But to me, being tolerant of the elderly means younger people not projecting their fantasies and their own prejudices onto us seniors, and not assuming you know ahead of time what we think and how we will react to situations that haven't occurred yet.

To me, what stood out about this TIF's diatribe is that Gramps has actually not expressed any dismay or disapproval about her clothing style, "identity" or homosexuality himself because he hasn't been given a chance to see or talk to her in years. The claims that Gramps will be "upset" to see a woman in a necktie or learn that his grandkid is a lesbian are all imagined hypotheticals made up by other people in her family, her therapist and herself. They are not realities that have come from Gramps. All these other people are behaving as though they have powers of clairvoyance that enable them to read Grandpa's mind and predict with 100% confidence how he'll react to his grand daughter in any future dealings with her.

I am pressured to keep in contact with my grandfather. I am pressured to meet with him, but the family tells me to take off my ties. Grandpa is of sound mind. My parents and uncle say that the ties will upset him. I haven't seen or spoken to him in years, since knowing that I transitioned would hurt his feelings and I didn't want to cause him pain. My compromise was not to hurt his feelings but also not to hurt my feelings by pretending to be someone I am not. My parents can make something up for why I can't speak to grandpa, like I lost my phone or am out of the country. I don't waive it in anyone's face, but I don't change my style of dress for anyone. I am considerate, so if it's an event at a nice restaurant, I will wear "male" dress pants rather than "male" jeans, which I wear normally, but I will not wear a dress or skirt just to please someone's emotions. Because grandpa grew up in a conservative environment, my therapist said he is unable to understand. But, I think, it's more "unwilling." Regardless of how he grew up, if he wants to accept me, he will. If he wants to learn about LGBTQ culture, he can. It's a choice. But age and background aren't excuses for intolerance. But I know he won't accept it and seeing me in a tie will make him upset. Calling me by my male name will make him upset. So I just stay away. A therapist told me that I am being selfish and inflexible by refusing to take off my tie. My therapist said if I truly love someone, like a family member, I will take off my tie in an act of compassion. My therapist said I am lacking in compassion. Is the therapist right or is the therapist a homophobe?

As for your own comment that

Being old is very unpleasant for a lot of people, and we should try to be considerant of that.

The fundamental fact you are overlooking is that being old means you've been alive for a long time, and in the process you've seen, heard and dealt with a lot, including a lot of different kinds of people and a lot of social change, fashion trends, ideological movements and fads. Old people have a great deal of life experience, and have pretty much "seen it all." This attitude that that we need need to be handled with kid gloves and must be protected from exposure to the latest youth fad coz we can't handle it is, IMO, not "considerant" - it's condescending AF.