Autism and Transgender Identities

AUTISM AND TRANSGENDER IDENTITIES

by Lisa Macafee
Multiple studies point out an overrepresentation of autism among people seeking gender affirming care (Heylens et al., 2018; Jones et al., 2011; Nobili et al., 2018) and non-binary and transgender identities among autistic people (George & Stokes, 2018; Kirkovski et al., 2013; Strang et al, 2014). Gender-affirming care seekers are have been found to be autistic at eight to eleven times the rate of the cisgender population. Depending on the measurement tools used (Ehrensaft, 2018; Kallitsounaki & Williams, 2022) and some autistic AFAB people express concern that their autism conflicts with a traditional female gender identity (Allely, 2018). While only 0.6% of United States adults identify as transgender (Bowman et al., 2022), studies reporting rates of gender non-conformity or gender diversity among autistic people are reported near 15% (Kallitsounaki & Williams, 2022), yet there has been little summarization of data from different research projects linking them together, which is the intent of this literature review. The first question synthesized the research on autism and gender diversity.

Theme One: Rates of Gender Diverse People with Autistic Traits
Gender diverse people, which includes transgender, non-binary, and gender non-conforming people, have autistic traits disproportionately from the general population (Heylens et al., 2018; Maroney & Horne, 2022; Strang  et al., 2021). In fact, between 23% (Strang  et al., 2021) to 36% (Nobili et al., 2018) to 68% (Thrower et al., 2019), to 75% of gender-affirming seeking care patients show autistic traits (Ehrensaft, 2018). Studies vary on frequency, but people with gender identity disorder or gender dysphoria are autistic between six (Heylens et al., 2018; Pinna et al., 2022; Strang et al., 2023), seven (Strang et al, 2014), eight (Ehrensaft, 2018), or eleven times (Kallitsounaki & Williams, 2022) more frequently than the general population. Overall, 31.25% of gender-affirming care seeking AMAB and 22.22% of AFAB people were found to have elevated autistic traits (Heylens et al., 2018). While only 11% (Kallitsounaki & Williams, 2022) to 23% (Thrower et al., 2019) have an autism diagnosis, transgender people exhibit high levels of anxiety, depression, and substance use common among undiagnosed autistic adults (Mezzalira, 2022; Pinna et al., 2022).

Theme Two: Number of Autistics with Gender Diversity
Many studies demonstrate the relationship between gender diversity and autism (Attanasio et al., 2021; Cooper et al., 2022; Davies, 2023; Ehrensaft, 2018; Kallitsounaki & Williams, 2022; Kirkovski et al., 2013). Autistic people have higher rates of gender dysphoria (Lim et al., 2022; Thrower et al., 2019), gender non-conformity (Strang et al, 2014), and non-heterosexual orientations (Attanasio et al., 2021), possibly due to their distance from traditional gender identity (George & Stokes, 2018). Between 4.5% (Libsack, 2021) to 13% (Strang et al., 2023), to 15.4% (Kallitsounaki & Williams, 2022; Maroney & Horne, 2022; Strang  et al., 2021) report transgender or non-binary identities, which is more than seven times as the neurotypical population (Tankersley, 2021; Thrower et al., 2019). Autistic people often understand gender outside of typical binary norms or male or female and often express more diverse genders such as non-binary or gender fluid identities (Kallitsounaki & Williams, 2022), and disproportionately experience gender stress or gender dysphoria (Ehrensaft, 2018). Autistic people have expressed a need to more broadly understand their interrelated gender and autistic identities and have expressed acute distress when their bodies do not match their gender identity (Cooper et al., 2022). That being said, there is also a growing push to embrace a need to experience gender euphoria, to help transgender and non-binary autistic people feel authentic joy in their bodies and identities when gender identity is embraced (Strang et al., 2023).

Theme Three: AFAB Autistic Transgender Rates
While both AMAB and AFAB autistics are more likely than cisgender peers to endorse feelings of gender non-conformity, AFAB autistics do so at higher rates than their autistic male peers (Davies, 2023; Jones et al., 2011) or neurotypical female peers (Kallitsounaki & Williams, 2022). Autistic AFAB people exhibit greater typical male patterns of cognition and behavior than non-autistic AMAB people (Jones et al., 2011) and experience inconsistency between their gender and physical bodies, as they report higher levels of male-typical hormone conditions (Kirkovski et al., 2013). The extreme male brain theory suggests this is due to androgen exposure in the womb that both increases masculine hormones and autism rates (McKenna et al., 2021; Nobili et al., 2018) and contributes to feelings of gender incongruence for AFAB autistics (Saffie & Bauerle, 2023).

Roughly 30% of transmen (people AFAB who identify with the male binary gender identity) exhibit an autistic profile, which is eleven times as many autistic traits as compared to averages of cisgender men (Jones et al., 2011), and 45% (Nobili et al., 2018) to 68% of transmen show signs of autism (Kallitsounaki & Williams, 2022).

AFAB autistics have increased risk of suicidal behaviors, psychiatric conditions, central sensitivity syndromes, and quality of life (Davies, 2023), which may be related to increased gender non-conformity (Allely, 2018).

Discussion 
There does seem to be a consensus that autism and transgender identities are often related and occurring simultaneously at disproportionate rates (Strang et al., 2023; Thrower et al., 2019), but estimates vary between three to eleven times the rate of autism in transgender populations (Heylens et al., 2018; Kallitsounaki & Williams, 2022; Pinna et al., 2022) and up to 15% of the autistic population identifying as transgender (Maroney & Horne, 2022; Thrower et al., 2019). Given that transgender autistic people have lower quality of life than neurotypical transgender people (Mezzalira, 2022; Tankersley, 2021) and gender identity is a core part of self-understanding and shapes a person’s interactions with the world (Walker, 2021), this is an important issue to address. In addition to autism being overrepresented in transgender populations, transgender men and non-binary AFAB people have the most autistic traits from any other group (Pinna et al., 2022).

References

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Bowman, S. J., Casey, L. J., McAloon, J., & Wootton, B. M. (2022). Assessing gender dysphoria: A systematic review of patient-reported outcome measures. Psychology of Sexual Orientation and Gender Diversity, 9(4), 398–409. https://doi.org/10.1037/sgd0000486

Cooper, K., Mandy, W., Butler, C., & Russell, A. (2022). The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis. Autism, 26(4), 963-974. https://doi-org.csu.idm.oclc.org/10.1177/13623613211039113

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