Postoperative Regret Among Transgender and Gender-Diverse Recipients of Gender-Affirming Surgery.

This Viewpoint examines prevalence of and factors associated with surgical regret among transgender and gender-diverse individuals who undergo gender-affirming surgery.

Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults: A Structural Competency Approach.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults experience significant health disparities. Examining these disparities has become an international research priority, but gaps remain. In this review article, we summarize major contributions of and ongoing gaps in health disparities research among LGBTQ+ older adults, while focusing on four major content areas: (a) social determinants of health disparities, (b) mental, cognitive, and physical health disparities, (c) reproductive and sexual health disparities, and (d) seeking LGBTQ+-affirming and age-friendly care. Using a structural competency approach, we develop a four-part agenda for this research area that enhances our understanding of how macro-level systems, institutions, and structures drive health disparities among aging LGBTQ+ communities. We also outline future research on structural competency in LGBTQ+ older adult health, while providing recommendations for researchers and clinicians. These recommendations illuminate potential best practices for bettering the health and quality of life of LGBTQ+ older populations.

Transgender Youths and Sanctuaries for Gender-Affirming Care.

This Viewpoint suggests ways state and local governments can support transgender youths seeking gender-affirming care amid continued passage of antitransgender legislation.

Do supportive work environments matter for minority aging? Work stress and subjective cognitive impairment among middle-age and older lesbian, gay, bisexual, transgender, and queer adults.

Research has documented how people's experiences at work affect their cognitive health outcomes, but how these processes unfold for minority groups, particularly lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, is unclear. This study builds on the nascent literature by employing generalized structural equation models to test how experiencing major problems at work and working with LGBTQ+ supportive coworkers affect subjective cognitive impairment among middle-age and older LGBTQ+ adults. We also test for mediated and indirect effects of support and problems at work operating via vascular disease, sleep problems, and depression symptoms. Experiencing major problems at work is associated with a higher likelihood of reporting cognitive symptoms consistent with mild cognitive impairment, but this relationship is mediated by depression symptoms and sleep problems. Having LGBTQ+ supportive coworkers does not have direct effects on mild cognitive impairment, but does operate indirectly by decreasing problems at work and, in turn, decreases the likelihood of reporting cognitive symptoms consistent with mild cognitive impairment. Overall, we find that workplace stressors contribute to cognitive health directly and through mediated and indirect pathways and that supportive contexts reduce exposure to problems at work. We conclude with suggested possibilities to reorganize workplaces to improve long-term cognitive health outcomes for older adults, especially those who are LGBTQ+-identified.

Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults.

INTRODUCTION: Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender, and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs. This study examines whether access to an affirming provider improves health outcomes for lesbian, gay, bisexual, transgender, and queer populations across a range of preventive health and chronic disease management outcomes. METHODS: This cross-sectional study uses Poisson regression models to examine original survey data (n=1,120) from Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study examining older (aged 50-76 years) lesbian, gay, bisexual, transgender, and queer adults' health and aging, collected between April 2020 and September 2021. RESULTS: Overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions. Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past year provider visit, influenza vaccination, colorectal cancer screening, and HIV test. Access to an affirming provider is also associated with better management of mental health conditions. CONCLUSIONS: Inclusive care is essential for reducing health disparities among lesbian, gay, bisexual, transgender, and queer populations. Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.

Harnessing progress: Gender, sexuality, and positive self-perceptions of aging in midlife.

Drawing on interviews, this article analyzes how lesbians, gay men, straight women, and straight men construct positive views of aging during midlife, a life course period when negative perceptions of aging are salient. Interviewees engaged in harnessing progress-a process of crafting personal aging narratives that emphasize growth and improvement-which helped them to feel positively about their own aging. All interviewees shared these progress narratives, but reports differed across gender and sexuality groups. Men's narratives focused on the wisdom they gained and how that made them more relevant to older and younger generations. Regarding the latter, straight men viewed their children as beneficiaries of their progress and gay men viewed younger LGBTQ people as beneficiaries. Women's progress narratives focused on self-improvement. Whereas straight women described becoming more self-reliant with age, lesbians described learning to stand up for themselves. Overall, findings reveal how gender and sexual identities-and the lifelong benefits and burdens that accompany those identities-influence how people create positive perceptions of aging.

The subjective life course framework: Integrating life course sociology with gerontological perspectives on subjective aging.

The expansion of life expectancy has precipitated a cultural transformation of the life course - altering the perceived temporal contours of middle and later life. However, our understanding of these perceptions is limited by the absence of a framework within which to examine them. This paper builds on the life course perspective - which emphasizes the objective patterning of lives - by focusing on the subjective side of the life course. Drawing on theoretically, methodologically, and substantively diverse studies, this paper develops the concept of the subjective life course - a term we use to denote individuals' perceptions of the life course, including its structure and timing and their advancing location in it. We outline two dimensions of the subjective life course - the target of the perception (i.e., generalized other versus self) and the temporal frame of reference (i.e., past, present, or future). Using the resulting framework as an organizational tool, we then discuss key constructs located at each intersection along these dimensions, providing examples, where possible, of empirical studies examining them. We close with a discussion of two broad directions for research: leveraging the framework to yield insight on the subjective life course and exploring links between objective and subjective dimensions of the life course.

Variation in Subjective Aging by Sexual Minority Status.

The past few decades have seen increased scholarly attention to gay and lesbian individuals' aging experiences; however, few studies examine differences in subjective aging by sexual minority status. We identify four perspectives on the association between sexual minority status and subjective aging-double jeopardy, crisis competence, gender interactive, and limited salience perspectives. We examine each perspective's predictions using data from the first wave of Midlife in the United States (1995-1996; MIDUS). Ordinary least square regression models reveal strongest support for the limited salience perspective, suggesting that sexual minority status has weaker effects on subjective aging than do other social factors, such as age, health, and gender. However, some results provide support for the gender interactive perspective, positing that the effect of sexual minority status on subjective aging varies by gender. Our study provides an organizational framework of theoretical perspectives that can guide further examinations of variation in aging experiences by sexual minority status.