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Transgender people and the issues that affect them have never been more visible. But life can be difficult for over-60s who transition gender, writes Cat McShane.
Teraina Hird was 67 when she transitioned. She did so privately in Thailand after being told she'd need to wait 18 months just for her first NHS appointment.
It was a daunting process. "If you're 25, you've got your whole life in front of you, but at 67 do you want to spend three years in transition?" she says.
But Teraina, now 72, was sure of her decision and went ahead: "I felt I couldn't live with my body not matching my brain gender."
Referrals to the UK's seven gender identity clinics is growing by 20% each year, and the NHS is struggling to keep up with demand.
Image source, Getty Images
Older people like Teraina are often in a hurry to transition after a lifetime of hiding their true gender identity. Famously, Caitlyn Jenner appeared on the cover of Vanity Fair after transitioning at 65. In the UK, former boxing promoter Kellie Maloney recently announced that her gender reassignment was complete at the age of 62.
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Cat McShane's report on gender transition and the over-60s was broadcast on Newsnight
But age-related health conditions can also delay the process. On the eve of 62-year-old Dawn's final surgery to transition to female last year, a heart condition was discovered and her operation was pushed back.
"The moment I was sent home before the operation was one of the worst days of my life," she says. "For the first time in a long time I wanted to take my own life."
Older patients are more likely to have picked up conditions along the way, says Dawn's surgeon James Bellringer, who has performed more than 1,000 male-to-female gender reassignment operations.
"You're more likely to find someone with diabetes or a significant heart problem or a significant chest problem than if you are operating on someone in their 20s," Bellringer says.
There are emotional dangers, too.
Many older transgender people tried to cover up their feelings at a younger age by having marriages and children, and run a high risk of being cut off by family when they finally come out in their 60s or 70s. Nearly half of transgender people with children have no contact with them.
Dawn's son, Lee, 32, is today supportive of his dad's transition from Dave. But when he was first told four years ago, Lee was deeply shocked.
"I didn't know what transgender was," he says. "I never felt comfortable talking to any of my friends about what was happening with my dad. I felt like a freak."
Dawn recalls more positive experiences with her daughter, who oversaw Dawn's first forays into the world of ladies' fashion and make-up.
"It was a complete role reversal. I realised I was being told by my daughter, like an adolescent, to get changed into something more suited to my age," Dawn says.
For partners too, transitioning places a huge strain on the relationship. Many marriages fail. Jane and Barbara's 28-year marriage survived.
Barbara first discovered her husband John was cross-dressing 20 years ago, finding unknown women's clothes in their wardrobe. She was convinced John was having an affair.
Relieved at the truth, they agreed John could dress as a woman in private. "It may seem strange but it brought us closer together, it was our secret," Barbara said.
However, John's permanent transition to Jane four years ago placed a strain on the relationship. Barbara - a founding member of Beaumont Partners, a support group for the spouses and partners and an offshoot of transgender group The Beaumont Society - was forced to question her own identity.
"It was very confusing, one thinks one isn't feminine enough or attractive enough," Barbara says. But after she took time to explore her feelings she "realised it was nothing to do with me, it was Jane who needed to be her real self".
Most NHS Trusts require people to live in their new gender for at least two years before being referred for surgery. That period can be difficult, especially if done while working.
Teraina and her partner Anna May Booth, who's 68, both suffered workplace discrimination, but at an age when it was too late to start their careers anew.
Anna says she was bullied by her line manager and lost half her pension because she retired 10 years early.
Teraina was forced to sell her successful engine business. Customers dropped off as she wore more female attire, and she wrote to the local paper to explain the situation, hoping they'd return.
Unfortunately, a national newspaper picked the story up and ran it under the headline "Mechanic loses nuts and customers bolt," after which the business quickly floundered. She sold it for a fraction of what it was worth.
However, the UK 2010 Equality Act was pivotal for some older transgender people, as it offered a greater range of protections for people at work.
One person who took advantage of this was Jane, who's 66 - once a headteacher called John who had feared being found out by neighbours and colleagues across a lifetime of cross-dressing.
Jane recalls reading the document and being astonished - "the law protects me" - and began her transition.
Despite the medical challenges, Bellringer believes age should not be a barrier.
"In terms of cost effectiveness this is possibly the best operation the NHS does," he said. "Even in a 70-year-old, you've got 15 years of significantly improved quality of life."
And regardless of the challenges, there is an enormous amount of positivity from people transitioning at a later stage of life, who are happy to be living out their final years in their true gender identities.
"I really thought at times I was too old to transition, but the older I got the more determined I became," said Anna. "I'm so glad I did it."
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Image source, Getty Images
Cat McShane's report on gender transition and the over-60s was broadcast on Newsnight - watch it on BBC iPlayer
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