but not usually to the pitch of other men
⚫ cessation of periods if you are pre-menopausal

⚫ development of acne.

Breasts will not reduce in size so after a period of living as a trans man,
you may want to pursue chest reconstruction surgery. This removes
breast tissue, reduces nipple size and contours a masculine-looking
chest wall. Hormone therapy may be the only treatment you want, but
surgery to remove your breasts (mastectomy), create a penis
(phalloplasty) or to construct a scrotum (scrotoplasty), and testicular
implants are possible, and may be provided on the NHS.

4.1.2 The trans woman’s transition

A trans woman may undergo feminising hormone therapy by taking the
hormone oestrogen and possibly also a testosterone blocker (pre-
surgery). Feminising hormone therapy can be done alone or along with
feminising surgery.
When taking feminising hormones, physical and emotional changes you
may experience include:
⚫ reduction in sexual appetite
⚫ fat distribution onto your hips and bottom
⚫ slight reduction in the size of your penis and testicles
⚫ erectile dysfunction, finding erections and orgasm harder to achieve
⚫ reduction in muscle mass and power
⚫ breasts feel tender and lumpy and sometimes increase modestly in size
⚫ reduction in facial and body hair growth, which can support hair removal
using electrolysis, laser or other techniques
⚫ male pattern baldness slowing or stopping but not necessarily reversed

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 Your voice will not rise in pitch and you may need speech therapy to
achieve a more female tone. As hormone treatment can affect your
emotions, you may notice changes in your mood including mood swings.
You may only want hormone therapy, but surgery like the removal of
male genitalia, construction of a vagina (vaginoplasty), clitoris
(clitoroplasty) or vulva (vulvaplasty) may be available via the NHS.
Breast enhancement (mammoplasty) is not routinely available on the
NHS.
Electrolysis for the removal of unwanted hair is available for a limited
number of sessions via the NHS. Beyond this, you are required to pay
for additional sessions.

4.1.3 Risks of hormone therapy

There are risks associated with taking hormone therapy. Risks which
may depend on your overall health when you start taking hormone
therapy and how long you take it for. The most common risks or side
effects can include:
⚫ weight gain
⚫ acne
⚫ gallstones
⚫ hair loss or balding (androgenic alopecia)
⚫ blood clots
⚫ dyslipidaemia (abnormal levels of fat in the blood)
⚫ elevated liver enzymes

5 Surgical transitioning in later life

All the stages described above are possible for older people. However,
the older you are, the more you need to be aware of the limits, potential
impacts and risks of hormone therapies and surgery.
Issues discussed at a GDC assessment, if considering surgical
treatment, include:
⚫ your general physical fitness and whether you have a history of high
blood pressure, circulatory or cardiac problems
⚫ whether you smoke or have been a smoker
⚫ your weight, particularly if you are overweight.

Transitioning is a very personal process and will look different to each

person. You may find counselling useful particularly at the early stages of
your transition.

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 6 Getting older
The way that you experience later life varies according to the age you
transitioned and when that was. If you are now 60 and transitioned when
you were 20, you will have had a different experience compared to those
who are in later life now and starting to transition. Annual health checks
are recommended as a minimum.

6.1 Being a healthy older trans man

Issues to consider and discuss with health professionals, particularly if
you sense, see, or feel anything unusual, include:
⚫ bone strength and osteoporosis risk
⚫ side effects associated with testosterone hormone therapy
⚫ lifestyle issues – smoking, diet, and exercise
⚫ blood pressure
⚫ vaginal health (if you still have a vagina)
⚫ whether or not to undergo a hysterectomy
⚫ need for smear tests if you have not had a full hysterectomy
⚫ risk of urethral stones, if you had genital reconstruction
⚫ breast screening (even when breasts are removed, not all potentially
cancerous glands are removed)
⚫ the state of silicone testicular implants and/or penile prosthetics.

6.2 Being a healthy older trans woman

Issues to consider and discuss with health professionals, particularly if
you sense, see, or feel anything unusual, include:
⚫ bone strength and osteoporosis risk
⚫ the long term effects of oestrogen hormone therapy
⚫ lifestyle issues - smoking, diet, and exercise
⚫ blood pressure
⚫ oestrogen, testosterone, and prolactin (hormone), sex hormone binding
globulin (SHBG) levels and liver function
⚫ prostate health
⚫ dilation and douching advice if you had a vagina (vaginoplasty)
⚫ the health of your vagina
⚫ breast self-examination and mammograms
⚫ the state of silicone breast implants
⚫ Abdominal Aortic Aneurysm (AAA) Screening – checking for a swollen or
bulging aorta (artery from the heart). Offered to men over 65.

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 Health screening
Knowledge is improving as people age. There are still unanswered
questions about what later life and health are like for the generation of
trans people in their 60s and over who have taken hormone therapy for
40 years or more. Many are living with gender reassignment surgeries
performed using different techniques of the 1960s and 70s.
NHS England have a leaflet explaining which screening in the national
screening programme you can have. In Wales, visit the Public Health
Wales website to download their leaflet, ‘Screening information for
people who are Transgender, Non-binary, Gender-diverse’.

6.3 Looking after your mental wellbeing

Taking steps to transition, living in your acquired gender, and your
response to hormone therapy can have a significant and positive impact
on your mental wellbeing. At the same time, fears and uncertainties
about your new life and other people’s responses can undermine your
self-esteem and the positive impacts of your decision to transition. There
may be considerations you have simply not had time to address.
Many local authorities can put you in touch with local social and support
organisations for LGBTQ+ people, with some groups for trans people
only. Search the equality or support organisations area on their website
or contact the customer services department.
If you struggle with your mental wellbeing and it is starting to interfere
with your daily life and relationships, seek help from your GP. Common
mental health conditions include low mood, depression and anxiety. The
symptoms of depression can be complex and vary widely between
people. Depression is more than feeling low. As a general rule, you may
feel sad, hopeless, and start to lose interest in things you used to enjoy.
Symptoms like these can go on for weeks or months.
At its mildest, you may feel persistently low, while severe depression can
include thoughts of suicide, suicidal behaviours and self-harm. Many
people wait a long time before seeking help, but it is best not to delay.
With the right treatment and support at the right time, most people with
depression can make a full recovery. See Age UK guide Your mind
matters, for more information.

6.4 Sexual health

Regardless of your sexual orientation, having a fulfilling sex life,
practicing safer sex, and preventing sexually transmitted infections
(STIs) are important for good health and wellbeing. In England, contact
your local NHS GUM clinic (Genito-Urinary Medicine), search ‘sexual
health services and support’ on NHS website or call 111. In Wales, visit
the ‘Sexual & Reproductive Health’ section of the NHS 111 Wales
website. You do not need a GP referral. Clinic staff do not share
information with your GP or others unless you ask them to.

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 7 Your rights

7.1 The Gender Recognition Act: the basics

The Gender Recognition Act 2004 (GRA), introduced in April 2005, is the
framework that gives legal recognition to a trans person's acquired
gender and recognises a trans person as someone who lives
permanently in their acquired gender and intends to do so for the rest of
their life.
Whilst most applicants must provide evidence of a diagnosis of gender
dysphoria, there is no requirement to undergo hormone therapy or
gender reassignment surgery.

What gender recognition means

The GRA enables trans people over the age of 18 to apply to the Gender
Recognition Panel for 'gender recognition'. If successful, you receive a
Gender Recognition Certificate (GRC) which is needed to change your
sex marker on your birth certificate.
Once you have a GRC, you must be treated as your acquired gender for
legal purposes, including marriage, civil partnership, and registration of
death. A GRC gives you enhanced privacy rights. See section 7.2 if you
are married or in a civil partnership.
Non-binary identities are not covered by the GRA.

Applying for GRC

Official guidance contains information to help at each stage of the
process. It alerts you to organisations you must notify if successful, such
as HM Revenue and Customs.
To apply you need; an original or certified copy of your full birth certificate
or adoption certificate, two medical reports, evidence that you have lived
in your acquired gender for the past two years, £5 application fee and
copies of marriage or civil partnership certificates (if applicable).
For further details on how to apply for a GRC see: www.gov.uk/apply-
gender-recognition-certificate/changing-your-gender

A right to privacy
Section 22 of the GRA provides high levels of privacy protection. It
makes it a criminal offence for any individual who has information about
you in their official capacity to disclose you have a GRC without your
express permission. ‘Official capacity’ includes all service providers,
government agencies, local authorities, membership groups and
associations, employers, and the police (except in rare circumstances).
You should put in writing any limits you place on further disclosure to
anyone who knows your medical history. If you have privacy problems,
contact Galop.

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7.2 If you are in an existing marriage or civil partnership
You can stay married if you apply for a GRC. To do so, you and your
spouse must fill in a statutory declaration saying you both agree to stay
married. If you or your spouse do not wish to stay married, you get an
‘interim certificate’ instead of a GRC.
You can stay in a civil partnership if it was registered in England, Wales
or Northern Ireland. Your partner must fill in a statutory declaration
saying they agree to stay in a civil partnership with you. If your partner
does not agree, you get an ‘interim certificate’ instead of a GRC.
An interim certificate can be used to end a marriage or civil partnership
and must be used within six months of date of issue. You then get a full
GRC. An interim certificate does not change your legal sex or offer the
legal protections of a full GRC.

7.3 The Equality Act 2010

The Equality Act 2010 (‘the Act’) provides a legal framework to protect
the rights of people based on their ‘protected characteristics’ and to
advance equality of opportunity for all. The Act defines nine protected
characteristics, which means it is unlawful to discriminate against people
or treat them differently due to any one of the protected characteristics.
Gender reassignment is a protected characteristic under the Act. This
gives protection against discrimination, harassment, and victimisation. To
be protected, you do not need to have undergone treatment or surgery.
You can be at any stage in the transition process – proposing to, or
undergoing a process to reassign your sex, or have completed it.
The Act defines exceptions when it is lawful to treat people differently on
the grounds of a protected characteristic. In doing so it must be shown
that any action taken is proportionate in meeting a legitimate aim.
For example, a women’s refuge may provide single sex services to
females and in doing so, exclude, modify or limit access on the basis of
sex. This could be for reasons of privacy, to prevent trauma or ensure
health and safety. If so, a trans woman with the protected characteristic
of gender reassignment can lawfully be excluded from the service if it is
shown to be a proportionate means of achieving a legitimate aim.

Employment rights
The Act makes it unlawful for an employer, at the recruitment stage and
as an employee, to discriminate against you, or treat you less favourably
due to gender reassignment. Protection from harassment applies to
harassment from your employer, colleagues, customers, or suppliers.
The Act specifically requires employers to treat absence from work for
procedures related to gender reassignment as they would accept
absence for sickness, injury, or any other reason. You can bring a claim
at an Employment Tribunal if discriminated against on these grounds.

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 The Act says employers can, in some situations, take steps to encourage
people from groups with different needs or with a past track record of
disadvantage or low participation (including trans people) to access
employment or training. This is called positive action.

Public bodies
The Public Sector Equality Duty is an important part of the Act. It aims to
encourage public bodies to go beyond elimination of unlawful
discrimination, harassment, and victimisation and consider how they can
positively contribute to the advancement of equality and foster good
relations between different groups.
The duty applies to private bodies carrying out public functions, as well
as local or national government bodies. For example, a hospital could
offer a trans man the first appointment of the day for a hysterectomy.
This avoids the potential awkwardness or embarrassment of being one
man among many women in the waiting room.
Private clubs and other associations
A private club or other association cannot discriminate against, harass,
or victimise an existing or potential member or an associate on the
grounds of gender reassignment. For example, it cannot refuse
membership or grant membership on less favourable terms by applying
different conditions or fees.

Customers and service users

You are protected against discrimination, harassment, and victimisation
in the provision of goods, facilities, and services on the grounds of
gender reassignment. This applies to the public and private sectors.
For example, it is unlawful on the grounds of gender reassignment for a:
⚫ publican or shopkeeper to refuse to serve you
⚫ leisure centre to refuse you permission to use their facilities
⚫ housing association to refuse you accommodation, offer housing of
lesser quality, or on different terms.

The law applies to almost all circumstances, with some exceptions. For
example, providers of separate or single sex services can, in some
circumstances, lawfully exclude, modify or limit access to their service to
someone undergoing, or who has undergone, gender reassignment. See
the EHRC guide: Separate and single-sex service providers: a guide on
the Equality Act sex and gender reassignment exceptions.

Note
For advice and support about discrimination and human rights,
contact the Equality Advisory and Support Service.

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8 Hate crime
If you believe you are the victim of a crime motivated by prejudice or
hate, you should report it as a hate crime. The True vision website
states:
‘Transgender hate crimes' and non-crime incidents are acts which target
a victim because of the offender's hostility to a transgender person or to
transgender people in general. Hate crimes can be committed against a
person or property.
A transgender hate crime could target someone who is not themselves
transgender and the harmed person could be, for example, the child of a
transgender person or someone mistaken as being transgender, so long
as the offender was motivated, wholly or partially, by a hostility to
transgender people.’
Hate crimes can involve physical attacks, verbal abuse, domestic abuse,
harassment, damage to your property, bullying, or graffiti. Reporting an
offence as a hate crime to the police helps ensure it is treated in the
most appropriate and effective way. There are various safe, discreet or
anonymous ways to do this including online and through third parties.
You can discuss your experiences with Galop advocacy service, or go to
the True Vision website for information: www.report-it.org.uk/home

9 Financial issues
Getting a GRC can affect National Insurance (NI) contributions, tax
liability, benefits, and pensions that you, your spouse or civil partner may
be receiving now, or in the future. It can affect pensions that may be
payable to your spouse based on your earnings or NI contributions.

State Pension
For the purposes of State Pension, a trans person must be recognised in
their acquired gender if they have had gender reassignment surgery and
lived in their acquired gender for a significant period. This means that
trans women may be entitled to backdated State Pension if you:
⚫ were born between 31 October 1953 and 6 November 1953
⚫ lived in your acquired gender for at least two years by 31 October 2018
⚫ have had gender reassignment surgery
Contact the Pension Service for further information. State Pension age
for men and women is now 66 years and increases to 67 years by April
2028. See factsheet 19, State Pension, and factsheet 48, Pension
Credit, for more information.

Other benefits
You should not have problems claiming other social security benefits
such as Pension Credit or Housing Benefit following transition.

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 General financial issues
You may wish to seek advice from an independent financial adviser in
advance of any legal change of sex and take proactive steps to protect
your interests as much as possible.

Note
For State Pension information or how a GRC may affect a pension
paid to your spouse, contact the DWP Gender Recognition Team.
HMRC provides information about national insurance payments and
tax credits. The FCA authorises financial advisers. For more
information, see factsheet 43, Getting legal and financial advice.

10 Care services
There is now an ageing trans population. As a result, many health and
social care professionals are working for the first time with older trans
clients, who may have complex social or bodily needs relating to their
gender reassignment.
If you underwent treatment in the 1960s and 70s, you may experience
common issues that come with ageing and some unique to trans people.
If you pursued gender transition and reassignment more recently, you
may be an older person in most respects but ‘young’ in terms of your
experience of living and being in your acquired gender.
Given this potential complexity, it may be appropriate for a health or care
professional to seek advice from a multi-disciplinary team on how best to
meet your needs. However, if you have a GRC, your privacy rights mean
anyone involved in delivering care must get your permission before
discussing you with others in any way that might identify you as trans.
If approaching a care agency or local authority for a needs assessment,
or considering hospital tests or treatment, it is important to be mindful of
issues you face daily to manage your physical health and wellbeing and
your personal privacy needs. Consider the following questions and raise
concerns prior to engaging with health and care services.
Trans women
⚫ Do I still look masculine when undressed?
⚫ Do I still have a penis?
⚫ Do I have breasts?
⚫ Do I need to shave regularly?
⚫ Do I need my own room in which to dilate and douche?
⚫ What do I need in order to maintain my hormone regime?
⚫ Do I need to maintain my hair, wig, hairpiece or weave?
⚫ Am I taking medication normally associated with men?

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 Trans men
⚫ Do I still look feminine when undressed?
⚫ Do I still have breasts?
⚫ Do I have no penis?
⚫ Do I need to take special care of my penis or metoidioplasty (a
procedure that uses testosterone-related growth of the clitoris to create a
functioning penis) for example when undergoing catheterisation?
⚫ What do I need to maintain my hormone regime?
⚫ Am I taking medication normally associated with women?

10.1 Seeking care and support

All local authorities, care agencies, care homes, and organisations
providing care should have accessible equality, anti-bullying and
confidentiality policies and provide staff with equality and diversity
training. You can ask to see a copy of their policy and if their remit does
not include trans people, ask who you should contact to discuss this.
If needing help with care at home, you can involve your local social
services department or make arrangements directly with a care agency.
If you have dementia-related concerns or a diagnosis, the Alzheimer’s
Society can help you think about care and support options.

Needs assessment and care planning

If you approach your local authority social services department, they
must carry out a assessment if it appears that you may have needs for
care and support. The assessment must consider your mental capacity
to contribute to your assessment and make care decisions for yourself
and take into account all your needs – psychological, social and cultural,
as well as personal care needs. Based on national eligibility criteria, they
decide if you are eligible for care and support and if so, work with you to
decide how best to meet your needs. This may be through care at home,
a move to sheltered housing or care in a care home.
For more information, in England see Age UK factsheet 41, How to get
care and support. In Wales, see Age Cymru factsheet 41w, Social care
assessments for older people with care needs in Wales.

Financial assessment
Services – home care or residential care - arranged by the local authority
are means tested, and you may have to make a financial contribution.
They look at your income and capital to decide if you do, and how much.
In England see Age UK factsheet 46, Paying for care and support at
home, and factsheet 10, Paying for permanent residential care. In Wales
see Age Cymru factsheet 46w, Paying for care and support at home in
Wales and 10w, Paying for a permanent care home placement in Wales.

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 Direct payments for care at home
If eligible for financial help from a local authority, you have the option to
receive it as a direct payment. This means you arrange services
yourself, or with support from a third party. You can choose to recruit a
personal assistant, who can respond to your individual needs and
preferences and offer continuity of care at home.
In England see Age UK factsheet 24, Personal budgets and direct
payments in social care. In Wales see Age Cymru factsheet 24w, Direct
payments for social care services in Wales.

10.2 Sheltered housing and residential care

If you have eligible needs that can be best met by sheltered housing or
in a care home, you (and your carer if you have one) should identify
possible locations and visit all establishments you are considering.
In England: If eligible for local authority financial help towards a care
home place, they must provide you with a choice of at least one care
home within the personal budget amount they agree is required to meet.
In Wales: If eligible for local authority financial help towards a care home
place, the authority must have more than one option available for a
person to choose from within its ’standard amount’ for residential care.
For more information, see factsheet 64, Specialist housing for older
people. In England, see Age UK factsheet 29, Finding, choosing and
funding a care home, and in Wales, see Age Cymru factsheet 29w,
Finding care home accommodation in Wales.

10.3 Making a complaint about your care

Local authority services

If you have a concern or problem with social care arranged or provided
by the local authority, try to resolve it by speaking to your social worker
or their line manager. If this proves unsatisfactory, you can formally
complain using the local authority complaints procedure.
In England, see Age UK factsheet 59, How to resolve problems and
complain about social care. In Wales, see Age Cymru factsheet 59w,
How to resolve problems and make a complaint about social care in
Wales.

Privately arranged care

If you have a concern or problem with privately arranged care, use the
agency or care home’s complaints process.
If you remain dissatisfied, you can approach the Local Government and
Social Care Ombudsman in England or the Public Services
Ombudsman in Wales.

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 NHS services
The LGBT Foundation offers a quality assurance scheme to help GP
practices and other NHS services strengthen and develop their
relationships with LGBT patients. If you have a concern or problem with
your GP practice, community health services or hospital care, raise it
with the health professional concerned or their manager. You may be
able to resolve it informally but if your concerns are not adequately
addressed, or their seriousness warrants a wider investigation, you can
make a formal complaint.
In England, see Age UK factsheet 66, Resolving problems and making a
complaint about NHS care. In Wales, see Age Cymru factsheet 66w,
Resolving problems and making a complaint about NHS care in Wales,
or contact your local Llais team.

11 Mental capacity and making decisions

There may come a time when you can no longer make or communicate
decisions about your care or treatment. To address this, you can write
down your beliefs and values, important aspects of your life, and
preferences about future care in an ‘advance statement’.
You could, for example, describe the type of clothing you wish to wear or,
if you are a trans man with small feet, ask that care staff only purchase
male footwear for you, or who you would like to be involved in your care.
An advance statement does not have legal standing but can be a guide
to anyone who must make decisions in your best interests, if you lose
the capacity to make such decisions or communicate them.
For more information, see Age UK factsheet 72, Advance decisions,
advance statements and living wills and Age UK guide Thinking about
end of life useful when considering advance care planning.

Lasting powers of attorney

You can make two separate Lasting Powers of Attorney (LPA), one for
financial decisions and another for health and care decisions. You can
only make an LPA whilst you have mental capacity to understand the
powers you are giving to your attorney or attorneys.
They are legal documents where you appoint one or more people you
trust to act as your attorney. They must make ‘best interests’ decisions
on your behalf, when you no longer have mental capacity to make or
communicate a particular decision that needs to be made.
For more information, see Age UK information guide Power of attorney
and Age UK factsheet 22, Arranging for someone to make decisions on
your behalf.

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12 Wills and intestacy
Making a will
You should write a will to ensure your property and assets go to those
people you want to have them. Make sure you are fully and clearly
identified in your will – this is especially important if you use two names
or have only recently begun to live permanently in your acquired gender.
For information, see Age UK information guide Wills and estate planning
and factsheet 7, Making a Will.

Being the beneficiary of a will

To ensure you can benefit from a will, keep evidence of your past
identity, including your biological sex. Your GRC provides the link but if
you do not have one, keep any legal paperwork associated with your
change of name.

13 Bereavement and registration of death

Most deaths are registered by a relative of the deceased or someone
present at the death if no relatives are available.
If you have a GRC, your acquired gender must be used when registering
your death. If living permanently in your acquired gender but you did not
have a GRC, it is permissible to register your death in your acquired
gender, as long as your passport and medical card support this (a birth
certificate is not a legal requirement to register a death).
Problems can arise, in the case of a trans person, when stating the sex
of the deceased. Relatives sometimes register the death in their
biological sex, no matter how long they lived in their acquired gender.
If an error is made registering a death, the law allows for details to be
changed or added. Approach the office where the death was registered,
although paperwork needs to be sent for authorisation to the Corrections
and Re-registration Section at the General Register Office.

Note
If responsible for registering a trans person’s death, contact the
General Register Office with any uncertainties. If you were not
responsible but are concerned someone else registered their
gender identity incorrectly, contact the General Register Office.

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14 Partners of trans people
If you are the partner of a trans person, watching what happens to your
loved one as they explore their gender identity can be challenging,
whether or not they decide to pursue transition.
Many trans people and their partners remain in settled, happy
relationships but as a partner, you may feel a sense of loss, confusion,
anger, or hurt. It can affect your sense of who you are.
Many concerns may arise, such as how do you address each other in
public? How and what do you tell people, including friends and relatives?
In addition, you may have to witness or help your partner deal with
comments or discrimination including transphobia.
As a partner, you may benefit from your own independent support, see
the Useful Organisations section.

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15 Glossary
⚫ Acquired gender: a legal term used in the Gender Recognition Act
2004. It refers to the gender in which an applicant is living in and seeking
legal recognition of.
⚫ Affirmed gender: your gender identity following transition – the gender
with which you identify has been affirmed.
⚫ Asexual: term used to describe someone who does not have a sexual
attraction to individuals of any gender.
⚫ Bilateral mastectomy: removal of some breast tissue from both breasts
and the reconstruction of the chest wall to resemble a male chest.
⚫ Clitoroplasty: Surgical construction of a clitoris
⚫ Gender dysphoria: medical term used to describe the feeling of
discomfort or distress between their biological sex and gender identity.
⚫ Gender expression: the way in which a person expresses their gender
identity, typically through their dress and behaviour.
⚫ Gender fluid: a wider and more flexible range of gender identities that
varies over time.
⚫ Gender identity: your internal sense of being male or female, both or
neither.
⚫ Gender incongruence: describes a sense of discomfort or distress that
a person may feel about the difference between their biological sex and
gender identity.
⚫ Gender reassignment: describes the process a trans person
undertakes to transition socially and/or medically to live in their gender
identity.
⚫ Gender reassignment surgery / genital reconstruction surgery:
surgical procedures that alter secondary sex characteristics to reflect a
person’s gender identity.
⚫ Gender variance: describes a sense of discomfort or distress that a
person may feel about the difference between their biological sex and
gender identity.
⚫ Metoidioplasty: a surgical procedure using the growth of the clitoris,
which results from taking testosterone, to create a penis.
⚫ Non-binary or Enby: someone who does not subscribe to a binary sex
and who may regard themselves as neither male or female, or both male
and female or take another approach to gender identity.
⚫ Oophorectomy: surgical removal of the ovaries.
⚫ Orchidectomy: surgical removal of the testes.

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⚫ Pansexual: term used to describe someone who is attracted to
individuals of any sex or gender identity.
⚫ Penectomy: surgical removal of penile tissue.
⚫ Phalloplasty: surgical procedure to construct a penis.
⚫ Scrotoplasty: surgical procedure that creates a scrotum for testicular
implants.
⚫ Trans or transgender: umbrella terms that embrace the many different
identities of people whose gender identity differs from their biological
sex.
⚫ Trans*: an asterisk is sometimes added as a way of including all trans,
non-binary and gender nonconforming identities.
⚫ Transsexual: used largely in medical or legal circumstances to describe
someone who proposes to undergo or has undergone gender
reassignment.
⚫ Transition: the process of social and/or medical changes a person may
take to live in their gender identity. This may include hormone therapy,
surgery, social and legal changes.
⚫ Transvestite: a person who enjoys wearing clothing associated with the
opposite sex for personal comfort and pleasure – the term cross-dresser
is generally preferred.
⚫ Vaginectomy: surgical removal of the vagina and closure of the vaginal
opening.
⚫ Vaginoplasty: surgical procedure performed to create a vagina.
⚫ Vulvaplasty: surgical construction of a vulva.

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Useful organisations
Alzheimer’s Society
www.alzheimers.org.uk
Support line 0333 150 3456
Provides information on a range of issues affecting people living with
dementia and their carers

Beaumont Society
www.beaumontsociety.org.uk
Information line 01582 412 220 (24 hour)
A self-help body run by the trans community, providing support, advice
and training. Beaumont Partners offers support to women experiencing
issues when they discover their partners are trans.

CliniQ
www.cliniq.org.uk
A holistic sexual health and wellbeing service based in London for all
trans people, partners and friends delivered by a trans-led team.

Department for Work and Pensions (DWP) Gender Recognition

Team
Telephone 0191 218 7622
Email: [email protected]
Department providing information on state pension entitlement if you
have a GRC or for information if you have a spouse or civil partner.

Depend
www.depend.org.uk
Depend offers free web information and online support to family
members, partners, spouses and friends of transsexual people.
Dementia UK
www.dementiauk.org
Admiral Nurse Dementia Helpline: 0800 888 6678.

Works to improve the quality of life of people with dementia and provides
online and printed information resources. Contact their helpline to speak
to the LGBTQ+ Admiral Nurse service.

Equality Advisory Support Service

www.equalityadvisoryservice.com
Telephone helpline 0808 800 0082 Mon-Fri 9am-7pm, Sat 10am-2pm
Funded by the Equality and Human Rights Commission, the EASS
Helpline provides information and advice about the Equality Act 2010.

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Financial Conduct Authority
www.fca.org.uk
Telephone 0800 111 6768 or 0300 500 8082
Financial Conduct Authority regulates the UK financial services industry.

Galop
www.galop.org.uk
Telephone 0800 999 5428
Galop is a community-led group for LGBT+ people and offers advocacy
support to help tackle discrimination, hate crime, or domestic abuse.

Gender Identity (NHS Wales)

www.gender.wales
Provides information about gender dysphoria for individuals and
professionals in NHS and public services in Wales.

General Register Office

www.gov.uk/general-register-office
Telephone 0300 123 1837
The register holds records of births, deaths, marriages, civil partnerships,
stillbirths and adoptions in England and Wales.

GIRES (Gender Identity Research and Education Society)

www.gires.org.uk
GIRES is a volunteer operated membership charity that aims to
empower, and provide information and support to trans, gender non-
conforming, non-binary and non-gender individuals, and their families.

Gov.uk
www.gov.uk/apply-gender-recognition-certificate/overview
Telephone 0300 1234 503
Government website with information on benefits and explains how to
apply for a Gender Recognition Certificate.

Healthwatch England
www.healthwatch.co.uk
Telephone helpline 03000 683 000
The consumer champion for health and care services in England. Find
your local Healthwatch by searching the website or calling their helpline.

LGBT Foundation
www.lgbt.foundation/
Telephone helpline 0345 3 30 30 30
The Foundation’s Trans programme aims to improve the health,
wellbeing of trans people.

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LGBT+ Cymru Helpline
www.lgbtcymru.org.uk
Telephone 0800 917 9996
Provides information, advice and confidential support on various issues
that affect LGBTQ+ people, their families and friends.

Llais
www.llaiswales.org
Telephone 029 20 235558
A body that represents the voices and opinions of people in Wales in
regard to health and social care services. Can provide complaints
advocacy service.

Local Government and Social Care Ombudsman

www.lgo.org.uk
Telephone helpline 0300 061 0614
Investigates complaints about local authorities and social care providers.

NHS Gender Dysphoria National Referral Support Service

(GDNRSS)
Support line 01522 857799
The GDNRSS Coordinates access to gender reassignment surgery for
men and women.

NHS 111 Wales

www.111.wales.nhs.uk/
Telephone helpline 111
Service offering a telephone helpline and web information on finding
local health services in Wales and on a wide range of health conditions.

NHS website
www.nhs.uk
A comprehensive web information service to help you learn more about a
wide range of health conditions, find NHS services in England, improve
and make choices about your health and manage long term conditions.

Older Peoples Commissioner for Wales

www.olderpeople.wales
Telephone 03442 640 670
An independent voice and champion for older people across Wales,
standing up for and speaking out on their behalf.

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Pension Service (The)
www.gov.uk/contact-pension-service
Telephone: 0800 731 0469
Details of state pensions and how to claim.

Press for Change

www.pfc.org.uk/
Adviceline 08448 708 165
Provides legal advice, training, and research to trans people, their
representatives, and public and private bodies.

Public Services Ombudsman for Wales

www.ombudsman.wales/
Telephone 0300 790 0203
The Ombudsman investigates complaints about public services and
independent care providers in Wales.

Royal Osteoporosis Society (NOS)

www.theros.org.uk
Telephone helpline 0808 800 0035
Information on prevention and treatment of osteoporosis.

Sibyls
www.sibyls.co.uk
A confidential Christian spirituality group for trans people, their partners
and supporters.

TranzWiki
www.gires.org.uk/tranzwiki/
TranzWiki aims to be a comprehensive web-based directory of the
groups campaigning for, supporting or assisting trans and gender non-
conforming individuals and their families across the UK.

True Vision
www.report-it.org.uk/home
True Vision provides information about hate crime or incidents and how
to report them.

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Age UK
Age UK provides advice and information for people in later life through
our Age UK Advice line, publications and online. Call Age UK Advice to
find out whether there is a local Age UK near you, and to order free
copies of our information guides and factsheets.

Age UK Advice
www.ageuk.org.uk
0800 169 65 65
Lines are open seven days a week from 8.00am to 7.00pm

In Wales contact
Age Cymru Advice
www.agecymru.org.uk
0300 303 44 98

In Northern Ireland contact

Age NI
www.ageni.org
0808 808 75 75

In Scotland contact
Age Scotland
www.agescotland.org.uk
0800 124 42 22

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Our publications are available in large print and
audio formats

Next update July 2025

The evidence sources used to create this factsheet are available on
request. Contact [email protected]

This factsheet has been prepared by Age UK and contains general advice
only, which we hope will be of use to you. Nothing in this factsheet should
be construed as the giving of specific advice and it should not be relied on
as a basis for any decision or action. Neither Age UK nor any of its
subsidiary companies or charities accepts any liability arising from its use.
We aim to ensure that the information is as up to date and accurate as
possible, but please be warned that certain areas are subject to change
from time to time. Please note that the inclusion of named agencies,
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does not constitute a recommendation or endorsement by Age UK or any of
its subsidiary companies or charities.
Every effort has been made to ensure that the information contained in this
factsheet is correct. However, things do change, so it is always a good idea
to seek expert advice on your personal situation.
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