Madge Woollard, an autistic pianist, said, “A lot of us autistic people don’t really fit in socially, and I think this extends to ideas around gender.” As unlikely as it may sound, there is some evidence that individuals with autism are more likely than others to experience gender dysphoria, or distress related to gender incongruence. In fact, one study conducted by Warrier et al in 2020 found that people who don’t identify with their biological sex are three to six times more likely to have an autism diagnosis. Another study by Pasterski et al. found similar results. They found that 5.5% of adults with gender dysphoria also had traits of ASD Gender diverse individuals, on average, score higher on self-report measures of autistic traits and sensory sensitivity and in some cases autistic individuals experience fewer positive feelings about assigned gender identities. It’s also been found that the higher the number of self-reported traits that are common in ASD, the more reports of gender-related feelings of distress.

As a researcher who has heard of this idea before, I honestly am confused. I wonder to myself, “why is gender diversity so common in autistic people than in the general population?” It’s a weird concept to think about. One idea came to mind, however. I’ve found that individuals with autism are less influenced by social norms. There isn’t always an instinct to adjust their behavior based on different social contexts or situations, and therefore they present themselves to the public as more authentic. Rather than explaining the co-occurrence as a product of biological causes, maybe it’s just a matter of a more honest representation of oneself, which we can all admire. I mean, imagine what it would be like if we all had no fear of judgment or had less rigidity in our ways of thinking socially. This can also be explained in that autistic-like traits could drive gender dysphoria. For example, a boy with autism may become hyper-focused with feminine clothes or activities and may cause confusion with gender identity. But like autism, gender can be imagined as a spectrum where some people feel as if they’re a mix with male on one end and female on the other.

However, there are theories of biological mechanisms that support this cooccurrence. High levels of testosterone in the womb results in an extreme male pattern of thought, which can have implications in both autism and gender dysphoria but only applies to females.

Overall, there is evidence that distress related to gender identity can be found in a percentage of individuals with ASD. However, there is limited research on the reasons why so the mechanisms behind this cooccurrence remain unclear and require more research.

Citations:

1. Warrier, V., Greenberg, D.M., Weir, E. et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun 11, 3959 (2020). https://doi.org/10.1038/s41467-020-17794-1
2. Pasterski V, Gilligan L, Curtis R. Traits of autism spectrum disorders in adults with gender dysphoria. Arch Sex Behav. 2014 Feb;43(2):387-93. doi:10.1007/s10508-013-0154-5
3. Sadr, M., Khorashad, B. S., Talaei, A., Fazeli, N., & Hönekopp, J. (2020). 2D:4D Suggests a Role of Prenatal Testosterone in Gender Dysphoria. Archives of sexual behavior, 49(2), 421–432. https://doi.org/10.1007/s10508-020-01630-0