Over the past decade, researchers have increasingly recognised an important relationship between autism and gender diversity. Studies consistently show that autistic people are more likely than non-autistic people to identify as transgender, non-binary, gender-diverse or gender-questioning. Likewise, transgender and gender-diverse individuals are more likely to be autistic than the general population.
While this association is well established, it is important to emphasise that autism does not cause someone to be transgender, and being transgender does not cause autism. Rather, research suggests that autism and gender diversity co-occur more frequently than would be expected by chance alone.
This article explores what current evidence tells us about the relationship between autism and gender diversity, the possible explanations for this overlap, the mental health implications, and how professionals can provide appropriate support.
Understanding Gender Diversity
Gender identity refers to a person’s internal sense of their gender. For many people, this aligns with the sex they were assigned at birth. These individuals are referred to as cisgender.
Transgender people have a gender identity that differs from the sex assigned to them at birth. Some people identify as non-binary, gender-fluid, agender or another gender-diverse identity.
Gender diversity is a normal part of human variation and is recognised across cultures and throughout history.
What Does the Research Show?
One of the most consistent findings in recent autism research is the elevated rate of gender diversity amongst autistic people.
A large study involving more than 600,000 adults found that transgender and gender-diverse individuals were between three and six times more likely to report an autism diagnosis compared with cisgender individuals.
A recent systematic review and meta-analysis estimated that approximately 7.4% of autistic individuals identify as gender-diverse, substantially higher than prevalence estimates in the general population. The same review found particularly high rates of non-binary identities amongst autistic participants.
Conversely, a 2024 scoping review reported that around 11% of transgender and gender-diverse individuals have a diagnosis of autism.
Although estimates vary between studies depending on methodology and definitions used, the overall conclusion is clear: autism and gender diversity frequently co-occur.
Why Might Autism and Gender Diversity Co-Occur?
Researchers do not yet have a definitive explanation.
Several theories have been proposed, and it is likely that multiple factors contribute.
Reduced Adherence to Social Norms
Many autistic people approach social conventions differently from non-autistic people. Research suggests that autistic individuals may be less influenced by social expectations and more likely to question societal assumptions about gender roles and identity.
Whereas some people feel pressure to conform to traditional gender expectations, autistic people may be more inclined to explore and express their genuine experiences of gender regardless of social norms.
This does not create gender diversity, but it may increase the likelihood of recognising and openly expressing gender incongruence.
Differences in Identity Development
Researchers have also suggested that autistic individuals may engage in more explicit, analytical self-reflection regarding identity.
Some studies propose that autistic individuals often spend considerable time examining aspects of themselves that others may take for granted, including gender identity.
Biological Theories
Some researchers have explored whether shared biological mechanisms may contribute to both autism and gender diversity.
Areas of investigation include genetic factors, prenatal hormone exposure and neurodevelopmental pathways. However, findings remain inconclusive, and no single biological explanation has been established.
Current evidence suggests that the relationship is likely complex and multifactorial rather than having one simple cause.
Biological Theories
Some researchers have explored whether shared biological mechanisms may contribute to both autism and gender diversity.
Areas of investigation include genetic factors, prenatal hormone exposure and neurodevelopmental pathways. However, findings remain inconclusive, and no single biological explanation has been established.
Current evidence suggests that the relationship is likely complex and multifactorial rather than having one simple cause.
Gender Diversity in Autistic Children and Young People
Research indicates that gender-diverse experiences can emerge during childhood in both autistic and non-autistic young people.
Some autistic children express discomfort with gendered expectations from an early age. Others become aware of gender incongruence during adolescence, particularly as social pressures and gender expectations become more pronounced.
Importantly, autistic young people demonstrate the same range of gender identities and experiences as non-autistic young people. The presence of autism does not invalidate a person’s understanding of their gender.
In fact, recent clinical guidance emphasises that autism itself should never be considered a reason to deny or exclude a person from appropriate gender-related healthcare.
Mental Health and Wellbeing
Both autistic people and transgender individuals experience higher rates of mental health difficulties than the general population.
Research suggests that when autism and gender diversity co-occur, rates of anxiety, depression, social isolation and suicidal ideation may be particularly elevated.
It is important to understand that these difficulties are not caused by autism or by being transgender.
Rather, research consistently points to factors such as:
- Social exclusion.
- Bullying and discrimination.
- Lack of understanding from others.
- Minority stress.
- Difficulties accessing appropriate healthcare.
- Pressure to mask or hide authentic identity.
These experiences can have a profound impact on wellbeing.
Autism, Masking and Gender Identity
Many autistic people learn to “mask” or camouflage their differences to fit into social situations.
Masking can involve:
- Copying others’ behaviours.
- Rehearsing conversations.
- Suppressing autistic traits.
- Closely monitoring social interactions.
Some researchers have suggested that individuals who have spent years masking autistic traits may subsequently begin exploring other aspects of identity, including gender identity, once they develop a better understanding of themselves.
However, being autistic, masking and gender diversity remain distinct experiences and should not be viewed as interchangeable explanations.
Supporting Autistic Transgender and Gender-Diverse People
Recent reviews have highlighted the need for more autism-informed gender services and more gender-informed autism services.
Effective support may include:
- Respecting an individual’s stated identity.
- Providing clear, direct communication.
- Recognising sensory and communication needs.
- Supporting emotional regulation.
- Addressing co-occurring anxiety or depression.
- Creating safe environments for identity exploration.
- Using a neurodiversity-affirming approach.
The emerging consensus within the research literature is that autistic transgender and gender-diverse people benefit most when both aspects of identity are recognised and supported rather than viewed separately.
Conclusion
Research consistently demonstrates a significant overlap between autism and gender diversity. Transgender and gender-diverse individuals are more likely to be autistic, and autistic people are more likely to identify as transgender, non-binary or gender-diverse than non-autistic individuals.
Although the reasons for this overlap are not yet fully understood, current evidence suggests that a combination of neurodevelopmental, psychological and social factors may contribute.
Most importantly, autism does not invalidate gender identity, and gender diversity does not invalidate autism. Both represent aspects of human diversity. As awareness grows, professionals are increasingly recognising the importance of providing affirming, person-centred care that supports autistic transgender and gender-diverse individuals to understand themselves and thrive
References:
George, R. and Stokes, M.A. (2018) ‘Gender identity and sexual orientation in autism spectrum disorder’, Autism, 22(8), pp. 970–982.
Hisle-Gorman, E., Landis, C.A., Susi, A., Schvey, N.A., Gorman, G.H., Nylund, C.M. and Klein, D.A. (2019) ‘Gender dysphoria in children with autism spectrum disorder’, LGBT Health, 6(3), pp. 95–100.
Kallitsounaki, A. and Williams, D.M. (2023) ‘Autism spectrum disorder and gender dysphoria/incongruence: A systematic literature review and meta-analysis’, Journal of Autism and Developmental Disorders, 53, pp. 3103–3117.
Kahn, N.F., Keuroghlian, A.S., Murchison, G.R., Sandberg, J.C. and Reisner, S.L. (2023) ‘Co-occurring autism spectrum disorder and gender dysphoria among adolescents’, Pediatrics, 151(3).
Lai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P. and Ameis, S.H. (2019) ‘Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis’, The Lancet Psychiatry, 6(10), pp. 819–829.
