“Insistent, consistent, persistent”: Autism spectrum disorder seen as no barrier to child transition–or sterilization

The headline I chose for this post comes from the oft-repeated axiom (unsupported by any robust research to date) that kids who are “insistent, consistent, and persistent” in their assertion that they are, or want to be, the opposite sex, are somehow innately “transgender.” Yet rigidity (a concise paraphrase for that three-word catchphrase) is also a hallmark of autism spectrum disorder (ASD).

In May, I posted about a recent Finnish study which found that girls presenting to gender clinics in that country have an increased rate of autism spectrum disorder as well as other mental health problems. The researchers found a 26% incidence of ASD in the study cohort.

Sixty-four per cent … were having or had had treatment contact due to depression, 55% … due to anxiety disorders, 53% … due to suicidal and self-harming behaviours, 13% due to psychotic symptoms …, 9% … due to conduct disorders, 4% … due to substance abuse, 26% … due to autism spectrum disorder, and 11% …due to ADHD…

…Gender identity issues could arise from autism spectrum people’s predisposition toward unusual interests, or gender dysphoria in ASD could represent OCD rather than genuine gender identity issues. The cross-gender behaviour in ASD minors could also rather represent non-normative sexual interests or unusual sensory preferences. Our clinical impression is that a long-standing feeling of being different and an outsider among peers could play a role in ASD children developing gender dysphoria in adolescence. In our clinical sample of gender dysphoric adolescents, autism spectrum disorders by far exceeded the prevalence of 6/1000 suggested for general population .

It turns out that the link between ASD and GD has been noted by many other researchers, clinicians, and (if the mothers and fathers who comment on this blog are any indication), many parents as well. Poor social and/or communication skills, a hallmark of ASD, as well as a tendency to have obsessive interests, to isolate socially and spend inordinate and unusual amounts of solitary time on the Internet, have been noted by both professionals and parents. I’ve also noticed, on several of the blogs run by parents who are supporting their child’s transition, a theme of frequent temper tantrums and refusal to wear certain clothing.

A 2014 study from Washington, DC found that

compared with normally developing children, young people with ASD were nearly 8 times more likely to express a desire to be other than their biological sex — a phenomenon the authors describe as “gender variance.” Those with a diagnosis of ADHD had more than 6 times the odds of communicating gender variance, according to parent-reported data.

Dr. Strang said they were initially surprised to find an overrepresentation of gender variance among children with ADHD. However, they later realized that prior studies have shown increased levels of disruptive behavior and other behavioral problems among young people with gender variance.

A 2010 Dutch study on found an increased rate of autism in the gender dysphoric children referred to their clinic.

Most individuals with co-occurring gender dysphoria and ASD fulfilled the strict criteria of autistic disorder. For several youth with ASD, their ASD-specific rigidity made enduring gender variant feelings extremely difficult to handle. After all, in our society a considerable amount of flexibility is needed to deal with gender variant feelings. Normally developing young children (age 3–5) display more rigidity in gender-related beliefs than older children; this rigidity decreases after the age of fiveIndividuals with ASD may not reach this level of flexibility in their gender development.

The implications of this are profound: If some of the very young children with GD (many of whom are currently being profiled in celebratory media portrayals) have co-occurring ASD, yet are being socially transitioned and then put on puberty blockers, how much of their distress is due to the rigid thinking and behavior characteristic of ASD?

Social difficulties are a key trait of people on the ASD spectrum. A 2011 study published in the Journal of Autism and Developmental Disorders that focused particularly on female-to-male transsexuals found that

 Autism Spectrum Conditions (ASC) are characterized by difficulties in social interaction and communication, along-side restricted interests and repetitive behavior.

… A recent study of play by girls with ASC found they show masculinization in  choosing toys that do not require pretend play …, and women with ASC report higher rates of tomboyism in childhood.

…We speculate that this increased number of autistic traits is likely to have made the transmen (in their childhood and adolescence) less able to assimilate in a female peer group, instead gravitating towards males. This may also have led to difficulties socializing in a female peer group, and a feeling of belonging more in a male group, thus increasing the probability of GID.

One comment on my earlier post on the Finnish study submitted by a teen girl who says she is autistic, appears to support some of these findings.

I’m autistic and a LOT of autistic girls my age (teenagers) I know from support groups (to learn social skills, etc) are questioning their gender/thinking about transition. I mean a much much higher percentage than not-autistic girls I know… The majority of girls in those groups consider themselves genderqueer/bigender/nonbinary & some talk about transitioning or at least “presenting” as a boy…

I wonder if the number of transgender/gender questioning autistic girls is bc autism makes all this gender stuff really hard – there’s hypersensitivity to touch/smell/etc which means many of us can’t shave, can’t wear makeup or tight-fitting feminine clothing, can’t have long hair (bc it touches your skin in unpleasant ways), wear nail polish (it smells too strong) etc.

Also ppl think girls have better social skills than boys… so a lot of autistic teenage girls end up feeling like they’re “not girl enough”, like all the other girls can do those things easily and they can’t & that probably means they should be a boy.

Idk if this explanation is too simple, there’s probably more to it, but I’m really noticing how MANY autistic girls are in this situation, of wanting to be called “he”, to pass as a boy, to get breast surgery, etc, compared to not-autistic girls my age, and I wish the links between autism and transgender/discomfort with gender were explored more, so we could better help them. If autistic/other disabled people are more affected by dysphoria than the general population, we really should be wondering why? instead of just “accepting that their body is wrong for them”… Why would so many autistic girls’ bodies be WRONG? For no reason???”

An adult woman, also diagnosed with ASD, adds

People on the autistic spectrum feel very different from others, and often “wrong”. We often have trouble fitting in and understanding social situations. Since femininity is a social construct that requires a lot of work, autistic girls and women might not feel or be able to act feminine enough.

One common thing is “special interests”. People with AS can easily be obsessed with certain topics.

So, with the combo of feeling different and not like a real girl/boy and all the info about transgenderism on the internet, it could lead to people going from feeling wrong, seeing others online talking about being trans, to researching the topic intensively and thinking it could be me, that it could solve their problems to be trans.

In “Musings of an Aspie” (highly recommended), a blogger diagnosed with high-functioning autism offers insights about her experiences with disconnection from female stereotypes.

Women are expected to be intuitively skilled at social interaction. We are the nurturers, the carers. To be born without natural social instincts can leave you questioning your innate womanhood.

The first hint of what was to come arrived long before I’d given any thought to what being a woman would mean. At some point in sixth grade, many of the girls in my class became huggers. They hugged when they met each other and when they said goodbye. They hugged when they passed in the hallway. They hugged when they were happy or sad. They hugged and cried and squealed with excitement and I watched from a distance, perplexed. What did all this hugging mean? And more importantly, why wasn’t I suddenly feeling the need to hug someone every thirty seconds?

This was the first of many confusing conversations I was to have with myself.

In a very recent review of research (publication date November 2015), the authors observe that

…kids with autism spectrum disorder may hold more rigid views of what it is to be male or female and thus be more at risk toward developing gender dysphoria if they do not feel fit within their binary categories of girls and boys. …and that … the fragility of identity experiences in gender dysphoric minors leads to a more rigid fixation on gender-based stereotypes.

As a critic of pediatric transition, all of this research evidence, as well as the personal anecdotes I’ve shared here, lead me to question: Is it wise to subject children who might have autism to “treatments” that involve permanent administration of hormones, repeated plastic surgeries, and likely sterilization? And further, is a child with ASD even capable of giving “informed consent” for such treatments?

As you might suspect, trans activists–and increasingly, gender specialists and researchers–don’t appear to be much troubled by such questions.  In the UK, written evidence recently submitted to Parliament by the Tavistock clinic, one of the key providers of transition services, included this passage:

We offer assessment and treatment not just to those young people who are identifiably resilient and for whom there is an evidence base for a likely ‘successful’ outcome. We have carefully extended our programme to offer physical intervention to those who have a range of psychosocial and psychiatric difficulties, including young people with autism and learning disabilities, and young people who are looked after. We have felt that these young people have a right to be considered for these potentially life-enhancing treatments. This has involved careful liaison with local service mental health providers and Social Care, who may know these young people well and who have particular responsibilities for their well-being.  Indeed, the service has no record of refusing anyone who continues to ask for physical intervention after the assessment period. Some young people back off from physical treatment at an early stage, but the majority who choose to undertake physical interventions stay on the programme and continue through to adult gender services where surgery becomes an option.

This March 2015 article, published in the Yale Journal of Biology and Medicine, draws a similar conclusion.

Individuals with ASD have the same rights as other individuals to appropriate assessment, diagnosis, and treatment of gender-related concerns. The challenge that exists surrounds being attentive to the particular concerns that may influence this presentation in ASD individuals; the goal should be to facilitate improved understanding and patient satisfaction and not to increase the number of barriers to appropriate treatment.

It’s likely that some parents might disagree with some of these statements when it comes to their underage kids (though they’d be out of the loop in Oregon, which recently approved gender “confirming” surgeries on children as young as 15 years without parental consent.) But judging by this comment on the publicly viewable Facebook page of Jenn Burleton, the executive director of TransActive, which lobbied for the lowering of the age of consent for gender “transition,” some family members of kids with ASD are aboard the bandwagon, too.

8 year old aspergers implant

“Gatekeeping”–the imposition of any restrictions on obtaining transition services–is a dirty word to trans activists, and increasingly, compliant gender specialists. “Informed consent” (essentially, giving the patient whatever they ask for, based strictly on self identification) is the new norm. And this push for an end to gatekeeping extends to children and people with disabilities; the hot term is personal  “agency,” and trans activists have little patience for the idea that perhaps not all people have equal capacity to make sound decisions. To take but one recent example, the mother of a young woman with Down Syndrome created a fundraising website, which, while mentioning that her daughter had been hospitalized in an intensive care unit, insisted that she still needed “top surgery.” A prominent Los Angeles gender therapist, who happens to be FTM, helped with fundraising for the double mastectomy on a public post on Facebook, which as of this writing is still a live link, despite some scathing coverage in the gender critical blogosphere.

But I digress.

Providers are now recommending treatments for childhood gender dysphoria (puberty blockers followed immediately by cross sex hormones to prevent the “wrong” puberty) that will result in sterilization of minor girls, at least some of whom will have ASD. This is a strange reversal, given that sterilization of minors with any sort of disability is controversial, to say the least. Another hotly debated issue is the sterilization of intersex children. In fact, as this article emphasizes,

Generally, consent of a parent or guardian is not legally adequate to authorize sterilization — a court order is necessary… How can a physician address this uncertainty? It is certainly prudent to consult with an experienced attorney before undertaking elective gonadectomy or other procedures that could affect fertility. To avoid conflicts of interest, the attorney should represent the medical providers, not the parents. The child may need separate representation. It will be important for counsel to understand the medical issues involved…”

In another strange twist, Lupron, a puberty blocker, is administered to prepubescent children (some, obviously, with diagnosed ASD), despite the fact that lawsuits have halted the drug’s use by some doctors to treat ASD.

So off-label Lupron is the answer for gender dysphoria in a child with autism, but is forbidden to be used to treat the autism? Well, given the current trend in medicine and psychiatry to treat GD as the core problem, perhaps this is not so strange. None other than the American Psychological Association, in its recent guidelines for treatment of trans-identified young people, actually supports the notion (on page 21) that treating GD is something of a panacea for all and sundry mental disorders:

In addition, the presence of autism spectrum disorder may complicate a TGNC person’s articulation and exploration of gender identity (Jones et al., 2012). In cases where gender dysphoria is contributing to other mental health concerns, treatment of gender dysphoria may be helpful in alleviating those concerns as well (Keo‐Meier et al., 2015).

With the lofty endorsement of the APA, what parent wouldn’t look to “transition” as the magic answer for their gender dysphoric, autistic child? And what APA-certified therapist would dare to question these guidelines? (We know of at least one who is raising concerns.)

The sister of an autistic FTM has written an article cheering on her “female-born” sibling. As is usual in such articles, the preference for stereotypical male clothing, interests, and haircuts is used as evidence that this natal female is actually male.

Draped in a royal blue wool cape, my female-born autistic brother wears a homemade pin that reads, “I am a transgender male and I’m proud.” The 23-year-old points to it whenever he’s at restaurants, anticipating people making pronoun mistakes, which have been aggravating him for nearly two years.

For several years, he has been dressing like a boy, though his interpretation of what is “masculine” differs from most transgender males. For him, the color blue signifies masculinity more than attempting to “pass” as a man, and so he chooses to wear only monochromatic blue athletic clothing all the time.

He has been cutting his hair at a man’s barbershop for a decade, but he only came to identify as male roughly two years ago. He said the epiphany came to him after waking up from a nap, kind of like in Virginia Woolf’s Orlando, in which the male-born protagonist suddenly awakens a woman.

And Wenn Lawson, a trans-identified “highly regarded psychologist, lecturer and author” on the autism spectrum, pushes the idea that stereotyped interests and gender presentation in an autistic child are indicative of true “gender dysphoria”:

But, in children especially, the possibility of gender dysphoria must be considered, and parents need to watch out for the clues. These might be:

  • looking for gender biased separate interests

  • wishing they were a girl (or boy)

  • dressing in girls (or boys) clothes,

  • wanting to play with toys stereotypically used by the opposite gender

But what of the young people who are “on the spectrum” themselves? Are they all on board with the no-questions-asked, informed consent model of treatment? Put another way: Are the gender specialists providing these people with the best possible care,  care that actually provides the most benefit with the least harm?

There is a large online support forum for the autism community called “Wrong Planet.” A search for “gender dysphoria” turns up numerous threads, with commenters discussing their feelings of discomfort or confusion with their bodies and gender identity. Opinions appear to be mixed, with some commenters attributing their dysphoria to their ASD (and denying the need for “transition”), and others discussing their desire to change genders. Interestingly, another commenter on my earlier Finland post had this less-than-rosy observation:

[Wrong Planet] has been co opted by the trans community in other places, and they skew the facts about ASD, and some get kicked off the board for pushing an agenda and posting incorrect facts[which bother people with AS like myself]. I don’t even like to talk about my own AS, because- ‘Maybe you are trans’ gets forced on me[been there-done that] outside of a Wrong Planet board. Men also use this as an excuse to bully women online.

The trans community tries to convince non conforming ASD people to join their cult, but some can’t stand it if someone keep misquoting science, or making things up even after corrected[like they do].

That is a dead give away too, Many ASD people, if you can prove your facts, they will correct themselves with the new information, and not feel badly about having the wrong information previously. They will update everything accordingly. If you are saying ‘bullshit’ and non reality is true, they will kick you off that site for teasing them.

It does appear that at least some people on the ASD spectrum have come to terms with their childhood feelings of gender incongruence and resolved them as adults. Once again, we hear from the author of “Musings of an Aspie”:

At five, I wanted to be a boy. I don’t know what I thought being a boy meant. Maybe I thought it meant playing outside in the summer, shirtless and barefoot. Maybe I thought it meant not wearing dresses.

Dresses were all scratchy lace trim and tight elastic sleeves. Stiff patent leather shoes pinched my sensitive feet. Perfume tickled my nose. Tights made my legs itch and had maddening seams at the toes.

Too young to understand sensory sensitivities, I followed my instincts. While other girls favored frilly clothes, I gravitated toward the soft comfort of cotton shirts and worn corduroys.

Somehow, comfort got mixed up with gender in my head. For decades, “dressing like a girl” meant being uncomfortable. And so began a lifelong tension between being female and being autistic.

49 thoughts on ““Insistent, consistent, persistent”: Autism spectrum disorder seen as no barrier to child transition–or sterilization

  1. In my observation and personal experience I totally agree that there are many in this community who have OCD as well as asbergers, which goes hand in hand with what I have been saying for the longest time, that this is a neurological impairment disorder. GD is like a cough is to a cold. We actually touched based on last night show. We even had a caller who expressed the same feeling regarding this and shared his experience with us. https://www.youtube.com/watch?v=HjZ-9P61GRY

    Keep up the great work

    Liked by 3 people

    • And I’d think that secondarily to whatever the clinical factors are, kids who recognize that they’re distinctly different from others in some ways don’t get to grow up in Popeye mode – “I am what I am.”

      More than other kids, they have to wonder WHAT am I? In sifting through all the ways people can be different they’re bound to test important categories like sex and gender to see where they might fit best. Also, if you absorb a lot of “Something’s wrong with you” messages, why wouldn’t you decide to be something other than what people have decided you are?

      I get a lot out of your podcasts, by the way, Mark. They’re always interesting, and the humanity you two evoke with your guests has struck me as an important contribution to the overall discussion that elsewhere often devolves into a hostile shriek fest.


  2. What jumped out at me from the Tavistock clinic’s quote was the mention of learning disabilities along with autism. It is well known that Caitlyn Jenner has a severe case of dyslexia. Maybe there’s no link between that and her being transgender, but it made me go hmmmm…


    • Dyslexia is a specific learning difficulty, not a learning disability. Learning disabilities refer to an IQ below 70, whereas dyslexia and other learning difficulties are unrelated to intellect.


      • I just looked it up. Dyslexia is classified as a **specific** learning disability. The Tavistock statement doesn’t specify which type, so seems the comment is pertinent…?


      • Dyslexia used to be considered a learning disability when I was in grad school. IQ below 70 was called mentally impaired. The term “retarded” was still in use in some states, but not in mine. But a learning disability meant someone with an IQ in the normal range but whose academic achievement is below grade level. For example, a 5th grader with an IQ of 102 would be expected to read at a 5th grade level. But a 5th grader with a learning disability (such as dyslexia) would have the same 102 IQ but might be reading at a 2nd grade level. That’s more along the lines of what Caitlyn Jenner went through as a child.


  3. Yup and thanks for looking into all those things.

    I just post like someone writing on a toilet door. (Conversing with strangers without shared environmental contexts and cues from body language etc. scare the crap out of me, so I post this barely even communicative way online. Sorry).

    OCD Mark Angelo Cummings? Also yup. Seen that. People describing the oncoming dread at a lack of control over reproductive systems that we all have no more direct control over than we would sweating in a hot climate. (Master of Meditation at the back? Sit down, you and your breathing excercises don’t count for for the rest of us).

    Anyway, we also have Mind Blindness to consider, which,”can be described as a cognitive disorder where an individual is unable to attribute mental states to the self and other”

    Go on, look some of that stuff up for more details.

    My take on it is that many of these cross dressing males have simply found a novel way of reconciling their mind blindness with their sexual desire.
    They want to be as close as possible to the woman they want, and think she’s thinking the same as them. About herself. Their female partner’s contexts, her own desires don’t even register in these guy’s minds and they’re losing out on the sexual experience as a result.
    Dressing like her is some sort of “lifehack” for them, but to us on the outside, it’s just a sexist, narcissistic loop of feedback.

    For ASD women though, it’s different because of the socialisation, where we’ll all be told we’re useless shits if we cannot anticipate the wants of others (as boys are left off the hook) so tend to learn it hard and/or break under the strain. If you don’t know what men want, can’t gave it to them, then you are bad. Thank goodness there is so much to be learned from porn! (That was sarcasm).

    A Mind Blind Lesbian though…no worries there. In bed I mean…not society as a whole.

    Gay and Mind Blind…well, hmm, you desire men and know who you want. what you want, but have been lead to doubts about your own “man-ness” through not being like like the other, non ASD boys.
    Blame “Extreme Male Brain” theory here.

    Or, you know, we could look at all this through the lens of gender and fetishism and miss what might really be going on.

    Liked by 1 person

  4. What a beautifully thorough post! I’ve long been frustrated with the inability to see the obvious link with these hormone/brain/behaviour issues. The ADHD, OCD, ASD threads are so obvious in many of the tumblr-trans narratives.

    Some people have noted anecdotally how many trans people (especially MTF) seem to be in the IT field. Same goes for the Asperger community, lol!

    I’ve also read anecdotally that several FTM pregnancies resulted in kids on the spectrum, for whatever that’s worth. I really worry about the health of babies in testosterone’d wombs, setting aside whatever social and existential angst will result.

    It’s hard for me to separate the threads of how and where hormones may actually affect the brain, from the parts where false conflating will gender certain behaviour traits (and get distorted into people mistaking their issues for being trans).

    Thanks for an insightful post that is far clearer than my own muddled thinking.

    Liked by 2 people

    • I have read with horror about the “trans men” who inject “T” throughout pregnancy and while nursing their babies. We are in a brave new world now and no telling where this is all going to end up.

      Many of these Tumblrites that you refer to discuss the fact that they are both “on the spectrum” and trans. The dual identity is common. I do appreciate, though, what that one commenter said: that people with ASD have a lower tolerance for BS and lies, so it seems that at least some would be open to hearing alternatives to the standard trans narrative.

      And thanks for your compliments about the post. It was pretty time-consuming, but I really only presented the tip of the iceberg. Much, much more to be found on the confluence of ASD and GD.

      Liked by 3 people

      • You’re another one who goes around evoking humanity in the midst of a hostile din, y’know that? I always shut your blog’s window on my screen feeling like I can be a little bit less of an asshole, not just about this issue but in general. Maybe I should just leave your window open…


  5. As someone with aspergers i completely agree. When i wanted to transition my mother tried to bring up concerns but i would shut her down as unsupportive every time, when she brought up the link between aspergers and trans people i got so annoyed because i thought she was trying to say i didn’t know myself or trying to use my aspergers against me.
    I’ve since realised she was right even though i refused to see it at the time all the while knowing the only trans people in my town also have aspergers or similar conditions.
    Doctors need to start taking notice of this

    Liked by 4 people

    • Doctors seem to be noticing it, but many subscribe to the idea that people on the spectrum should be supported in “transition” anyway. How do you think this might change? Seems like people like you speaking up could make a difference?

      Liked by 1 person

  6. Thank you for another wonderful post, 4thWaveNow!

    I read the “sister of an autistic FTM” article. The sister did some research into the autism and gender dysphoria link, which I admire, but she came to the opposite conclusion I did. She believes that because “gender is a social construction, and people on the autism spectrum have difficulty processing social cues, they are less influenced by the rigidity of gender binaries.” That this somehow frees those with autism to become their authentic selves more so than neuro-typical people.

    I don’t know why I am continually amazed at how people presented the same information can come to radically different conclusions, but I am. My interpretation: Because gender is a social construction, and people on the autism spectrum have difficulty processing social cues, they are MORE influenced by the rigidity of gender binaries. Rejecting things commonly associated with their natal sex could make them believe they really are the opposite sex.

    These kids (some not even on the autism spectrum) are growing up in confusing times. They are told that gender and sex are separate and unrelated entities. That they are entitled to choose their own gender based on their choice of colors, clothing and interests. That if they feel different or depressed or anxious, these feelings will be alleviated by medically transitioning. It is no wonder that a child with difficulty processing social cues would be baffled by this!

    And, no one really talks about how the medical interventions themselves would cause distress for these individuals. Cross-sex hormones and surgeries are no cake walk even for neuro-typical people. I would imagine that it would be more difficult for those on the autism spectrum to cope with these treatments.

    Liked by 2 people

    • The researchers who have looked into the correlation between ASD and GD are in agreement with you, overwhelmed, that most people on the spectrum have MORE rigid ideas about gender than neurotypical people.

      You know, I find it highly ironic that, on the one hand, the general public is encouraged to accept people who fall outside the norm as unique and fine “just the way they are.” But at the same time, we are being encouraged (vis-a-vis “trans”) to support and encourage extreme medical treatments that sorts people into rigid male or female boxes (complete with never-ending horror at thought crimes like “misgendering”). Like so much else to do with this, the cognitive dissonance is stunning.

      Liked by 2 people

  7. Yes, I know what you mean. When I try to follow the logic trans activists use I end up in a knot. If more attention was paid to untying the knot by the public, I truly believe we would not be seeing this transgender trend in our children. The hard part is trying to focus attention on the subject (Hello, media, wake up!). Unfortunately, since being transgender is so closely tied (no pun intended) to the rest of the LGB, any questioning is quashed as bigotry.

    Liked by 1 person

  8. A Japanese clinic for gender dysphoria did not find a higher than normal number of patients with autism or Aspergers. This could be because of a difference between people in Japan and the Netherlands or it could have something to do with the referral process in the two countries.



    • Right. But the studies cited in my article are not just from the Netherlands. Still, cross-cultural comparisons are interesting. Makes me wonder about the overall incidence of autism in Japan. There is some accumulating evidence that there is a genetic component to autism, as well as indications that advanced paternal age is a key factor.

      Liked by 1 person

      • Yes, at one time I thought that the data from the Netherlands might just be a fluke, but it is being repeated at other clinics, like the Finnish one.

        I think this is an important question that researchers should be looking into. Is it that Japanese children with autism don’t develop gender dysphoria but Dutch children do? Is it that doctors don’t refer children with autism to gender identity clinics in Japan but they don in the Netherlands?

        It might also be, as you suggest, that there are fewer children with autism in Japan.


    • I was just reviewing the studies and I noticed something important – the Japanese clinic in the study I referred to was looking at adults. The clinic in the Netherlands was looking at children and teens.


  9. More anecdotal evidence from me. My “would-be trans” daughter has never been diagnosed with Aspergers, but she certainly is a quirky kid with sensory and social issues. I just looked at a list of possible female Aspergers traits, and she has quite a few of them, including the sensory and social issues already mentioned, plus anxiety and depression, a fixation on letters and words as a toddler, self-taught artistic ability, hyperempathy, naivete, immaturity compared to others her age, and a near-obsession with sci-fi fantasy and certain video games.

    Liked by 1 person

    • I urge you to get her tested for high functioning ASD. Most girls and women are only diagnosed later in life. With the diagnosis comes more peace of mind, ironically, Especially when she as gender dysphoria. My formerly “would be trans” very bright daughter was diagnosed late – at age 18 – as being high functioning on the Autistic Spectrum- previously only diagnosed by me – (by my own research, it is obvious) – as having NLD. NLD is math/spacial awareness LD, social awkwardness and hyper ability in verbal skills. She is gifted in vocabulary, reading (prefers fantasy genre), writing and drawing. She has the exact symptoms as you describe your daughter, including being very immature and suggestible, vulnerable to predators, and empathetic. She had a painfully long period of “gender dysphoria” at age 17 for about a year, growing from “gender fluid” to FTM trans, binding, the works. It came from her severe depression/loneliness, and Aspie rigidity and obsessively of following such trends on the internet, not to mention teen TV shows, and being socially disconnected with her peers. She was in a psych hospital for self-harming for a couple of months, where they let her express herself as “a boy”, and it took good therapy AFTER that experience, to get her through the feelings of gender dysphoria, and realize she is not truly trans. She is more stable in her feelings now, 3 years later, but we are wary of GD rearing its head in the future depressive episodes. I feel for the truly trans neurotypical kids who feel they are born in the wrong body, and express that feeling all their lives – that is different – and I support their cause. However, Trans activists would have you believe the depression comes from being trans and ensuing societal rejection. I have no doubt that is the case for TRUE trans kids. But with kids like ours, the latching onto “gender dysphoria” as the cause of their problems COMES FROM the depression and rejection (and autistic traits of rigidity and inability to be like neurotypical girls). Doctors and therapist MUST become educated on this topic and stop being knee jerk PCs who accuse questioning parents of bigotry.This article was invaluable to me, thank you!! Very brave.

      Liked by 1 person

  10. Hi 4thwavenow, I’m a mental health nurse who reads your site frequently.
    I was struck by the following finding in the material quoted:
    “Normally developing young children (age 3–5) display more rigidity in gender-related beliefs than older children; this rigidity decreases after the age of five …”
    I realise this is not the crux of the post (which is an incredibly important one – I cannot believe that in 2015 we are staring down sterilisation for non-neurotypical females being recommended by the medical establishment). But it grabbed my attention because it does not correspond with my memories of my own childhood (1980s).
    I remember learning social rules, like “boys don’t cry,” when I got to primary school. I remember noting how important it was, now that I was in school, whether one was a boy or a girl. I didn’t buck the system (e.g. remember being as cruel as my peers to boys who did cry). But I really don’t remember any such ideas prior to primary school.
    I know anecdotal recollections like this are notoriously unreliable. But I’m also aware that the 1990s saw huge investment in marketing research for advertising directed towards infants and toddlers. – Not overt stuff like television ads for toys, but things like what level to put brand symbols in a shopping centre, and what colours to use. Could this explain the appearance of rigid gender beliefs in such young children?
    I’m genuinely curious, would love to hear from others – be it anecdotal or research data.
    Have I mis-remembered? Or are very young children learning from a very different world to the one I lived in?

    Liked by 2 people

    • I think marketing has had an effect on gender. Companies that sell toys want parents to buy separate toys for their sons and daughters so they can sell more. The marketing of pink toys for girls is a strategy to increase sales.


  11. Great article! Autism in girls is often missed. On average girls who are diagnosed are caught at a later age than boys. So keep in mind with that research that it may be greatly underestimating the percentage ftm who have autism.

    Liked by 3 people

  12. I was a would-be trans teen (a stage of my life I don’t regret; I just passed the point where transition would have achieved what I wanted at the time) and I have to say I often wonder what would have happened if my brother, who has Asperger’s and Tourette’s Syndromes, had been the one who wanted to transition. I think he’d have got a harder time from our family (our father is a very “I expect my son to be manly” type) but doctors, authorities etc. would have been more sympathetic to him. IMO a key factor is that neurological conditions like autism are ostensibly incurable and as such the focus is on mitigating any problems that result. Whereas if someone has a mental illness, it’s considered more treatable and something from which they can potentially make a full recovery. Basically, with autism the underlying condition can’t “go away” and I think it is sometimes seen as kinder to help the person transition and live as comfortably as possible than try to “cure” the dysphoria


    • You don’t know much about mental illness, then. They don’t “go away,” either. And medications don’t work for everyone or don’t actually alleviate all the symptoms.


    • What I am finding in my limited, parental research on the connections between Asperger’s/Autism spectrum disorders in females and transition is startling. Many females have a different Asperger’s presentation to that of males, and that muddies the waters in terms of correctly diagnosing these girls. Very common characteristics of girls with Asperger’s are: not being very feminine in presentation, trouble with basic hygiene, preferring cotton, loose-fitting clothes (sensory issues), enjoying play that is usually more common to boys (and having more male friends as a result), social immaturity, not picking up on social cues and the hierarchy of female relationships. Many of them feel that they are androgynous or don’t have any gender at all. However, many of these girls are very good imitators. They latch on to a friend or two and try to act just like that friend. The imitation is obvious to others, but not to them. Most of these girls make eye contact and have facial expressions.
      I think some of these girls latch on to the idea of being transgender because they have always gotten along better with boys, had male friends, and don’t feel very feminine. Since they tend to see things as black/white, right/wrong, it makes a lot of sense that these girls would think that they must be boys. “I don’t feel like a girl, so I must be a boy.” There is no in between, no gray area. It makes sense to them, and puts their world in order. They have an answer as to why they don’t fit in, and if they could just transition, then everything would be better.
      I have to wonder why we as a society are not interested in figuring out better ways to help these girls with Asperger’s to understand why they feel as they do, and to help them feel more comfort with their healthy bodies. The reality is that Asperger’s won’t go away with transition, so these girls still won’t feel like they quite fit in, and will have to do even more pretending than they did before.

      Liked by 2 people

  13. I have reviewed a few more case studies of children and teens with autism and gender dysphoria. There are not many studies and very little data, but what we have is interesting. You can read about them at: bit.ly/1OQEJSe


  14. Honestly this is sickening. You accurately represent everything wrong with my life right now. Please never talk about trans issues again – it’s something you clearly have no idea about. Also – why does being autistic make you not capable of making decisions about what you need to do to feel comfortable in your own freaking body?

    Sure there’s problems with medically transition at a young age. I can acknowledge that. But how is it any of your business if we want to transition or not? Does it affect your life? Stop forcing your opinions on other. It really just feels like you’re trying to kick us while we’re down. You might not be a bad person. I don’t know you. I haven’t the faintest clue.

    But you’ve done a really shitty thing to my community by writing this article.

    Your approach to this whole article speaks from this a place of great privilege. I’m sure you have no idea what it feels when part of your body feel like parasitic organisms that have attached themselves to you. I’m sure you’ve never considered ending it because you can’t even see yourself in the mirror and it feels like you’re watching yourself die. I’m sure you’ve never had everything you say and need (desperately) thrown into doubt because of a real or suspected diagnosis.

    You might know a whole ton about autism (I have no idea) but you obviously know nothing about trans people. Your frequent misuse of quotation marks speak for that.

    I hope you feel ashamed but I imagine that this is too much to hope for. I’m sure you’ll continue along your life, misgendering us and making us feel lesser. I just want to say (and this comes from the heart – the same as my gender identity does you fucking bastard) that I hope you get hit by a bus 🙂


    • This site is geared to parents who are concerned about their gender nonconforming children, many of whom, it turns out, are on the autism spectrum. None of us question that some people experience dysphoria (in your case, extreme dysphoria). What we critically investigate is what to do about that experience when it comes to young people—our kids.

      You sound like an adult, and no one is trying to stop you, as an adult, from seeking whatever medical services you choose.

      You want to silence parents who dare to question the current dogma around transitioning kids, many of whom have other mental health issues they are struggling with. Worse, you wish death on us because we aren’t toeing the line.

      Let the record show that thoughtful parents disagreeing with the current trans activist and medical paradigm attracts this kind of hate from complete strangers—delivered, no less, with a smiley face emoticon. Whatever your personal pain or anger, sending death wishes is a despicable way to get your point across.

      Liked by 3 people

    • Scott, I don’t think any of us are attempting to deny medical treatment to consenting adults who experience extreme dysphoria, as it appears that you do.

      Most of us are coming from the perspective of parents who are trying to help our own kids. We want to make sure our kids get the best treatment possible for any and all conditions they may have. Sometimes treating and helping a person deal with another condition can ease their dysphoria. Some kids have multiple things going on, but once they announce that they are trans all other issues are ignored. We are trying to educate ourselves so we can help our individual kids get the best treatment that is right for them.

      Transition may be the right choice for you. As an adult, I assume you have weighed all of the risks to your long-term physical health and have determined that those risks are acceptable to you. That is your right, and I wish you well. My child is not an adult. She does not have the life experiences necessary to make major medical decisions that cannot be undone. It is my job as her parent to make those decisions for her and help her to get as much accurate information as possible so she can make educated decisions about her healthcare as an adult. It is really difficult for teens to imagine life at 40 or 50 years old under the best of circumstances. They just can’t relate, and we shouldn’t expect them to. My teen also happens to be somewhat immature and impulsive. She was feeling like she didn’t fit in anywhere, and she was looking for a quick fix without fully understanding the consequences of her actions.

      You clearly do not want strangers making medical decisions for you. I do not want strangers making medical decisions for my child. Frankly, I wish trans activists would stop encouraging kids to transition. I wish they would encourage kids to take time to grow up and make truly educated decisions. I wish they would tell them the realities of life after decades on testosterone, the surgical complications, that dysphoria doesn’t go away for everyone after transition is complete, etc. But all they do is cheerlead, and the parents are the evil ones because they give their kids a dose of reality.

      Liked by 1 person

    • Nobody wants real transpeople hurt. They just dont want young people who are in a vulnerable stage to be sent for major surgery to slice off healthy body parts, after only 2 appointments. Is that a fair demand? Is it ok to ask that more research be done? That support be offered? that time be taken and that doctors not send young people with autism to be sterilized…is that ok?

      You see, there it is again: the rage. The demands for ‘shame’..People are concerned about 15 year olds being sterilized and drugged by unscrupulous doctors who want to make a name in the latest ‘sexy’ condition. You remember, like the doctors during the Aids crisis, who didnt share research so they could get to the virus first…

      and how is it people’s concern? Because they have children, whom they dont want to see sterilized and mutilated. There are young people totally not trans having their bodies cut to pieces..look, this isnt like being a Goth! What the hell do you mean ‘how is it your business?’ because its spreading everywhere and because unscrupulous people are influencing teens to think they are trans…and people dont want this to happen to those they love. If they are really trans, fine. But no way are all these thousands of sudden appearances really trans.

      Nobody has ‘done a shitty thing to {your} community”. See, that is the kind of collective language and attack mode that is shutting down serious discourse. Look what you are saying: “Shut up, stop talking..or you are evil and transphobic!” Have you even ever read what is happening?

      I have seen transwomen/men calling for worried people to be ‘killed’; ‘raped to death’ ‘have skulls smashed with baseball bats’;…I have seen a lesbian try pitifully to make a transwoman accept that she cannot have a penis near her…it isnt a ‘female penis’ to her, it is a weapon, because of her PTSD from rape. answer: ‘you are a transmisogynistic piece of trash and deserve to have your teeth beaten in…by refusing to consider the female penis, you are literally killing transwomen’. Another woman, again, in the female please-dont-hurt-me style that comes from a lifetime of ‘being lesser’ (dont try and tell natal women about ‘being lesser’, please) tried to make a different transman understand she wants a real penis, not a ‘male vagina’ and she wants to have a family. The answer was first, insults, degrading insults (filthy trash, etc) followed by a 5 point list (very female!) instructing her that her perfectly normal desires and hopes should be abandoned to put the requirements of transpeople first.

      In other words, you are a woman, do as I say. Part of that was, use strap-ons and adopt. Whether you like a hard piece of plastic and to not have your own baby, doesnt matter..you are ‘literally killing transpeople’ when you want to conceive.

      Even talking about periods or breastfeeding is ‘literally killing transwomen’ and the perpetrators need to be ‘burned to death’ or ‘die of cancer’. There are in fact plenty of attacks done BY transwomen, which cannot be talked about, or its ‘transphobia’. What do you call it when a group is above the law and can dictate to others how to think, feel and behave?
      You call that ‘privilege’. It is you who are privileged now. Nobody can even get a word out about the abuses. Christ, arent you concerned that ruthless doctors are pumping kids full of untested drugs? that people are doing this DIY? that people are selling hormones? Pumping silicone into people with caulking guns?

      When people try and expose this, up goes the scream of transphobia…and people are losing their jobs over this word. Dont you try and say privilege, when you are the ones shutting it all down with your magic curses: ‘terf’ and ‘transphobe’. people are sick with fear about being called that..

      Get angry at these people. These are the ones causing a steady concern. Meantime, nobody wants anyone like you not to transition. You sound like the real thing: cant see yourself in the mirror and so on.

      Having said that, that is also a symptom of Asperger’s. I cant see myself, either. See that picture there? thats me. supposedly. I cannot relate to it at all.


  15. Elliot Rodgers had autism spectrum disorder. I read his ‘manifesto’, really autobiography, and noticed something: he was desperate to have a girlfriend but everything he did to get one was female behaviour. He would get beautifully dressed, soothe his nerves with a little alcohol and then go to crowded areas and display himself at a table, waiting to be approached. Nobody ever did approach.


  16. This is an important follow-up study of a child who had both gender dysphoria and autism. His gender dysphoria alleviated as he went through puberty, according to the study’s authors.

    This is the first time we have any data on what happens to children who have both gender dysphoria and autism. It is only a case study, so we don’t know what happens to most children. However, it shows that it is at least possible for children with gender dysphoria and autism to desist in their gender dysphoria.


    Liked by 1 person

  17. Pingback: Autistic kids don't need mastectomies

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s