Recent evidence suggests that there may be an association between autism spectrum disorders and being transgender. What started as an observation made by a few physicians is now gaining evidence in peer-reviewed research. This week, I take a look at a new research paper that shares new data on the association.

First, some background. Autism is a spectrum of disorders. The core is difficulty with social interactions along with repetitive or restricted interests or behaviors. People with autism lack an innate sense of the “socially correct” thing to do. They may struggle to see the world from other people’s perspectives. People with autism are often said to think in a “quirky” manner, different from many people. At its most severe, an individual with autism can be unable to take care of him or herself. They may be profoundly mentally disabled and need life-long care. At its least severe, a person with autism can be a socially awkward but brilliantly intelligent scientist. They may make critical breakthroughs because of that “quirky” thinking.

So — did this study find that trans people were more likely to be autistic? Or that people with autism are more likely to be trans? It’s more subtle than that. Let’s look at the methods…

This study reviewed the medical records of roughly 2,000 children in a specific center in New York. Roughly 3/4 did not have autism. The other 1/4 were diagnosed with autism. They did not have a subgroup of individuals who were diagnosed as transgender. Instead, they looked at a specific question on a standardized clinical survey that had been used with all the children. The question asked the children to agree or disagree with the statement: “I wish to be the opposite sex”.

(edit, 3/23/16: For clarity’s sake, “I wish to be the opposite sex” is different from “I am the opposite sex” or “I should have been the opposite sex”. Different trans, genderqueer, or gender non-conforming people may agree with those different statements differently.)

So they were specifically looking at non-autistic and autistic children and asking: “Are autistic children more likely than non-autistic children to report desiring to be the opposite sex?” Technically, this isn’t the same thing as a diagnosis of gender dysphoria or transgender. The authors describe it more as “gender variance” — a pretty good description. And a decent approximation since they could’t go back to get the children an official diagnosis.

What did they find?

5.1% of the children with autism said that they did wish to be the opposite sex. Only 0.7% of non-autistic children said that they wished to be the opposite sex. It didn’t matter whether the children were assigned males or females at birth. It also didn’t matter what age they were.

That’s a huge difference. That means autistic children are 7.76 times more likely to have some gender variance.

Why might autism and gender dysphoria (transgender) be associated? We don’t know why some people are autistic, and we don’t know why some people are trans. The authors hypothesize about the effects of common environmental effects, like birth weight and autism severity.

I wonder if it has to do with some of the different ways that people with autism think. People with autism tend to think differently about the world from people without autism. They often report a sensation that they are strangers or aliens, somehow apart from the rest of the world because of that difference of thinking and perceiving. That sense of alienation can extend to one’s body. People with autism are also less likely to perceive or care about culturally defined sex roles (e.g., only girls wear dresses). Perhaps these differences play a role? I’m only hypothesizing here. If any trans people with autism would like to share their thoughts, please let me know in the comments or send me an e-mail.

Regardless, it’s slowly becoming clear as more and more papers are published that people with autism are more likely to be transgender than people without autism. It’s time we took a good look at the association and made sure that medical and psychological health care is available and appropriate for these populations.

Want to read the study for yourself? It’s publicly available from the journal Transgender Health.

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