traumatic. Among transgender individuals, there is some evidence of an association between poor hormonal therapies (e.g., outside of regular medical venues) and negative health outcomes in later life, including osteoporosis, cardiovascular disease, and poor oral health (Witten and Whittle, 2004). Williams and Freeman (2005) and Witten and Whittle (2004) suggest that many transgender elders may be at greater risk for health impairment than those who are younger because of the longer duration of hormone use, which may well exacerbate the effects of aging, such as cardiac or pulmonary problems. In addition, many transgender women start hormone therapy at older ages (middle age or later) and while having other aging-related health conditions, which may place them at risk for short- to medium-term adverse events (Feldman, 2007). Moreover, the options for lowering hormone doses or discontinuing hormone therapy are limited given the lack of access to sex reassignment surgery under Medicare and the health risks involved. Fredriksen-Goldsen and colleagues (2011) found that 45 percent of the older LGBT persons in their large study reported having high blood pressure; 43 percent reported high cholesterol and 6 percent reported having had a heart attack.

A variety of studies, both qualitative and quantitative, have found that lesbians are more likely than heterosexual women to be overweight and obese, and research suggests this remains true into the later years (Clunis et al., 2005; Roberts et al., 2003; Valanis et al., 2000). This is an issue that has not been examined empirically for gay men and transgender persons in later life.

HIV/AIDS remains a special and significant case for aging men and transgender women in particular. About 29 percent of people living with AIDS in the United States are currently aged 50 and over, but 70 percent of people with HIV in the United States are over age 40, suggesting that aging with the disease will be a significant health issue in years to come (CDC, 2007). The Centers for Disease Control and Prevention (CDC) estimates that the proportion of people living with HIV who are over age 50 is now more than double that of people under age 24, yet few (if any) HIV prevention programs target older adults, and it remains rare for physicians and other health care providers to talk with their older patients about HIV risk. While the percentage of gay and bisexual men included in these estimates is not clear, the percentage can be assumed to be large given that more than half of all new HIV infections in the United States occur among men who have sex with men (CDC, 2010).