“We grow older. We also have lots of sex. I just want a doctor who will at least ask about it.”: Transgender, non-binary, and intersex older adults in sexual and reproductive healthcare

Transgender, non-binary, and intersex (TNBI) older adults experience significant disparities in sexual and reproductive healthcare. Utilizing data from 50 semi-structured individual interviews with TNBI older Americans, we examine how TNBI older adults experience and mitigate inequity in sexual and reproductive healthcare. We explore elders' negotiation of inequity through what we term resourcefulness strategies – tactical processes involving marginalized communities obtaining and utilizing resources to minimize inequalities within and beyond healthcare settings. Resourcefulness strategies differ from resiliency insofar as they directly acknowledge the need for social privilege, capital, and resources – on a community level – to overcome difficult situations (e.g., inequalities in healthcare), rather than drawing upon individual coping strategies alone. Our analysis reveals medical providers' lack of cultural competency with TNBI communities and older adults as primary drivers of TNBI older adults' experiences of inequity within sexual/reproductive healthcare settings. Consequently, TNBI older adults aimed to minimize inequity in sexual/reproductive healthcare through particular resourcefulness strategies. Specifically, we found a bifurcation in respondents’ strategies, wherein trans men engaged in health service avoidance while trans women and non-binary respondents engaged in health service self-advocacy. These strategies required respondents to assume primary responsibility for transforming (or avoiding) sexual/reproductive health services that were perceived as lacking or actively harmful. We argue that such approaches are neither effective nor structurally-sustainable for attaining older-age and TNBI-affirming, inclusive, and culturally-competent healthcare for TNBI older patients.