Managing a Midlife Transgender Transition

Dr. Kristen Vierregger discusses the physical and mental health concerns for people pursuing a transgender transition later in life.

Discussing the physical and mental health concerns for people engaged in a transgender transition later in life.Beginning hormones is a monumental relief after waiting decades to be yourself, and once the hormonal balance has shifted to the appropriate levels, you’ve never felt so good in your life — and in your body.

The following are common challenges for those transitioning at 40+:

Challenge #1: Managing a Midlife Transgender TransitionHEALTH ISSUES: If you have heart disease, diabetes, or other chronic illnesses, these must be addressed to ensure optimal health while on hormones. There are only a handful of conditions that must be treated prior to beginning, so most are managed closely as we go along. Some will see actual improvement in chronic disease, however, once you begin caring for the body that’s emerging during a transgender transition.

Challenge #2: Managing a Midlife Transgender TransitionREGRET FOR NOT HAVING STARTED SOONER:  All who embark on a transgender transition later in life at some point encounter powerful feelings of regret over the perceived “wasted” years they lived inauthentically. Mourning those “lost” years, ideally with the help of a skilled therapist, enables you to reconcile that you made the only decisions you could make at the time, and nothing is ever wasted. Your path is your path.

Challenge #3: Managing a Midlife Transgender TransitionMAKING UP FOR LOST TIME: Hormones initiate a phase just like puberty. You’ve finally given yourself permission to express yourself, and the hormones are kicking in. You’re feeling sexy, and, like many teenagers, you may have a tendency to go a little crazy. While it’s fun and liberating — by all means enjoy it! — please be careful and always practice safe sex. If you are concerned about exposure to HIV, ask your doctor about PrEP, a really effective medication you can take to prevent getting HIV.

Challenge #4: Managing a Midlife Transgender TransitionLETTING GO OF THE IDEALIZED SELF: You’ve spent years fantasizing about the wo/man inside, and when the person that emerges falls short of that ideal, you may feel discouraged. “I’ll never be pretty,” is one of the most heartbreaking things I hear patients say. The reality is, you already are, as you are. “I’ll never pass” is another one. I challenge you to look closely at the cis-wo/men your age around you. Some are genetically lucky, but most aren’t. Be you. Be beautiful. Be your handsome self.

Challenge #5: Managing a Midlife Transgender TransitionSPOUSES/PARTNERS: To conform to societal norms, many have married by this age. Some have never disclosed to their partner that they’re transgender, so when they find the courage to come out, it changes the relationship. Some marriages make it, especially if the spouse is willing to participate in individual and/or group therapy. Many don’t, so it’s especially important you have a strong support system to help you navigate through this. Feelings of grief, anger, loss, and accusations of selfishness and betrayal are hard to cope with alone. You don’t have to. You’re at a point where you can’t continue living a false role, and your fulfillment, happiness, and very life depend on you moving forward with your transition. Optimizing the chances of keeping your relationships intact will benefit from the advice of others who have faced similar situations, as well as from your therapist and doctor. It’s ok to ask for help.

In spite of the challenges, this will be the best thing you’ve ever done for yourself, so surround yourself with those who love and support you as you are, because you’re worth it.


Dr. Kristen Vierregger is an Orange County-based physician discussing the challenges of a midlife transgender transition.Dr. Kristen Vierregger is an Orange County-based physician specializing in transgender hormone therapy, bio-identical hormone replacement therapy, skin rejuvenation, and scar/laser tattoo removal. She has worked with transgender patients for a number of years and is a member of The World Professional Association for Transgender Health (WPATH). Dr. Vierregger’s passion is delivering the highest standard of care to promote her patients’ goals for optimal health, well-being, and beauty.