Gender and Autism Spectrum Disorder

An exclusive preview of chapter 8 of The Gender Framework

The intersection between autism spectrum disorder (ASD) and gender dysphoria has become an area of growing clinical and research concern. The frequent co-occurrence of these conditions raises complex questions about diagnosis, identity, and care, making it important to provide an in-depth analysis of how autism and gender-related distress overlap.

ASD is a neurodevelopmental condition based on significant challenges with social communication and a restricted, repetitive pattern of interests and behavior (APA, 2013). It affects approximately 1–2% of the worldwide population (Lai et al., 2013; Maenner et al., 2020). Children and adolescents with mild or high-functioning autism (formerly known as Asperger’s syndrome) are disproportionately represented among the new cohort of young people who self-identify as transgender, with a significant percentage of those referred to gender clinics diagnosed with autism or exhibiting autistic traits. Multiple studies from gender clinics have reported high incidences of autism or autistic tendencies, as determined by various assessment tools. In a recent study of 68 youth seeking medical treatment at a pediatric gender clinic in the United States, 47% had an autism diagnosis (Cohen et al., 2023). Chart reviews of adolescents presenting to the Gender Identity Development Service (GIDS) in London revealed that approximately 35% exhibited moderate to severe autistic traits (Butler et al., 2018). Different aspects involving the overlap between autism and trans identification are outlined below.

It’s important to acknowledge that many of the conditions frequently diagnosed alongside gender dysphoria—including ADHD and mild forms of autism—are behaviorally defined and lack objective biological markers. In recent years, concerns have grown around the potential overdiagnosis of these conditions, particularly in young people. Just as with gender dysphoria, psychiatric labels can sometimes reflect an individual’s effort to make sense of emotional or psychological distress rather than a stable or lifelong identity. Children in distress may meet criteria for multiple diagnoses, which can overlap, fluctuate, or evolve over time. These labels—especially when applied early—should be approached with caution, as they may represent temporary frameworks for self-understanding rather than fixed disorders.

In this light, it may be more helpful to consider the specific traits associated with autism individually, rather than viewing them solely through the lens of a diagnosis. Many of these traits—social difficulty, intense focus, rigidity, sensory sensitivity—can be present to varying degrees in the general population. Still, individuals diagnosed with autism may represent a group with unique vulnerabilities that shape how they experience and respond to gender-related distress.

What follows is a review of relevant research and interpretations of that research, but readers should be mindful of the potential for overdiagnosis of mild autism and the limitations of behavior-based criteria when drawing conclusions.

8.1 Overlap Between ASD and Gender Distress

While there is significant overlap in masculine and feminine traits between the sexes, autistic individuals display heightened gender nonconformity compared to their peers. Autistic women have been found to show more masculine physical traits, whereas autistic men often present with less masculine attributes (Bejerot et al., 2012). Studies have consistently found that autistic women identified as tomboys during their childhood (Bejerot & Eriksson, 2014; Ingudomnukul et al., 2007). Gender nonconformity is particularly pronounced in autistic females, with estimates ranging between 22%-33%, compared to 8%-22% in autistic males (Bejerot & Eriksson, 2014; Dewinter et al., 2017; George & Stokes, 2018). Autistic children are also significantly more likely to express gender variance than their peers (Strang et al., 2014). Autistic females may struggle to identify with traditional definitions of femininity (Kanfiszer et al., 2017). Overall, autistic individuals tend to identify less with, and hold more negative views about, the gender group they belong to than their peers (Cooper et al., 2018). Several hypotheses, such as elevated androgen levels in autistic women and differences in brain structure, attempt to explain the notable overlap between autism and gender nonconformity (Beacher et al., 2012; Knickmeyer et al., 2008).

8.1.2 Body incongruence and sensory sensitivity

Autistic individuals often face sensory processing challenges, manifesting as either hypersensitivity or hyposensitivity to stimuli such as sounds, lights, and textures (APA, 2013; Elwin et al., 2012; Tavasoli et al., 2014; Taylor et al., 2020). Furthermore, they encounter difficulties with interoception, making it hard to interpret internal body signals and alexithymia, the inability to understand and convey emotions (Brewer et al., 2016). Proprioception, or the sense of body positioning and movement, can also be problematic, causing coordination and balance issues (Fournier et al., 2010). Cooper et al. (2023) suggest a link between these sensory needs in autism and an increased risk of gender dysphoria. Sensory discomforts, like irritation from specific clothing or grooming activities, may push autistic individuals toward preferences typically associated with the opposite sex. For example, autistic girls might prefer boyish, looser clothing, and boys may prefer feminine attire, not necessarily because such clothing is stereotypically feminine or masculine, but because the individual prefers the sensory aspect of that particular clothing (Milner et al., 2019; Tateno et al., 2008).

The pressure to conform to societal clothing expectations can present significant challenges for autistic individuals, particularly for adolescent girls who may not want to adhere to the latest fashion trends, leaving them feeling excluded and reinforcing their sense of otherness at a developmental period when their peers are absorbed by these topics. Adolescents with developing bodies that do not feel like they meet stereotypical ideals for their sex may reject their bodies, hyper-focusing on their perceived flaws, leaving them at risk of body image disorders. Exposure to discussions on gender dysphoria, in educational settings and online, may particularly resonate with autistic individuals’ experiences of bodily discomfort, leading them to seek social and medical transitions as potential solutions to reconcile their discomfort. These dynamics are increasingly visible in schools and youth programs, where educators and staff are often the first to observe signs of gender distress in autistic students, yet may lack the training to distinguish between gender identity issues and autism-related sensory or social challenges.

8.1.3 Intense and restricted interests

Autism is characterized by intense and focused interests known as “special interests” (APA, 2013). Autistic males often gravitate toward objects and gaming, while autistic females are drawn to social content like people, animals, psychology, and even autism itself (Grove et al., 2018; McFayden et al., 2019). In a study by Grove et al. (2018), autism itself emerged as the most prevalent special interest among female participants and ranked third among males. The researchers proposed that this fascination with autism may be linked to a significant proportion of the participants being diagnosed later in life. They developed an interest in autism to enhance their understanding of themselves and found “comfort in autism as an identity” (Grove et al., 2018, p. 9). Similarly, when autistic individuals identify as transgender or receive a gender dysphoria diagnosis, they may also perseverate on their diagnosis or what it means to be transgender, which may further cement a transgender identity.

Professionals diagnose gender dysphoria with “insistent, persistent, and consistent” assertion of a cross-sex identity (Hidalgo et al., 2013, p. 286). This pattern mirrors autistic engagement with special interests, which vary in duration and can last for many years, complicating differentiation between the two conditions. Psychologist Dr. Zucker suggests that autistic fixation could drive the embracing of transgender concepts, potentially making some believe they are transgender (BBC, 2017). Some researchers propose that intense interest in opposite-sex-associated activities could lead to the formation of a cross-sex identity (Vander-Laan et al., 2015). Boys with ASD and gender dysphoria often favor stereotypically feminine interests (van der Miesen et al., 2018), potentially linked to sensory needs (Nabbijohn et al., 2019), and connecting gender dysphoria to ASD (Tateno et al., 2008).

Autistic individuals also exhibit a strong sense of fairness and justice (Kirchner et al., 2016), which may predispose them to engaging in contemporary social justice causes. In online autism communities, discourse centers around the “neurodiversity movement.” It is notable that online autism and transgender communities frequently intersect. In an online survey of detransitioners and desisters who had been diagnosed with autism or exhibited autistic traits (Buttons & Rowley, 2025), significant interest in social justice was reported by 95.6% of 94 participants. Further, 85.3% of participants reported that gender identity became an engrossing special interest.

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Christina Buttons is an Investigative Reporter at the Manhattan Institute

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