Autism and Gender Dysphoria

The link between autism and gender issues has long been recognized. Renowned autism expert Tony Attwood even mentions it in his seminal guide to autism, “The Complete Guide to Asperger’s Syndrome”, which was published in 2008 and now, as large numbers of young people with autism or autistic traits are presenting to paediatric gender clinics, the link is undeniable. Even gender clinicians, such as child psychiatrist Susan Bradley, who founded a gender clinic in Ontario, are expressing concerns about this issue in general, and the fact that autistic kids with gender issues are being rushed towards physical transition in a way that never occurred in the past.

We are already beginning to see the wave of regret from those who have been treated by these clinics, as young desisters and detransitioners, both male and female, have begun to speak out, and now believe that their autism (in some cases undiagnosed until later) contributed to their development of trans identities.

Some of these impacted young people have chosen to share their experiences, providing us with valuable insight that we would do well to learn from. Elizabeth, is one such desister. In her personal testimonial, Elizabeth explains how she identified as trans from the age of 15 but was not diagnosed with autism until adulthood. She feels that autistic traits, such as difficulty adjusting to changes (like puberty), the tendency to develop obsessional special interests (in this case gender) and awareness of her systematizing brain (a typical trait of both males, and autistic people of both sexes), led her to believe that she was trans. In her words:

“Looking back with the knowledge that my diagnosis has given me, it’s obvious that I was unwittingly dressing up my Autism in the more fashionable clothing of Gender Dysphoria…

It was my ASD diagnosis in 2017 that made me begin to put all the parts together and realize I had made the wrong decision about transitioning. My ASD diagnosis explained the non-normative behaviors I had been showing my whole life in a way that the Gender Dysphoria diagnosis never quite could.”

Elizabeth further explains that:

“Going undiagnosed is fairly common for girls on the spectrum. Girls on the spectrum can pass as neurotypical far better and for longer than boys. We can socially camouflage to some degree, copying the social behaviors of those around us even if we don’t understand those behaviors. This means that autistic girls slip under the radar but are still experiencing all the internal struggles of autism.”

She then goes on to express her concerns about the future for young, trans identifying females:

“my own anecdotal experiences of transgender spaces…[is that]…they contain a lot of autistic people. The trans community is currently packed with young, mostly biologically female people, many of whom display quite distinct autism traits. Yet, it seems to go ignored. In ignoring this co-occurrence of ASD and trans identity in young women, we risk jeopardizing the mental and physical health of an entire generation of autistic girls.”

While Elizabeth was fortunate not to have made any permanent changes to her body, Penny, was not so lucky. She took puberty blockers at age 13, testosterone from age 14 and had a mastectomy at just 15 years old,  which was covered by her health insurance. By 16, she regretted what she had done and had to resort to crowdfunding to raise money to try to reverse the changes she had made to her body. She tells us:

“I was diagnosed with autism last summer, and my current doctors have researched the link between autism and gender identity, finding that might have been the cause of my issues……. But my doctors didn’t take into account my autism, body issues, or other mental illnesses when allowing me to transition

Boys with autism are affected too. In a recent survey by one of our parent support groups, parents reported that 21% of their boys had a confirmed diagnosis of autism. For perspective, the general rate in the US population as a whole is estimated at just 2%. A further 29% of the boys in the survey were considered by parents to have autism-like behaviors, and another 39% to have poor social skills.

My own son is one of these affected boys, and it’s easy for me to see how the autistic traits – black and white thinking, difficulty with social gender roles, anxiety about rapid pubertal development, emotional immaturity – all play into feeding his trans identity.

In Benjamin Boyce’s excellent interview with young adult desister, Ash, and his father, Raphael, we hear how a male with (then undiagnosed) autism came to develop a trans identity.  Ash explains how multiple aspects of his autism, including black and white thinking, sensory issues (he hated the feel of body hair), difficulty managing his emotions and social skills difficulties, led to the belief that he was not a male. He also explains how gender nonconformity is extremely common among autistic people, and how is this day and age this can lead to young people concluding that they are trans. Reflecting on these factors led him to shed his trans identity, and any desire to physically transition. 

There are an increasing number of other moving and fascinating accounts written by autistic people appearing online, exploring how their autistic traits fueled their gender dysphoria or trans identity,  in some cases leading to physical transition that they later regretted.

My teen’s autism diagnosis was quite recent, and both he and I have been exploring autism advocacy organizations looking for information and support. I am disturbed to notice that many have embraced gender ideology wholesale, promoting it without any awareness that their young clients’ gender issues may be due to their autism, rather than a sign that they are inherently “transgender” (if there is even such a thing) and require physical transition. Although it seems to be politically incorrect to say so, autism IS a disability. It also seems that there is a strong genetic component. As a parent, I must agree with autism educator Christian Wilton-King, who was pushed out of his job as a result of questioning what he saw as harmful links between the transgender and autism advocacy (neurodiversity) movements. As he comments, comments, “When disproportionate numbers of autistic people – children, even – are being diagnosed with gender dysphoria, the ‘treatment’ for which can lead to infertility], this starts to look worryingly like backdoor eugenics.”

Many trans identifying people themselves are now recognizing the link between autism and gender issues, but refusing to consider the possibility that characteristics of autism may be feeding the trans identity. They will often claim that it is transphobic to take the autistic traits into account, and try to help people (especially kids) to reconcile with their natural bodies as a possible alternative to undergoing lifelong, drastic medical interventions.

We parents would like to see health care professionals consider the possibility of autism in all young people presenting with concerns around gender, rather than dismissing it as a possible factor, in order to avoid misdiagnosis and mismanagement which can have unnecessary tragic and permanent consequences.