The Manifestation of Multilevel Stigma in the Lived Experiences of Transgender and Gender Nonconforming Older Adults

Transgender and gender nonconforming (TGNC) people experience disparities in mental health when compared with non-TGNC sexual minorities and the general population. One line of inquiry with respect to these disparities is the examination of stigma and its connection to emotional and psychological well-being. Recent conceptualizations of stigma draw attention to multiple levels-individual, interpersonal, and structural-that are thought to impact well-being for TGNC people. However, little is known about how multilevel stigma is experienced by TGNC older adults. who navigate stigmatizing environments over a lifetime and who may be especially vulnerable to its cumulative effects. We conducted an interpretive content analysis of biographical interviews with 88 TGNC adults aged 50 and older, from across the United States, obtained from the photography and interview project To Survive on This Shore. Our analyses suggest that TGNC older adults' mental health is indeed impacted by multiple levels of stigma. Individual level stigma is experienced as ongoing vigilance about aspects of oneself that break gender norms, often manifesting in internal conflicts. At the interpersonal level, TGNC older adults navigate unpredictable relationships marked by conflicting expressions of love, acceptance, strain, and exclusion. Structural stigma manifests in constraints brought about by transphobic policies and social norms but also sparks intentional action on the part of TGNC older adults to resist and change these social forces. Clinical interventions to combat stigmatization can use life narratives and a focus on consciousness-raising to promote empowerment and well-being for this group of older adults.