Aimee Challenor is 20 years. She is a transgender individual and also autistic. She and others from Trans communities feel they have had their Transgender identity undermined by medical professionals because of their autism. This has led to the delaying of gender reassignment procedures. How does it feel to ‘come out’ as Trans, only to have to hide autism? Challenor speaks out about juggling these two identities.

Challenor’s first real taste of prejudice was at her secondary school. She wanted to attend the end of year dance in a dress and this led to her head-teacher banning her attendance. Her parents demanded section thirteen of the Equalities Act 2010 be respected; a person cannot be discriminated against because of protected characteristics which include sex and gender reassignment. She was allowed to go to the ball.

“I dug my high heels in, and I have never felt so free. This was everything that I had dreamed of!”

Some of the teachers were supportive and helped Challenor apply make-up. The event was her first time publicly ‘out’ and she feels it was an important step to becoming true to herself. Although Challenor became confident about her Trans identity she was soon to discover her autism would cause complications. The first indication arrived in an email from her extended family.

‘How do we know this isn’t part of your autism? When did you first feel different? Have you had genetic testing? What’s it all about? A need to be different?’

Challenor was deeply hurt by these accusations from people she had trusted. Her very personal experiences with identity were being questioned and undermined. She believes her extended family were not purposely malicious but instead badly educated on the subject. However, she feels her relationship with them has been permanently damaged. It was not only her family who thought that autism could be related to being Transgender. She went to her local GP with the intention to be referred to a specialist clinic, but because of her autism, was instead referred to Child and Adult Mental Health Services (CAMHS). While at CAMHS Challenor was scared her autism diagnosis would invalidate her female identity,

“They had the power to refer me or refuse me because of my autism. I tried to mask it and just kept telling them that I wanted access Gender Identify Services.”

When asked to make a statement about procedures surrounding Trans and Autistic individuals NHS England stated:

“We do not routinely ask for any reassessment for autism. If a child or young person seen at GIDS is assessed for ASD we would be hoping that this would be helpful to the family and other professionals (like teachers) to guide them to support the young person more effectively and sensitively in many areas of their development, not just gender identity.”

Although this is the official stance of the NHS, Challenor, who has previously spoken for the Green Party on Lesbian Gay Bisexual Transgender Queer Asexual and Intersex (LGBTQAI+) matters, says she knows of people from Trans communities who have faced huge obstacles,

“I know people who have been refused because of their autism, and people who have faced massive barriers.”

Witnessing the devastating effect that being turned away from gender identity services had on her friends made her feel nervous about proceeding. She no longer wants this to be a fight that Autistic Transgender individuals have to face.

Dr Kate Nambiar, a Trans woman who is the coordinator of Clinic-T, a specialist sexual health clinic for Trans and non-binary individuals, says that part of the problem occurs from there not been enough standardized procedure around Trans Autistic individual’s treatment. Though every case should be treated on its own merit, she believes that the lack of set procedures can lead to decisions around Gender Reassignment being dependent on individual clinician’s views and experiences.

From her experience at the T-clinic Nambiar believes there is a higher proportion of autistic individuals living within the Trans community (Around 5-7%) and this is backed by current research published in the Archives of Sexual Behaviour in 2014. Vickie Pasterski, Liam Gilligan and Richard Curtis conducted a study into, ‘Traits of Autistic Spectrum Disorders in Adults with Gender Dysphoria’ where they examined a total of 91 patients at a London based gender clinic,

‘The prevalence of autistic traits consistent with a clinical diagnosis for an autism spectrum disorder was 5.5 % compared to reports of clinical diagnoses of 0.5–2.0 % in the general population.’

Although Dr Nambiar thought that Gender Identity Dysphoria (GID) might be more common with Autistic individuals, she did not believe that it in any way invalidated their Trans identity,

“When autism and Trans co-exist, it does not mean that one causes the other. It’s a shame that autistic individuals are feeling the need to mask, because it’s a part of who they are.”

Dr Nambiar believes that part of the problem arises from doctors not being specialists in both areas. If GPs are not confident they may be reluctant to refer someone to Gender Identity Services. This was Challenor’s experience,

“Before you access Trans healthcare you need to access autism healthcare. But if you access autism healthcare as a trans person, they want you to firstly access Trans health care. It shouldn’t be one before the other, you should be able to access them alongside.”

NHS England commented:

“We do have some staff at GIDS who are specifically trained and experienced in the nuances of Autism. Whilst it is true that many CAMHS Autism specialists aren’t trained around gender dysphoria, we work closely with local professionals to ensure that each young person’s needs are met in a holistic way. Many of the young people referred to GIDS have a diagnosis of ASC (Autistic Spectrum Condition) or strong autistic features – this is not a barrier to accessing the service.”

At her own clinic Dr Nambiar advises Autistic Trans individuals,

“If I know the clinician they’re seeing, and, I know they are open-minded, I’ll tell them just to be honest.”

She encourages Autistic individuals to be open about diagnosis but Challenor thinks autistic people wishing to be referred to Gender Identity Services should be wary. Her experiences have coloured her view of autism. She saw it as something to be eliminated for her to transition which is why, up until now, she has been very secretive about her diagnosis. Despite the steps that GIDS clinics take to train and educate staff it seems that many Autistic Trans individuals still feel they face resistance. Challenor’s current Gender Identity doctor wrote in her latest report,

‘Challenor’s views appear consistent over time and quite well thought out, though there is a degree of influence from a Asperger’s/Autistic Spectrum Disorder diagnosis made when she was 4 years old.’

Challenor asked why this was included in the report. She was told that future professionals would question her Trans identity because of her diagnosis. Her doctor included the above detail to show that her autism had already been addressed. It was an attempt to protect her from further questioning. Challenor is tired of having to defend her Transgender identity.

Nambiar commented,

“It’s a really tiny proportion of people who ever regret transitioning, and there is no evidence to suggest that the people that regret transitioning are more likely to be autistic.”

Challenor was not given any explanation as to why her autism was thought to be linked to her Transgender identity. It was just presumed there was a connection and for her to be referred to the gender identity services her autism needed to be reassessed.

“My autism was becoming a block to me accessing what I wanted: the healthcare and support I needed. It was preventing me from moving forward. If I could have magically removed it, I would.”

After six months CAMHS wrote a clinical report re-confirming her autism but stating that she could now proceed to Gender Identity Services. Challenor was angry at having her identity questioned because of her autism and frustrated at what she saw as an unnecessary and frightening wait. She wonders what the purpose of this re-diagnosis was and believes autism is being used to police the amount of people allowed to transition. Some GPs may believe that an autistic individual’s Transgender identity is just a strong fixation/obsession with their own gender. Challenor speaks about this being unjust,

“Most Trans people will be persistent and consistent. But if you’re autistic it isn’t taken seriously!”

Though these situations are what Challenor and other Trans Autistic people have experienced NHS England Commented:

“The legitimacy of gender dysphoria in people with features of ASD is not in question. It is important to recognise challenges that a young person having features of ASD may experience, in order for possible communication issues not to negatively impact their exploration of their gender identity.”

Being Autistic does not affect a person’s legal rights, their right to vote, or their right to freedom of expression; So why are Trans Autistic individuals finding it a barrier to self-identification? Trans and Autistic individuals having problems with medical professionals was given international recognition when Kayden Clarke, an Autistic Trans individual was shot dead in Arizona by police sent to intervene in a suicide attempt in 2016. It was reported that he held a knife when police forced themselves into his apartment.

Only weeks earlier Clarke had publicly reported via a YouTube diary that his Gender therapist did not know what ‘Asperger’s’ was. In his last video Clarke quotes them,

“We need to fix your Asperger’s disease before we write a letter to your doctor for you to start T (Testosterone).”

That Clarke, a Transgender person seeking assistance, was refused on the grounds of an Autistic diagnosis saddened Trans and Autistic communities worldwide. Autistic individuals who have successfully transitioned have even suggested it has lessened some traits such as heightened anxiety and meltdown. These ‘symptoms’ may be more prominent when people are uncomfortable in their gender. Challenor herself spoke on the topic,

“My autistic qualities have lessened a bit. I still have bad days. I’m still very peculiar about certain things. I still don’t like sudden changes. But overall, now that I’ve been able to be myself, I find it a lot easier to manage.”

At twenty years old Challenor become the head spokesperson for Lesbian Gay Bisexual Transgender Questioning Intersex and Asexual (LGBTQIA+) matters for the Green Party England and Wales. She has only recently come to the realisation that autism can also be an important and positive element of her personality. She believed she was able to channel some Autistic qualities into her role as Green Party LGBTQIA+ Spokesperson,

“It made me persistent. It made me a go-getter. If someone gave me an unsatisfactory answer, I’d challenge it!”

Autism Pride events organised by The National Autistic Society (NAS) have started up all around the UK. Challenor hopes that she can advocate that Autistic people live and work in all sectors of society. She hopes that speaking out about her experiences will make it easier for future Trans individuals who are also autistic,

“We need to acknowledge that there are significant amounts of autistic people within our communities.”

But because her Trans Identity was questioned by medical professionals it has made her anxious about her autism now being publicly discovered. She has even been worried that there might be a backlash from her own LGBTQIA+ community as many Trans individuals have worked hard to stop Transgender Identities being affiliated with mental illness. Challenor stresses that though there may be a higher correlation of autistic individuals in the Trans community (5.5%) this in no way suggests that the majority of Trans individuals should be affiliated with autism (94.5%). She also advocates that larger more comprehensive studies need to be conducted on the topic which better reflect Trans and Autistic people’s views.

NHS England commented,

“We agree that more research on aspects of the trans experience that might be particular to people with ASD would be welcome.”

Challenor would like the LGBTQIA+ community to be more inclusive of autistic individuals. She wishes to speak at her local gay bar but finds the noise overpowering and suggests that clubs could start introducing autism friendly nights with the music played lower. She says that the Pride celebration can also be difficult,

“Lots of people! Lots of flashing lights! Movement! Noise! A great way to send autistic people into sensory overload.”

For the first time in 20 years she is now ‘out’ not only as a Trans woman, but also an autistic woman. She hopes that the next generation of Trans autistic people will be able to embrace all elements of their personality. She is studying for a degree in Politics, Philosophy and Economics which she hopes will strengthen her political career.