Autism, Puberty, and Gender Dysphoria

After six years of identifying as a trans man as a teenager, I desisted (stopped identifying a trans) at the age of 21. Since reclaiming my womanhood, I have been thinking long and hard about what exactly happened in my 15-year-old brain that made me feel I would only be stable and fulfilled if I took testosterone, changed my name and pronouns and socially became a man. The conclusion I have come to is that thinking I was trans was completely inseparable from my autism.

For most of the time I identified as transgender, I was not yet diagnosed with ASD (Autism Spectrum Disorder). Looking back with the knowledge that my diagnosis has given me, it’s obvious that I was unwittingly dressing up my Autism in the more fashionable clothing of Gender Dysphoria. Gender Dysphoria is defined as “the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.”; it is the clinical diagnosis received by transgender people.

Autism is a lifelong developmental disability which causes restrictive and repetitive thinking and difficulty with communication and social interaction. If you have an Autism Spectrum Disorder (ASD) you often develop very narrow obsessions that are difficult to see outside of. In the ASD community, these interests/fascinations/obsessions are called “special interests.”

Trans activism was definitely one of my special interests from age 16-19. My interest in trans issues became my main special interest that I was completely absorbed in; I didn't really think about anything else. I initially found out about online trans communities when I was 15 and nervously typed into Google something like: “I feel half boy and half girl,” which brought up the definition of non-binary. I immediately followed every blog I could find that posted about being non-binary and got very involved in the trans community, especially on Tumblr. After that, I loved nothing more than spending hours researching and debating trans topics, and online I surrounded myself with everything trans and non-binary.

I was so assured that I needed to “educate” the people around me about this expansive world of gender that I had discovered online. I talked about it so much that people who had enjoyed my company up until that point blocked me across social media because they were fed up with hearing about it.

Difficulty adjusting to change is another classic autistic trait. In my everyday life this mostly manifests as trivial eccentric things like still wearing the clothes I wore at 14 because I am so attached to them. However, whilst I was going through puberty, this aspect of ASD meant I really struggled with my changing body. It was made worse because I didn’t understand why I was struggling. I simply could not handle the way my body was changing during puberty and the speed at which it was changing. The changes didn't make sense to me. I didn't want to look at my body, take proper care of it, or, God forbid, show it to anyone else.

When you are female & autistic (diagnosed or not), you are aware from a young age that your brain seems to be wired differently to the girls around you. In the current social media climate of gender identity fixation, it was easy for me to misinterpret this as having a brain wired like a boy's. Autism makes you good at systematizing but bad at empathizing, which are traits we typically associate with men. Autistic women tend to lack the emotional depth that is expected from women, and this can result in struggling to socially bond with other women, instead feeling closer to men.

When I was 15, undiagnosed autistic, and surrounded by trans culture online, it was easy to conclude that I must have a male brain because I had typically male patterns of thinking. I also struggled with body image issues, and I felt totally at home in the insular trans community that I had found online. Factor into that my tomboyish childhood, the fact I grew up with entirely male friend groups, and that I had been getting mistaken for a boy throughout my life (even with hair down to my hips), and I had all the evidence I needed that I was a boy in a girl’s body. I came out as trans at 16 and stayed that way until I was 21.

I didn’t medically transition, unless you count the medicine I bought online that made me grow facial hair, which I don’t as its effects were so easily reversed. My social transition consisted of me legally changing my name, changing pronouns, and trying in every way that I could to pass as a teenage boy. Because I couldn’t buy a binder, I bound my chest in extremely unsafe ways, including (to my current self’s horror) with duct tape and gaffer tape.

It was my ASD diagnosis in 2017 that made me begin to put all the parts together and realize I had made the wrong decision about transitioning. My ASD diagnosis explained the non-normative behaviors I had been showing my whole life in a way that the Gender Dysphoria diagnosis never quite could. It truly changed my life and saved me from doing something I would certainly have regretted. After I got diagnosed I began researching autism in females, which was what opened a whole Pandora’s box of doubts and second thoughts about transitioning, which eventually led to me desisting.

I began, for the first time, to question the entire philosophical basis of gender ideology, and to critically examine the transgender community. Before then I had never truly questioned any of the things I was reading about gender online, probably because I was so consumed by it. Once I stepped outside of that bubble, I began to realize that I had been sold a false step-by-step guide to self-actualization, and I think that’s what was so intoxicating to me about transition. It presented an opportunity to turn myself from this awkward, self-loathing autistic girl into a cool and confident man, and I couldn’t resist it. It’s not that I was being pressured into altering my body exactly, but I was always itching to take the “next step” up the ladder to eventually become that cool confident man I wanted to be.

After you’ve changed your wardrobe, then your haircut, then your name, then your pronouns, then after you’ve started binding and packing and voice training, the natural next step is hormones and then surgery. I don’t think I ever truly felt I needed those medical interventions, they just felt like the logical next steps in this process I was undertaking to make me eventually feel “normal.” Here I would like to note that autistic people love to follow a clearly laid out step-by-step process. It’s logical and linear, and it makes the world easier to understand for us. Could this linear thinking, and being presented with a step-by-step path to happiness be another aspect that is driving autistic people to transition in their teens?

Between the ages of 15 and 16, I was looking for answers as to why I had all these issues, why my mind seemed to compute so differently, and the answer that came from the online spaces I was inhabiting was “you’re a boy in a girl’s body, here’s what to do about that,” to which I thought “that’s the answer to my problems!” and proceeded to do all the things that were supposed to make me feel like my true self: change my name, pronouns, mannerisms and the public bathroom I used. However, none of this really made any “true self” shine through, although I told myself, and everyone else that it did. Something always felt off; I felt I wasn’t meant to be a woman because of my differences, but I didn’t feel like a proper man either. If I had been diagnosed with ASD at 15 or earlier, I imagine my adolescence would have been very different: more authentic, freer and much more in tune with myself. Being aware of the difficulties I have could well have stopped me from spending 6 years thinking I was meant to be a boy.

Being transgender was the only explanation I had when I was younger for issues that were actually rooted in autism. I thought testosterone would “fix me” and make my body as masculine as my brain seemed to be.

In fact, my brain wasn’t “masculine” at all, it was autistic.

A large part of why I was so convinced I was trans was that I wasn’t diagnosed with ASD until adulthood. Going undiagnosed is fairly common for girls on the spectrum. Girls on the spectrum can pass as neurotypical far better and for longer than boys. We can socially camouflage to some degree, copying the social behaviors of those around us even if we don’t understand those behaviors. This means that autistic girls slip under the radar but are still experiencing all the internal struggles of autism.

Autistic girls also go under the radar because they are misdiagnosed with other conditions. Common misdiagnoses for autistic girls include anxiety, depression and ADHD. I hypothesize that we are witnessing a new type of common misdiagnosis for ASD girls emerging: Gender dysphoria. This misdiagnosis is very different to the others; where treatment for these mental illnesses involve cognitive-behavioral therapy (CBT), changes to your day-to-day living like eating healthier, and sometimes medication, the treatment for gender dysphoria is physical, irreversible body-altering hormone injections and surgeries.

Studies into the co-occurrence of autism, gender variance and gender dysphoria have returned some striking numbers. A study by John Strang in 2014 found that children with ASD were 7.59 times more likely to be gender non-conforming or “express gender variance.”

A 2012 study of trans adults and adults with ASD tested the two groups’ AQ scores (Autism Quotient, a common test for ASD traits). The study found that trans men had a higher average AQ than typical females, typical males, and trans women, but lower than individuals with ASD. This suggests that biologically female trans people display more autistic traits on average than most people.

More recently, in 2019, Anglia Ruskin University tested 177 people, including a trans and non-binary group and a cisgender group, on AQ, empathy, systematizing the Reading the Mind in the Eyes Task. In this study, 14 percent of the transgender and non-binary group had a diagnosis of ASD, while a further 28 percent reached the AQ cut-off point, suggesting that the group of trans people surveyed contained more undiagnosed ASD cases. The researchers said that these numbers were driven mainly by the high scoring of biologically female participants. In the conclusion of the study the authors advise gender clinicians to “consider whether clients, especially those assigned female at birth, have an undiagnosed ASD” and the lead author suggests that gender clinics routinely screen patients for autism.

I was not surprised to read the figures in these studies, as they consolidated my own anecdotal experiences of transgender spaces, that is, they contain a lot of autistic people. The trans community is currently packed with young, mostly biologically female people, many of whom display quite distinct autism traits. Yet, it seems to go ignored. In ignoring this co-occurrence of ASD and trans identity in young women, we risk jeopardizing the mental and physical health of an entire generation of autistic girls.

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