Trans and Autistic? Join the Club
a lot of autists are trans, and a lot of trans people are autistic
This is the autism chapter from my book. If you have a touch o’ the ‘tism, I hope you enjoy this post. But even if you’re an allist, I hope you’ll enjoy it anyway.
Autism studies show that autistic people are more likely to be gender variant or transgender, and transgender studies show that trans people are much more likely to be autistic. The relationship goes both ways.
One study found that autistic people are about 5.5 times as likely to identify as nonbinary[i], showing that autism’s relationship with gender variance isn’t limited to binary trans identities.
Similarly, a study utilizing parental reports found that both autism and ADHD were associated with higher gender variance in children: kids with either disorder were seven to eight times as likely to have repeatedly expressed the wish to be the other sex[ii].
ADHD and autism are both part of my mental makeup, so this overlap with gender variance doesn’t surprise me—I have long noticed that autistic-identified people are particularly common in online trans spaces.
After surveying the scientific literature connecting autism to sexuality and gender variance, I noticed three ways that autism appears to contribute to greater gender variance:
Increased rates of nonheterosexuality
Increased rates of nonvanilla sexuality (and thus more autoheterosexuality)
Autistic gender alienation
Rates of nonheterosexuality are significantly higher in autistic people. One study specifically exploring sexual orientation in autistic people found that both sexes were more likely to report homosexual, bisexual, or asexual sexual identities and attractions than non-autists of their sex[iii].
Other autism studies have also found this same overall pattern of increased nonheterosexuality[iv], with one finding that all the nonheterosexual groups of participants had markedly higher levels of gender dysphoria than the heterosexual group[v].
Nonvanilla sexualities tend to cluster within individuals[vi], so someone with one form of nonvanilla sexuality is also likely to have another form of it. Since autoheterosexuality is a nonvanilla sexuality and nonvanilla sexualities are more common among autistic people, it’s likely that autism is associated with higher rates of autoheterosexuality. This correlation is another way that autism may contribute to gender variance.
Studies looking into the relationship between nonvanilla sexuality and autism have found that autistic males have significantly higher rates of nonvanilla sexuality than typical males[vii]. One study that asked autists an open-ended question about their turn-ons found 5% of autistic males reported autogynephilia and 12% reported arousal from crossdressing[viii]. They reported these experiences without being asked about them directly, so I suspect these were consistent sexual interests in the people who reported them.
Researchers have also found that autistic traits are associated with higher levels of gender dysphoria[ix]. This correlation was noticeably stronger in females, which suggested that autistic traits were more likely to contribute to gender dysphoria in females[x]. Even though autistic females had higher gender dysphoria scores, however, autistic males were more likely to be on cross-sex hormones[xi].
Other research examining mental health outcomes found that autism, nonheterosexuality, and gender dysphoria were all associated with a negative impact on a person’s well-being: membership in just one of these three groups significantly added to stress, depression, and anxiety, while also lowering well-being[xii]. Gender dysphoria had the greatest negative impact of the three, and being in all three groups simultaneously was associated with even worse mental health than being in any one group on its own[xiii].
Autistic Gender Alienation
A qualitative study that asked autistic and non-autistic participants about their gender feelings and experiences found drastic differences between the two groups[xiv].
Compared to the non-autistic control group, members of the autistic group were far more likely to say that they felt different from their own sex, that they felt more like the other sex, or that they had struggles understanding their gender identity. They were also much less likely to say their birth sex aligned with their self-conception or fit their gender role.
Some of these autists felt alienated not just from their gender but also from humanity itself. After researchers asked one participant how she fit in with either sex, she said, “It’s like asking me if I feel more affinity to girl aliens or boy aliens”[xv].
Consequently, autistic people in this study were far more likely to identify as androgynous or nonbinary, state that gender wasn’t important to their personal identity, have an undetermined sexual orientation, or say that a romantic partner’s companionship mattered more than their gender.
In sum, autists are more likely to feel alienated not only from the gender associated with their sex, but also human gender as a whole. Understandably, autists place less emphasis on gender—a pattern that shows up in their self-identity, sexual orientations, and sexual partner preferences.
Autism Is Associated with Neurological Masculinization
The Empathizing-Systemizing theory (E-S theory) of autism holds that, on average, females are better than males at perceiving another person’s mental state and responding with an appropriate emotion (empathizing), while males are better at analyzing or constructing rule-based systems (systemizing).
In E-S theory, empathizing and systemizing are two poles of a spectrum on which the sexes tend to differ, and it conceives of autism as a shift in the male-typical direction, toward systemizing[xvi]. One of the largest psychological differences between the sexes is that females prefer to work with people and males prefer to work with things[xvii], so E-S theory’s prediction about female-male differences in empathizing and systemizing isn’t surprising.
A gigantic study involving over 600,000 participants demonstrated the same patterns predicted by E-S theory: within autistic and non-autistic groups, females showed more empathizing and males showed more systemizing. Autists of both sexes were higher in systemizing and lower in empathizing than their non-autistic counterparts, and this difference predicted autism far better than any demographic characteristics, including sex[xviii].
The most obvious sign that testosterone exposure may contribute to autism is that males are much more likely to be autistic. There are, however, several other lines of evidence supporting the idea that testosterone plays a role in the development of autism.
When scientists measured fetal testosterone levels, they found a positive association between fetal testosterone levels and autistic traits[xix]. On the other hand, testosterone usage among trans men later in life doesn’t seem to correlate with different levels of autistic traits[xx], so the timing of testosterone exposure matters.
There is other evidence suggesting autism has a link to testosterone exposure: autistic females are more likely to report testosterone-related health issues such as polycystic ovarian syndrome, hirsutism, unusually painful periods, or a history of severe acne[xxi].
Female autists are also more likely to be attracted to women or to have been tomboys as children[xxii], both of which are associated with masculinization. They are also much more likely to be transsexual or have gender dysphoria[xxiii]. Unsurprisingly, autoandrophilia in females is also associated with autistic traits[xxiv].
In addition, congenital adrenal hyperplasia—a disorder of sexual development that leads to elevated testosterone levels—is associated with increased autism traits and nonheterosexuality in females, as well as decreased female gender identity[xxv].
Autohet Trans People Have High Rates of Autism
In general, it’s estimated that less than 1% of people are autistic, perhaps about 0.6% [xxvi]. Among trans people, though, autism is far more common.
Research conducted by gender clinics has found that trans people with nonhomosexual orientations or late-onset gender dysphoria are more likely to show autistic traits. This pattern implies that autism is particularly associated with autoheterosexual transgenderism.
A study at a London-based gender clinic found that 7% of FTMs and 5% of MTFs met the threshold for an autism diagnosis[xxvii]. Perhaps not coincidentally, all of the transsexuals with marked autistic traits were nonhomosexual[xxviii] and nearly all of them said their gender dysphoria started at or after puberty[xxix]. In addition, nonhomosexual orientations predicted higher scores of autistic traits[xxx].
A different study from England found that 5% of MTFs and 30% of FTMs in their sample met the threshold for an autism diagnosis. Nonhomosexual MTFs had significantly higher scores than homosexual MTFs, but this same relationship wasn’t found among FTMs[xxxi].
Children and adolescents at gender clinics also seem to have elevated rates of autism. A study from a famous Dutch gender clinic—The Center of Expertise on Gender Dysphoria at the VU University Medical Center Amsterdam[xxxii]—found that 7.8% of children and adolescents referred there had autism[xxxiii]. Adolescents were more likely than younger children to be autistic, which suggested that autism was more closely associated with a later onset of dysphoria. Among adolescents themselves, the autistic ones tended to be older[xxxiv] and most of them were nonhomosexual[xxxv].
Altogether, these patterns suggest that autism contributes to gender variance in several ways and that it’s particularly associated with autoheterosexual transgenderism.
In Sum:
Trans and nonbinary people are much more likely to be autistic. In turn, autistic people are much more likely to be gender dysphoric or gender variant. This association goes both ways, and it shows up repeatedly across many studies.
Autistic people are more likely to be nonheterosexual, have nonvanilla sexualities, or feel alienated from their default gender—each of which contributes to gender variance in its own way.
Autistic gender alienation makes it likely that autists will feel different from their own sex or feel similar to the other sex. They are far more likely to identify as androgynous or nonbinary, and may even feel alienated from other humans to a degree that gender itself seems irrelevant. In short, autistic gender alienation contributes to gender issues.
Autism is associated with neurological masculinization: males are more likely to be autistic, and autistic females are far more likely to report testosterone-related health issues, gender nonconformity in youth, or attraction to women. Furthermore, fetal testosterone levels are positively associated with higher scores on measures of autism later in life.
Studies from gender clinics show that autistic traits are more common in trans people who have nonhomosexual orientations or whose dysphoria started around puberty. These patterns indicate that autism is particularly associated with autoheterosexual transgenderism.
[i] Greenberg et al., “Testing the Empathizing–Systemizing Theory of Sex Differences and the Extreme Male Brain Theory of Autism in Half a Million People,” 12154.
[ii] Strang et al., “Increased Gender Variance in Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder,” 1529.
[iii] George and Stokes, “Sexual Orientation in Autism Spectrum Disorder,” 5.
[iv] Schöttle et al., “Sexuality in Autism,” 386; Dewinter, De Graaf, and Begeer, “Sexual Orientation, Gender Identity, and Romantic Relationships in Adolescents and Adults with Autism Spectrum Disorder,” 5; Pecora et al., “Characterising the Sexuality and Sexual Experiences of Autistic Females,” 3.
[v] George and Stokes, “Gender Identity and Sexual Orientation in Autism Spectrum Disorder,” 7.
[vi] Abel and Osborn, “The Paraphilias,” 686.
[vii] Fernandes et al., “Aspects of Sexuality in Adolescents and Adults Diagnosed with Autism Spectrum Disorders in Childhood,” 8; Schöttle et al., “Sexuality in Autism,” 389.
[viii] George, “Sexual Orientation and Gender-Identity in High Functioning Individuals with Autism Spectrum Disorder,” 216.
[ix] George and Stokes, “Gender Identity and Sexual Orientation in Autism Spectrum Disorder,” 6.
[x] George and Stokes, 7.
[xi] George and Stokes, 10.
[xii] George and Stokes, “A Quantitative Analysis of Mental Health Among Sexual and Gender Minority Groups in ASD,” 6.
[xiii] George and Stokes, 6–8.
[xiv] George, “Sexual Orientation and Gender-Identity in High Functioning Individuals with Autism Spectrum Disorder,” 193–229.
[xv] George, 209.
[xvi] Baron-Cohen, “Autism.”
[xvii] Su, Rounds, and Armstrong, “Men and Things, Women and People,” 891; Lippa, “Gender Differences in Personality and Interests,” 1098.
[xviii] Greenberg et al., “Testing the Empathizing–Systemizing Theory of Sex Differences and the Extreme Male Brain Theory of Autism in Half a Million People,” 12152.
[xix] Auyeung et al., “Fetal Testosterone and Autistic Traits,” 1.
[xx] Jones et al., “Brief Report,” 304–5.
[xxi] Ingudomnukul et al., “Elevated Rates of Testosterone-Related Disorders in Women with Autism Spectrum Conditions,” 600–601; Pohl et al., “Uncovering Steroidopathy in Women with Autism,” 5.
[xxii] Pohl et al., “Uncovering Steroidopathy in Women with Autism,” 5.
[xxiii] Pohl et al., 5.
[xxiv] Brown, Barker, and Rahman, “Erotic Target Identity Inversions Among Men and Women in an Internet Sample,” 6.
[xxv] Hines, Brook, and Conway, “Androgen and Psychosexual Development,” 78; Knickmeyer et al., “Androgens and Autistic Traits,” 150.
[xxvi] Loomes, Hull, and Mandy, “What Is the Male-to-Female Ratio in Autism Spectrum Disorder?,” 469.
[xxvii] Pasterski, Gilligan, and Curtis, “Traits of Autism Spectrum Disorders in Adults with Gender Dysphoria,” 4.
[xxviii] Pasterski, Gilligan, and Curtis, 1.
[xxix] Pasterski, Gilligan, and Curtis, 5.
[xxx] Pasterski, Gilligan, and Curtis, 4.
[xxxi] Jones et al., “Brief Report,” 304.
[xxxii] “Center of Expertise on Gender Dysphoria.”
[xxxiii] de Vries et al., “Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents,” 932.
[xxxiv] de Vries et al., 932.
[xxxv] de Vries et al., 934.
can you point me to your take on Andrew Lehman's work if any?
neoteny.org ... last time i checked there was a free pdf at a spanish site of his 2011 book ... i followed him at that time which prepared me well for the gender storms ..........