Have there been any studies about elderly trans people with dementia?

[GreatFox]

I am currently dealing with dementia in my personal life.

So many people with dementia revert back to childhood emotionally and withing their own version of reality. We are told the best thing to do is go along with this as correcting them can be upsetting (ie telling them their mums have passed away 30 years ago)

I was wondering if its known if Trans people go back to thinking they are their biological sex if they have dementia? As they most probably would have lived their childhoods as thei biosex.

And if they become confused/distressed if they have had gender reassignment surgery?

I don't know the answer to this, but given that people with trauma histories in childhood can often return to those frightening times, I'm guessing that their childhood sex and sexuality will be what they identity as. I think this will be a massive problem for those men who have surgery.

I think ones sense of identity and ego probably decrease a lot. It's an interesting question.

I wonder if there are statistics from how many Alzheimer's/dementia sufferers identify (or did do when had capacity) as trans? I'd have thought now not many.

This has in fact been recognised as an "issue" for some years.

I did a quick search and found these few. I am sure there are better ones than this that you could find.

https://www.alzheimers.org.uk/get-support/help-dementia-care/lgbtq-dementia-memory-problems

https://www.bbc.co.uk/news/uk-wales-43365446

https://www.reddit.com/r/asktransgender/comments/1iyeap3/if_a_trans_person_gets_alzheimers_and_forgets/

This is what I am thinking. Identity and social community is a big part of the trans world. I feel like if someone had dementia those types of things just wouldnt register as much, if at all.

Yeah, almost like, if you don't even know that other people exist, then the concept of trans no longer does. Like the thing about if a tree falls and nobody is there, does it make a sound? (Obviously it does, because, you know, physics) But how much of our character is based around knowing others are observing it?

It’s an interesting question. There was an interview with a Tim who was the first person in NI to get gender reassignment surgery on the Nolan podcast. A point he made was aging as a trans person is actually pretty tough as the cross sex hormones cause lots of long term health problems he was suffering with osteoporosis and other issues I think it was kidney and heart.

I feel a bit callous but I strongly suspect in the long term we will see that the average age of death of a person who has undergone gender reassignment surgery is far short of the average.

I think the point made in the links I give is that many (not all) with dementia reverty to early memories and experiences.

And in doing so remember themselves as the sex they were born.

Which to my mind makes it seem that even if they had issues as a child (as so many of us do eg when going through puberty) they didn't think it was about being in the wrong body, or identifying out of it.

So without external influences and false narratives being whichever sex they were born is the one their memory remembers.

I think the main issue is that as memories fade, the most recent ones go first - like my granny not remembering who my mother was, but being able to name all the neighbours on the street she grew up on.
So the trans person with dementia is likely to end up only with memories from the time before they transitioned.

The links provided by IwantToRetire are very useful, thank you.

Proof that this is not some kind of attempted GC anti-trans 'gotcha' is that the guidance referred to in the BBC article was drawn up by a trans person who was very upfront and honest about this being a real issue:

"Take for instance a transgender woman - they may well get quite concerned and disturbed at being in female clothes.
"They may worry why certain parts are missing from their anatomy. So it's these sort of things that I'd like staff to be aware of. There's no simple answer… but it really is a worrying scenario."

cross posted with IwantToRetire.

Proof that this is not some kind of attempted GC anti-trans 'gotcha' is that the guidance referred to in the BBC article was drawn up by a trans person who was very upfront and honest about this being a real issue:
"Take for instance a transgender woman - they may well get quite concerned and disturbed at being in female clothes.
"They may worry why certain parts are missing from their anatomy. So it's these sort of things that I'd like staff to be aware of. There's no simple answer… but it really is a worrying scenario."

That could create a genuine dysphoria. Imagine a man who had his body modified in order to live his fetish, goes on to develop dementia and is stuck inside a body that he genuinely doesn't recognise as his. A horrible situation I would not wish on anybody.

It does sit rather at odds with the insistence of many trans people that they've always known from a very young age that they were the sex/gender that they identify as.

This phenomenon does suggest a large element of choice or agency about the desire to change identity, as opposed to an innate knowledge of what they always 'really are'.

I agree that it must be absolutely horrendous for a person with dementia to realise that their body is missing basic parts and/or has additions that should never be there for a person of their actual sex.

You can easily go along with them and 'their truth' when it comes to other people - and agree with them e.g. that their beloved grandmother will indeed be coming to visit as soon as she can book a train ticket, even though they are aged 88; but how can you possibly comfort them and tell them white lies to avoid upsetting them when it's as clear as day to them that something is undeniably wrong?

Also, I wonder what happens when it comes to people who had their birth certificates and other documents legally falsified when they had capacity and firmly identified as trans? How does that eventually work with the death certificate? Do they legally have to be registered as having been their preferred sex/gender, even though they clearly wanted to revert to their actual sex once their dementia took hold, albeit no longer with the capacity to officially express this? Do you put out the death notices and then hold a funeral for Uncle Jonathan or for Auntie Jennifer?

People don’t forget they are straight or gay with dementia - but they do forget their gender identity. So it can’t be innate, can it?

The guide produced in Wales mentioned in that BBC link has disappeared from the NHS site and can now only be seen on this Dutch site.

supporting-me-transgender-dementia-final.pdf

It says:

A person may not recall their current gender. They may see themselves as being pre-transition resulting in heightened disorientation and anxiety. They may be surprised to see the physical changes that have occurred.

A person may not understand why they are being referred to as their preferred gender when they believe that they have not publicly voiced this preference.

I wonder why the guide has disappeared?

Not sure if there are comprehensive studies on this phenomenon but there is anecdotal evidence, e.g.

I read about trans person who took mushrooms and on that trip enjoyed being their biological self. When they came out of the trip they no longer wanted to be trans and they were sad about it.

When I read what the trans IDing man said in the BBC article, I felt a degree of respect for him for talking so honestly about this problem - he was obviously more concerned about the well-being of people with dementia than he was with defending gender ideology.

And now it has disappeared from the NHS site - which suggests that they are more concerned with defending gender ideology than the well-being of people with dementia.

I read something like that too, maybe it's the same one?

https://www.reddit.com/r/detrans/comments/1pk9u07/shroom_trip_got_rid_of_my_dysphoria_now_idk_what/

I wonder why the guide has disappeared?

Probably because it undermines the narrative that gender identity is innate and fixed.

It’s a hard thing to study because decades of hormone treatments mean trans people are much more likely to die young of other health matters before they have a chance to develop dementia.

Found a few things. A lot of the research appears to be single person case studies and most of it is behind, very expensive, academic journal paywalls (that my work doesn't subscribe to).

This systematic review has a short section on dementia and makes reference to the case study (second link)
https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2355232

https://onlinelibrary.wiley.com/doi/epdf/10.1002/pnp.724?getft_integrator=tfo&src=getftr&utm_source=tfo

Abstract only
https://www.tandfonline.com/doi/10.1080/07317115.2024.2399575?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Another abstract only link
https://journals.sagepub.com/doi/abs/10.1177/1363460719876835

This seems to be the original link - http://www.wales.nhs.uk/sitesplus/documents/861/Supporting%20Me%20Transgender%20%20Dementia%20-%20final.pdf

It's on the Internet Archive, a copy from 2022. But accessing it now it redirects to https://bcuhb.nhs.wales instead, where the document is gone.

Maybe when they changed the site from wales.nhs.uk to nhs.wales, they cleared out the old documents?

Well, quite.

Like the thing about if a tree falls and nobody is there, does it make a sound? (Obviously it does, because, you know, physics)

Sidenote: Actually that's not true technically there a 3 parts to needed to make a complete sound:

1. Source: AKA what makes the sound (the tree)

2. Medium: AKA the particles on which a sound wave is transmitted, as sound waves cannot travel in a vacuum. (the forest, but really in essence all the particles the forest is made of)

3. Receiver: AKA something to translate the sound waves into a sound, like how a human ear is designed to receive sound waves and then sends a signal to the brain interpreting what the "sound" actually is.

So, no one there means the sound waves are never received therefore never converted into a complete sound.

If they do not want to be referred to in a gendered way that they no longer remember identifying with, and do not identify with, why cannot that be respected? If carers would not impose distressing knowledge upon a patient with dementia (such as saying “Yes, your wife will be back from the shops soon,” rather than “Don’t you remember? Your wife died five years ago.”) why wouldn’t they just agree with patient’s current self-identification, rather than distress them by insisting that they are something that they do not believe or understand?

This guide implies that you should submit to a person’s attempt to gaslight you, until they get dementia, at which point you should gaslight them.

Interesting links that have introduced me to the work of researcher Alexandra Baril and the idea of ‘cogniticism’ which seems to be the assumption that decisions made by your pre-dementia unimpaired self should not be considered more important than the decisions made by your self with dementia. I’m guessing this has particular resonance in Canada because of legal Medical Assistance in Dying - I don’t know what the status of people with dementia is there wrt that, I assume they’re not considered able to consent. I don’t know if an advanced decision to refuse treatment if you have dementia would be valid once you’ve lost capacity.

I wonder if we could find common ground by referring to transition as cognitively grounded - and if you lose areas of cognition, the need to transition may end.

I feel a bit callous but I strongly suspect in the long term we will see that the average age of death of a person who has undergone gender reassignment surgery is far short of the average.

Also, if a large number of trans identifying people are autistic, that also goes against them health wise. Many autistic people don't advocate well for themselves in health care settings. My dd, diagnosed as autistic, but with gender identity issues, for example, does not have the desire to drink frequently enough. This has already had some negative impact on her health aged 30.