Mounting evidence over the last decade points to increased rates of autism spectrum disorders (ASD) and autism traits among children and adults with gender dysphoria, or incongruence between a person’s experienced or expressed gender and the gender assigned to them at birth. ASDs are characterized by difficulty with social interaction and communication as well as restricted, repetitive patterns of behavior. Approximately 1-2% of the population is estimated to meet criteria for ASDs, about twice higher in men than women.
The potential link between ASD and gender dysphoria was noted by researchers as early as 1981, when they noticed that 10% of 30 children with a clinical diagnosis of autism had trouble answering a gender identity question (“Are you a little boy or a little girl?”) that fewer than 1% of neurotypical children of the same age struggle with.
A number of case reports describing individual cases of people presenting with both gender dysphoria and autism spectrum traits followed, but it wasn’t until the 2010s that more systematic research on this topic began to emerge. Since then, at least nine larger-scale studies have been published in the medical and psychological literature, spanning several Western countries (the U.S., the UK, Canada, Finland, the Netherlands), ages (children, teens, and adults), and measures of ASD (self-report scales, parent-reported measures, and clinician-established diagnoses).
Across all of these studies, almost without exception, rates of ASD or autism traits range from 5% to 54% among those with gender dysphoria, significantly higher than among the general population. (The individual studies and their findings are briefly summarized, in chronological order, at the end of this article.)
Several different hypotheses have been proposed to explain the heightened link between gender identity and autism spectrum traits. Some researchers have suggested that the increased rates of ASD might be a product of social stigma against transgender expressions. For example, since transgender people experience very high rates of prejudice and discrimination, their aversion to social situations could serve as a self-protective response, thus artificially inflating their levels of autistic traits. Another possibility is that ASD children are just as likely to experience gender dysphoria but are more likely to express it explicitly because of their limited ability to understand social cues and realize they might get stigmatized by others for it.
On the other hand, the increased rates could be a real phenomenon. It is possible that some of the psychological characteristics common in children with ASD—including cognitive deficits, tendencies toward obsessive preoccupations, or difficulties learning from other people—complicate the formation of gender identity. It is also possible that there are common biological factors (for example, genetic predispositions, exposure to atypical levels of prenatal testosterone and other hormones, or environmental toxins) causing both ASD and gender dysphoria.
Increased gender dysphoria among folks with ASD (or vice versa) doesn’t necessarily mean that all these children and adults will eventually go through a gender transition. In fact, research shows that somewhere between 60% and 90% of children with gender dysphoria are no longer gender dysphoric 10 or so years later and accept the gender identity assigned to them at birth. But if and when folks with ASD do go forward with gender affirming hormone treatment and surgeries, they face some unique challenges in this process, particularly during the transitional period.
For example, individuals with ASD often fail to realize that others might not perceive them the same way they perceive themselves unless they conform to certain societal norms. Thus, an assigned-male-at-birth person who has privately transitioned to identifying as a woman but maintains a male-typical outwardly appearance might be confused and distressed when others treat them as a man.
More research on this topic is needed, as many of the studies use less-than-ideal measures of gender dysphoria or ASD and employ clinical rather than representative samples. However, to the extent that ASD and transgender issues are indeed linked, raising awareness among parents and health care providers becomes paramount. Accurate assessment, early detection, and appropriate treatment can make a big difference in the lives of these children, teens, and adults.