Gender identity is a personal concept that describes one’s internal experience of gender. This is influenced by the individual’s external experience of gender or how the rest of the world treats them based on the gender they were assigned at birth.
Gender dysphoria is the experience of being assigned a different gender at birth than the gender one actually is internally. While this is a rare condition, people on the autism spectrum seem to experience more gender dysphoria than neurotypical individuals.
Scientific research on this is just beginning, but small-scale studies suggest that social and communication differences between autistic brains and neurotypical brains can increase the experience of gender dysphoria in people with autism, leading to greater differences in gender self-expression.
Gender Identity, Dysphoria & Diversity in People With Autism
Gender identity is the personal concept of one’s gender experience. This is typically described as male or female, but it is increasingly considered a spectrum of experience.
For most of the population, the gender they are assigned at birth is the gender they identify with. However, some people do not identify with their natal gender, or the gender they are perceived to be from birth. This can lead to gender dysphoria, which the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) updated from the previous gender identity disorder.
Gender dysphoria is no longer considered a disorder, but it does indicate structural differences in the brain and body compared to cisgender people. Gender role is the outward appearance or performance of gender, and for cisgender people, these are congruous. For someone who is transgender, gender fluid, or gender neutral, the gender they perceive themselves to be and the gender others perceive them to be will be different.
While gender dysphoria is rare, autism diagnoses are on the rise, largely due to better diagnostic criteria in the DSM-5. According to the Centers for Disease Control and Prevention (CDC), 1 in 54 children has been identified with a level of autism spectrum disorder, with an average prevalence around the world of between 1% and 2%.
People who are receiving medical treatment of some type for gender dysphoria appear to have higher rates of autism compared to the general population. Studies have shown rates ranging from 5.5% to 7.8%. Compared to controls, one study found that children and teenagers with autism were 7.59 times more likely to express gender variance.
Research Behind the Co-Occurrence of Autism & Gender Identity Diversity
Gender diverse people on the autism spectrum often reference similar themes, such as:
- Recollections of early gender nonconformity.
- Feeling or experiencing gender dysphoria.
- Challenges specific to the comorbidity of gender diversity and neurodiversity.
An online study involving 727 people revealed that transgender identity and autism have a lot of overlap, with trans men having more traits associated with autism compared to trans women. Conversely, a study of gender dysphoria in people both with and without autism showed that those with autism were more likely to report gender dysphoric traits. In the study, 90 men and 219 women with autism were compared to 103 men and 158 without autism. Those with autism reported higher rates of dysphoria compared to the general population.
Another study, published in 2018, examined the rates of gender variance among autistic people. Researchers found support for their hypotheses, especially that autistic people assigned female at birth tended to have lower “social affiliation” to a gender group and greater variance in their gender expression. They reported a lower experience of femininity and a higher experience of masculinity compared to autistic men, and this group often preferred to socialize with men.
The research team offered two explanations. First, higher gender diversity among autistic natal females made it tougher for them to identify with femininity. Second, they selected a gender group and struggled to identify with individuals in that group.
Overall, the study concluded that higher rates of gender variance in people on the autism spectrum tended to be associated with lower social interest and identity, and more negative feelings toward gender groups in general, compared to the neurotypical control group.
Potential Reasons for Higher Rates of Gender Identity Diversity With Autistic Individuals
The 2018 study suggested that features of autism may contribute to higher gender diversity and lower gender identification, but it was clear that research on the issue was still limited due to the comparison groups mainly being neurotypical individuals.
Some of the potential differences in people with autism that might correlate to higher gender diversity included:
- Deficits in self-categorization that pose challenges to autistic individuals because struggling to place oneself in a social category led to more idiosyncratic identities overall, including gender.
- Deficits in social communication could lead to lower knowledge or understanding of gender norms and/or greater freedom from gender norms.
- Lower levels of socialization with members of one gender group led to a lower sense of affiliation to that group.
- Social communication deficits could enhance the experience of gender dysphoria and vice versa.
- An overlap between societal bullying or ostracizing of people who are gender nonconforming and people with autism.
For people on the autism spectrum, socializing and communicating are more difficult in general. Finding ways to socialize with people in minority gender groups could be a greater challenge, and gender self-esteem is lower in groups stigmatized by society.
Follow-up studies have shown that as gender diversity becomes more socially acceptable, more young people on the autism spectrum are self-identifying as gender nonconforming or transgender. This may be associated with more social categories to explain identity, so learning language and communicating about these feelings is easier. Some recent studies have suggested that between 6% and 22.5% of transgender and gender diverse adolescents are also autistic, which is a higher occurrence than with their neurotypical counterparts.
More Research Is Needed
Research into the comorbidity of gender dysphoria and autism is still new, and studies are small, but it appears that there is a lot of overlap between these conditions. Some clinicians choose to approach these as co-occurring disorders, as there may be overlapping biological mechanisms like sex hormones.
There is also the “theory of mind differences,” which suggests that people with autism are less influenced by social rules and norms. As a result, they are more likely to express their gender variance compared to neurotypical people.
Other clinicians argue that while there is a higher incidence of autism among gender diverse people, the conditions should not be considered comorbid. They may overlap, but they should be treated separately. People who have both conditions need support from medical teams, both for transitioning help with hormone therapy or gender identification support and for their autism diagnosis, which involves behavior therapy.
Regardless, finding support for people with autism who are also gender diverse is vital to their long-term emotional health.
Support Groups & Information for People With Autism & Gender Identity Diversity
An average of 15% of adolescents and young adults who are on the autism spectrum also identify to some extent outside of the gender they were assigned at birth. Unfortunately, support and clinical care approaches that manage both of these at the same time are still lacking, as the co-occurrence of these two differences is just beginning to be studied and understood. Some resources are improving, starting with a study published in the Journal of Clinical Child and Adolescent Psychology in 2020.
Autism Speaks has a resource page with answers to questions regarding gender diverse children and adolescents on the autism spectrum. The Australian group Amaze also lists resources for parents to better understand their children with autism who are also gender diverse.
Gender Identity and Gender Role. (March 2015). Medscape.
Data & Statistics on Autism Spectrum Disorder. (March 2020). Centers for Disease Control and Prevention (CDC).
Gender Dysphoria and Autism Spectrum Disorder. (May 2019). Seattle Children’s Hospital.
Autism and Transgender Identity: Implications for Depression and Anxiety. (January 2020). Research in Autism Spectrum Disorders.
Gender Identity and Sexual Orientation in Autism Spectrum Disorder. (September 2017). Research Gate.
Gender Identity in Autism: Sex Differences in Social Affiliation With Gender Groups. (April 2018). Journal of Autism and Developmental Disorders.
Clinicians and Autistic Transgender Youth Partner to Create First Community-Build Care Model. (May 2020). Medical Express.
Gender Identity and Autism. (June 2019). Autism Speaks.
Information Sheet: Resources About Transgender/Gender Diverse Youth for Parents of Autistic Young People. (May 2019). Amaze.org.au.
At the Intersection of Neurodiversity and Gender Diversity. (September 2018). Journal of Autism and Developmental Disorders.
Why We Need to Respect Sexual Orientation, Gender Diversity in Autism. (November 2018). Spectrum.
Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. (November 2018). Journal of the American Academy of Child and Adolescent Psychiatry.