AUTISM AND “TRANS” IDENTIFICATION
My kid was diagnosed with ASD in her late teens. So many of our kids seem to follow the same path: not fitting in, bullied, magical thinking, then suddenly completely captivated by the idea that becoming the opposite sex will solve all of their problems.
— Parent of an autistic child
Research in multiple countries over the last decade show that youth with autism spectrum disorder (ASD) and traits are overrepresented among those who present at gender clinics identifying as the opposite sex. The exact percentage of gender questioning and ASD-diagnosed patients varies from study to study. In the UK, the 2024 Cass Review noted that over a third of patients at their centralized Tavistock gender clinic were autistic. The correlation between the two is well established.
…the chances that there is not a link between ASD and [gender dysphoria/incongruence] are negligible.
Co-occurrence of gender dysphoria and autism spectrum disorder, overall and by age group
Source: Cass, H. (2024). Independent review of gender identity services for children and young people: Final report, Appendix 5, Epidemiology and Outcomes for Children and Young People with Gender Dysphoria: Retrospective Cohort Study Using Electronic Primary Care Records
Parents and detransitioners report that online influencers played an important role in the young person’s attraction to the idea of being “born in the wrong body.” Influencers use terms that resonate with vulnerable, lonely, and physically, sexually, and socially uncomfortable young people. They reframe the discomfort and awkwardness as unique, setting apart the enigmatic neurodivergent from the neurotypical, those with attention-drawing mental health or developmental challenges from the privileged normal, the edgy trans or queer from the dull “cis.” Once their attention is focused on what they believe to be a solution to their discomfort, depression, and alienation, young people with ASD can become rigidly fixated on the solution and defend against any attacks on their need and right to pursue it. Adopting a “trans identity” leads to “love bombing and affirming,” which provides positive social praise that reinforces the identity, increasing persistence. Once engaged with the medical system, youth latch onto “affirmative care” interventions as necessary and “lifesaving,” leading quickly to intrusive, readily available interventions such as hormones and mastectomies.
For female autistic teens for whom social acceptance is a significant motivator, a “trans” identity presents an opportunity to be accepted—an escape from being ridiculed for being different or out of step. While wearing a binder—an early intervention for this cohort—may offer the comfort found with other deep pressure methods that calm anxiety and reduce overstimulation, the effect can easily be misattributed to confirmation of the male identity.
For male autistic teens, sensory issues that cause them to avoid noise and rough physical contact may rule out the “standard” male activities and make socializing with girls more comfortable, confirming the female identity.
Once their attention is focused on what they believe to be a solution to their discomfort, depression, and alienation, young people with ASD can become rigidly fixated on the solution and defend against any attacks on their need and right to pursue it. Affirmation by social groups and trusted adults, and positive attention and confirmation by clinicians, further sets the ideation. Once engaged with the medical system, youth latch onto readily available “affirmative care” interventions as necessary and “lifesaving,” leading quickly to medicalization and the associated negative health impacts.
ASD Traits That Provide Fertile Ground for Trans Identification (source DSM 5):
Some gender clinicians believe the “insistent, consistent, persistent” criteria can predict whether a trans identity will be permanent. Far from an accurate assessment tool, this framework neatly parallels common autistic traits (especially excessive adherence to routines, ritualized patterns of behavior, and rigid thinking) and funnels vulnerable youth onto a risky medical pathway with no meaningful way to consent. The high number of autistic youth amongst detransitioners demonstrates the inappropriateness of using this test as a “standard.”
The DSM 5 criteria for ASD diagnoses feed into opposite-sex ideation:
DSM 5 ASD Diagnosis Criteria
Manifestation for Trans Identification
Persistent deficits in social communication and social interaction across multiple contexts.
Deficits in developing, maintaining, and understanding relationships.
Restricted, repetitive patterns of behavior, interests, or activities.
Symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
I don’t fit in. I am different from other boys/girls.
I want friends, but I miss the cues, so I end up alone—being trans opens the door to a "community".
I have finally found the solution to why I am different and I have a plan to finally fit in and no one can tell me otherwise (rigid thinking).
I feel uncomfortable in my body and “transitioning” provides a way to avoid facing the unbearable and confusing stresses of growing up.
I was always the odd kid, but middle-school cliques made the loneliness unbearable—coming out as trans finally gave me peers who cheered me on.
My brain works fast on facts, not faces; when social rules got too heavy, saying “I’m trans” gave me an instant team that didn’t demand I change.
ASD Traits That Provide Fertile Ground for Trans Identification (source DSM 5):
Some gender clinicians believe the “insistent, consistent, persistent” criteria can predict whether a trans identity will be permanent. Far from an accurate assessment tool, this framework neatly parallels common autistic traits (especially excessive adherence to routines, ritualized patterns of behavior, and rigid thinking) and funnels vulnerable youth onto a risky medical pathway with no meaningful way to consent. The high number of autistic youth amongst detransitioners demonstrates the inappropriateness of using this test as a “standard.”
The DSM 5 criteria for ASD diagnoses feed into opposite-sex ideation:
DSM 5 ASD Diagnosis Criteria and Manifestation for Trans Identification
Persistent deficits in social communication and social interaction across multiple contexts.
Manifestation: I don’t fit in. I am different from other boys/girls.
Deficits in developing, maintaining, and understanding relationships.
Manifestation:
I want friends, but I miss the cues, so I end up alone—being trans opens the door to a "community".
Restricted, repetitive patterns of behavior, interests, or activities.
Manifestation: I have finally found the solution to why I am different and I have a plan to finally fit in and no one can tell me otherwise (rigid thinking).
Symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life.
Manifestation: I feel uncomfortable in my body and “transitioning” provides a way to avoid facing the unbearable and confusing stresses of growing up.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
Manifestation: I was always the odd kid, but middle-school cliques made the loneliness unbearable—coming out as trans finally gave me peers who cheered me on.
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
Manifestation: My brain works fast on facts, not faces; when social rules got too heavy, saying “I’m trans” gave me an instant team that didn’t demand I change.
Accounts from Autistic Detransitioners
Anecdotal evidence through the words of desisters and detransitioners provides insight into the link between ASD and opposite-sex identification.
How Gender Ideology Became the New Script for Autistic Girls
Maia Poet
When I saw people describing themselves as “born in the wrong body,” it clicked. I had always experienced my body as glitchy, confusing, and unreliable. I had learning disabilities, physical disabilities and giftedness all co-occurring. I related better to boys than to girls, though in all honesty, my peer group has never made sense to me. And then eventually, I realized by talking with one of my male friends, that what I thought were stroke symptoms was actually intense attraction to other girls (with whom I struggled to communicate). No one, aside from trans influencers, had ever articulated such experiences to me before. To my systematizing, diagnostic-criteria-loving mind, this explanation fit perfectly.
Michelle Alleva
I believed that kids were seeing “masculine” traits in a girl and were bullying me for that reason; in reality, they were seeing traits of a neurodevelopmental disability and were bullying me for those reasons. I spoke out of turn and interrupted; I was blunt; I was a bit of a know-it-all; I was bossy because I liked things a specific way; and I was emotionally reactive. So when I was bullied, I had a larger-than-average reaction—crying and becoming extremely frustrated, which is amusing to children who bully, so it only reinforced their desire to harass me.
I felt like I was out of place and “different,” especially after I lost the girl friends that I did have. But even though I knew girls who were like I was, when I was introduced to the concept of being trans, I clung to that idea as the “reason” I felt different. I figured that none of the girls liked me because I didn’t act like a girl; none of the boys liked me because I didn’t look like a boy. That made sense to me at the time.
Studies
Gender dysphoria in adolescence: current perspectives
Adolescent Health, Medicine and Therapeutics, March 2018, Riittakerttu, K-H., et al.
“An increased prevalence of autism spectrum disorders (ASDs), varying from ~6% to over 20%, has been reported among samples of adolescents referred to gender identity services. This vastly exceeds the estimated prevalence of 0.6%–0.7% in the general population. In comparison, among children and early adolescents with ASDs, gender variance is >7-fold more common than among non-referred controls.”
Journal of Autism and Developmental Disorders, May 2022, Kallitsounaki, A., et al.
“To our knowledge, this is the most up-to-date systematic review of the literature pertaining [to] the overlap between ASD and GD/GI, and it is also the first meta-analysis of the prevalence of ASD diagnoses and ASD traits in GD/GI people. The findings of the current literature review and meta-analyses suggest that there is (a) a positive relationship between ASD traits and GD/GI feelings among people from the general population, (b) an increased prevalence of GD/GI in the autistic population, and (c) an increased prevalence of ASD diagnoses and ASD traits in the GD/GI population. Overall, these findings suggest the existence of a link between ASD and GD/GI that warrants the investigation of mechanisms that could explain that link and the intensification of clinical attention to autistic GD/GI individuals.”
Child and Adolescent Psychiatry and Mental Health, April 2015, Riittakerttu K-H., et al.
“The overlap between autism spectrum disorders and gender dysphoria has been recognized before. In a Dutch gender identity service, 9.4% of adolescents presented with autism spectrum disorder. In our sample, 26% of the adolescent SR applicants were diagnosed to be on the autism spectrum.”
A Typology of Gender Detransition and Its Implications for Healthcare Providers
Journal of Sex & Marital Therapy, January 2021, Expósito-Campos, P.
“One particular subcase within core detransitions concerns people with autism spectrum disorders (ASD). Anecdotal reports (e.g., Barnes & Cohen, Post-Trans, n.d.; Prestidge, n.d.) indicate that the rate of detransitioned individuals who fall within the autistic spectrum is higher than one would expect in the general population. In this regard, emerging evidence suggests a co-occurrence of GD and ASD (de Vries, Noens, Cohen-Kettenis, van Berckelaer-Onnes, & Doreleijers; Glidden, Bouman, Jones, & Arcelus; van der Miesen, Hurley, & de Vries,), which may be related to an elevation in intense/obsessional interests around gender-related themes (VanderLaan et al.; Zucker et al.). The high number of individuals with GD who appear to fall in the autistic spectrum may explain why a significant number of core detransitioners also present autistic traits.”
Understanding Vulnerability in Girls and Young Women with High-Functioning Autism Spectrum Disorder
Women, February 2022, Bradley, S. J.
“Early on in our clinic’s experience seeing children and teens with GID, we were less aware than we are today of high-functioning autism spectrum disorder (ASD). Despite searching for biological causes for GID and finding nothing specific, (for a more thorough review see Debra Soh’s book), we became more interested in the underlying issues that increase vulnerability in this area. Recently, and particularly with the emerging pandemic of ROGD, we and others have recognized that many of the young women we treated suffered from high-functioning ASD. This became clearer for me when I worked as a consultant to a variety of Children’s Mental Health Centers after leaving Sickkids. Most of the girls I saw had not been previously diagnosed with ASD because they melded into the mainstream more easily than boys with ASD. They presented with anxiety, depression suicidal thinking, self-harm behaviors, eating disorders and gender dysphoria. Before my retirement, one of the larger agencies estimated that, over a ten year period, I had seen more than 500 children and teens with undiagnosed ASD. This reflects a possible increasing prevalence of ASD but it also reflects my increasing awareness of this disorder as a risk factor for a variety of psychopathologies in young women.“
Gender dysphoria and autism spectrum disorder: A narrative review
International Review of Psychiatry, January 2016, Van Der Miesen, A.I.R., et al.
“In summary, although the literature reports on individuals with ASD that are diagnosed with GD and receive gender reassignment treatment, no conclusions could be drawn about the optimal diagnostic procedure, treatment protocol and treatment outcomes in gender dysphoric individuals with co-occurring ASD. Consequently, small and evolving steps seem to be advisable, with extra psychological support—including psycho-education—while taking into account not only the frequent obsessions, but also rigidity and other symptoms of the ASD spectrum.”
The Lancet Regional Health: Western Pacific, May 2024, Tollit, M.A., et al.
“There is an elevated co-occurrence of autism in trans individuals, with recent meta-analyses suggesting that 11% of trans individuals are autistic. The presence of autism in trans young people can create clinical challenges by adding complexity to the presentation, assessment and management of those presenting to gender clinics.”