Social work professor speaks out on behalf of her FtM autistic daughter

UPDATE 5/24/16: The National Review (NRO) has published an article discussing Dr. Levinstein’s post here on 4thWaveNow. It was pointed out in the comments thread on the NRO piece that Dr. Levinstein’s bio on the U Michigan-Flint site includes a statement that she is the “proud mother of a trans son.” I asked her for a response, and she submitted the following for this update.

That bio was written two years ago, prior to all my daughter’s surgeries and the ensuing and now chronic health problems resulting from testosterone, at a time when I was trying my best to be supportive of my child’s choices.

I am indeed proud of my daughter, who has been a victim in this process.

Dr. Levinstein also stated that she is happy to discuss her situation further with the press.

Dr. Kathleen “Kelly” Levinstein, PhD, LCSW, LMSW is a Professor of Social Work at the University of Michigan, Flint.  Among many other accomplishments, Dr. Levinstein was a Heilbein Scholar at the NYU School of Social Work, where she also taught, and has directed and provided clinical services for people with disabilities for many years, primarily in New York and New Jersey. A clinical and research social worker for 40 years, Dr. Levinstein describes herself as “the only out autistic PhD level social worker” in the world. Her research and advocacy work includes human and civil rights violations against the autistic community.

In this post and accompanying short interview, Dr. Levinstein tells us about the ordeal currently being experienced by her daughter who has undergone transgender medical transition. Dr. Levinstein also shares her thoughts about the current increase in young women with autism being diagnosed as transgender.

A version of Dr. Levinstein’s account will be published in an anthology entitled Female Erasure: What You Need To Know About Gender Politics’ War on Women, the Female Sex and Human Rights, Tidal Time Publishing, Fall 2016. Ruth Barrett, editor, forward by Germaine Greer.

For previous 4thWaveNow posts on the subject of autism and transgenderism, see here:

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

Guest post: For teen girls with autistic traits — a plea for watchful waiting

New study out of Finland: Girls with gender dysphoria have many other mental health issues

by Kathleen “Kelly” Levinstein, PhD, LCSW, LMSW

My daughter, who is on the autism spectrum, as am I, is now 19 years old. She had felt (and told others) that she was a lesbian most of her life. When she was 16, she began watching a TV show called “Degrassi,” which featured an FtoM character. After a few weeks, she announced that she was not actually a butch lesbian, as she had previously said, but was in fact trans. She started attending a local PFLAG meeting, where she met many trans people, including a number of FtoM trans teenagers who were raving about a certain “gender therapist.” Although the APA recommends a minimum of one year of “gender counseling” before surgery, this gender therapist (whom I consented to, before really understanding what I was doing) gave my daughter the go-ahead to have a bilateral mastectomy after only two sessions. This gender specialist never reviewed any of the Special Ed records or spoke to my daughter’s previous therapist, who had known her for a decade. And, crucially, she never asked my daughter, “Might you be a lesbian?”

The gender therapist (whom I believe has an unholy financial alliance with the surgeon) gave my daughter (then 18 and one day) the go-ahead for the $30,000 surgery (covered for all university employees and their families where I work). My daughter is now on testosterone (which she clearly is unable to evaluate the risks and consequences of).

To give you some sense of my daughter’s level of understanding of what it means to transition, she told me recently that she believes that the testosterone “will grow her a penis.” I had to break the news to her that, although this is the mythology in the PFLAG meetings (where a number of the other young trans people are also autistic), this is not the case.

She has been taken advantage of. Healthy organs were amputated. This is insurance fraud, poor clinical practice, a violation of APA standards, unethical and unjust. It is a crime not just against women, but particularly against disabled women. So many of these young women who are “transitioning” are also autistic.

My daughter has a representative payee on her SSDI [disability] check, as it was felt that she was unable to handle her own money. This was of little concern to the gender therapist. I believe that once the therapist realized the “treatment” would be covered by the University of Michigan insurance, it was full speed ahead.

You mention that your daughter previously considered herself a lesbian, and this changed when she started watching the TV program “Degrassi.” Was that the only thing that influenced her to claim a trans identity? Was there anything else?

Other than Degrassi, the PFLAG meetings–which are now the cult of trans–sealed her fate. There were no young lesbians there. In fact, there are very few young lesbians left–they are all transitioning. If she had been able to have a lesbian relationship prior to transitioning I believe that things would have transpired differently. I attempted to get her in a support group for young lesbians when she was 12, but was informed that because of liability insurance reasons,  she was not welcome until age 18. By that time it was too late.

She had a legal name change in Dec of 2014, a bilateral mastectomy in April 2015, and started testosterone in Sept 2015.  My daughter has severe Crohn’s Disease, and currently, she is having grave reactions to the testosterone. She has been hospitalized three times now for complications.

Many professionals, as well as some autistic people themselves, have written about the fact that young people on the ASD spectrum are often “gender nonconforming” and have a less stable sense of identity. Can you speak to this regarding your daughter?

I DO believe that there is an overlap with the autistic and transgender populations.  Some studies show a higher level of testosterone in autistic human beings. For males a high enough level of testosterone converts to estrogen. This may explain the large number of autistic people of both sexes claiming that they are transgender.

In recent years, activists have agitated for disabled people to be treated as having the same “agency” to make medical decisions as non-disabled people. In fact, when anyone brings up concerns about young people with autism being questioned about their transgender identity, they are accused of “ableism.” Do you have any thoughts about this?

Yes, I agree–anyone asking for critical thinking about these issues with autistics is accused of ableism and transphobia. This is often an effective silencing tactic. I have found no allies in the autism community. Instead, there is a vilification of anyone daring to ask questions about these issues, including the evidence of MtoF physical, sexual and psychological violence against women. Women who publicly question receive death threats, threats to rape us and our children, burn us to death with gasoline, decapitate us, and so on. This all coming from people who claim they are our “sisters.”

Given that your daughter was recently hospitalized for health issues related to her use of testosterone, have you found any medical professionals who are willing to speak up about this?

I have found no health professionals willing to go on the record against this. Everyone is afraid of professional suicide and threats of violence. I am standing alone.

My daughter’s latest hospitalization has been described by doctors as due to “absorption issues.” She now has a full beard but still has her period. The testosterone is wreaking true havoc on her system.

Autistic women (again, I am one) frequently have a difficult time, sensory-wise with their periods. But rather than attempting to help us with this difficulty, our problems get labeled  “gender dysphoria” and the answer has become to remove our periods from us.

We will find out in 20 years the effects of testosterone on our young women. I am confident that it will not be a pretty picture.

Guest post: For teen girls with autistic traits — a plea for watchful waiting

This guest post by 4thWaveNow community member neverfallingforit is second in a series exploring the increasingly well known connection between autism spectrum disorder (ASD) and gender dysphoria (or other gender-related issues).

 Many of us have shared observations that our kids show signs of ASD. Unfortunately, the current treatment paradigm tends to view ASD as no barrier to “transitioning” kids and young adults.

 A word about the title of this post. The current approach fostered by WPATH is generally referred to as “watchful waiting” with regard to diagnosing younger children as transgender. While this sounds like a hands-off approach, in reality “watchful waiting,” to trans activists and many gender specialists,  often includes the use of “preferred pronouns,” “social transition,” and (frequently) puberty blockers. Once these kids reach adolescence, “watchful waiting” ends and the path to full medical transition becomes available.

There is much that is still unexplored (and unstudied) about the impact of these supposedly benign interventions on actually helping to create a persistent transgender identity in children and young people. I’ll have more to say about this in a future post.

by neverfallingforit

When my daughter first started identifying as transgender, I quickly and easily found articles online which posed a link between autism and gender identity issues. I bought the books Aspergirls by Rudy Simone and I am Aspiengirl by Tania A Marshall. At the back of each book there is a checklist of traits for girls with Asperger Syndrome, many of which I learned were different from those which appear in the male Asperger profile.

146 cropped small

I also learned that formal research on the autistic female profile is relatively new, and as such, is years behind clinical and anecdotal observations. After reading the books, my daughter herself placed ticks next to a whole host of these traits, and I began to suspect that an autistic spectrum disorder (ASD) was in the mix here somewhere. Several traits particularly jumped out at me:

  • may have androgynous traits despite an outwardly feminine appearance. Thinks of herself as half-male/half-female (well balanced anima/animus)
  • may not have a strong sense of identity and can be very chameleon-like, especially before diagnosis
  •  will not have many girlfriends and will not do “girly” things like shopping with them or have get-togethers to “hang out”
  •  emotionally immature and emotionally sensitive
  •  strong sensory issues – sounds, sights, smells, touch and prone to overload
  •  will have obsessions but they are not as unusual as her male counterpart (less likely to be a “trainspotter”)

After finding 4thWaveNow, I read that gender identity clinics are seeing a higher number of natal girls in their referrals than they would expect from previous epidemiological knowledge, and also that it is very common to find that these girls had autism spectrum characteristics. Some of the studies alluded to the fact that cultural factors could also be at play in the increasing referral rates.

As I read the comments on many of 4thWaveNow’s posts, I could see a profile emerging of a subset of teenage girls who had come to believe that they were born in the wrong body. Most had never previously mentioned gender dysphoric feelings to their parents, although many had never been “girly girls.” They often seem to share the same personality traits; traits which fitted right into the female Asperger profile. 4thWaves’s comprehensive article on autism discusses how autistic spectrum traits could lead to a transgender presentation and I could clearly see how this applied to my daughter.

What really caught my attention was how these girls also seemed to share the same cultural traits. My parental antennae kicked in.

147 cropped small

Then, I found an article on GenderTrender, and some more pennies began to drop. Way back in 2010, that blog was insightfully covering the transgender trend in ‘tween and teenage girls

 who believe that rejection of increasingly constrictive female norms means they must be male. These girls don’t want to act out a ‘female’ role in relationships with boys.

Here was an apt description of my daughter, who kept telling me that she must be a boy because she was a “rubbish girl,” that she wanted “to be the boy in the relationship, saying the lines and making the moves.”

She and her friends had recently been watching porn videos on their phones at school, and a letter had been sent home to parents. I wondered if the images she had seen had frightened her. Girls with ASD often have sensory issues which can mean they don’t like to be touched much, or hugged; a few in my daughter’s online social group describe themselves as asexual. Maybe she felt that taking on a male presentation would ensure that she wasn’t pressured into situations which she was uncomfortable with? She refuses to discuss it with me.

As the same article also observed,

 they don’t want to be marginalized as the gender non-conforming women that they are. Femininity rejecting females simply DO NOT EXIST in the media reflection that is so important to children and teens in western culture. These kids want to fit into social norms, wear the right brands, get the right haircuts, and look like the people in magazines. “Transgender” has a certain cachet, a certain alterna-cool about it for those in middle school and high school years. Declaring one’s trans status is like getting the ultimate cool tattoo or piercing body mod and provides girls with special status and treatment amongst their peers as well as school officials, employers, parents and other authorities.

This, too, has been my experience. My daughter’s social popularity rose on her transgender announcement, and what teenager wouldn’t rejoice in that–especially one who had previously had trouble maintaining friends? She attracted much encouragement and support.

I read all the statistics about suicide rates, the suffering of those with crippling dysphoria, about the bravery of coming out as trans in a hostile world — and yet my daughter displayed no such angst. She declared herself the happiest ever and demanded that we catch up with the rest of the world. Her anger and distress were only directed at us, her parents, when we questioned her transgender narrative.

One of the most heartbreaking parts of my story is the way my daughter has been encouraged to believe that we, her parents, don’t love and respect her because “we don’t want her to be happy.” Outside of our family, her friends, college teachers and the media are cheering and validating her male presentation. She is genuinely bewildered, disappointed and hurt by our inability to sign up to her self-diagnosis, without question, without due diligence. Not long ago, she reblogged a popular post on her Tumblr account. It is an illustration of a parent cutting the multicolored wings on the back of a “transgender” child.

suicide meme pink wings cropped
It’s common knowledge that teenagers always run with their peer group. They try out identities and refute parental opposition. There’s nothing new in that. That’s healthy. But it’s the untested lifelong medical treatments and surgery involved here which frighten us, and make us cautious parents – not “transphobes.” And, if my daughter does have Asperger Syndrome, does she have the ‘theory of mind’ to understand the long-term implications of what she is proposing?

Back to GenderTrender:

 The trans tweener trenders bond and encourage online via YouTube groups and web forums which function much like pro-ana, pro mia and trans-abled communities, encouraging dysphoria and censoring questioning and dissent.

The online spaces my daughter visits have become saturated with transgenderism. Many 4thWaveNow parents mention that their girls spend a great deal of time on Tumblr in particular. During Trans Awareness Week recently Tumblr was described glowingly:

 Tumblr seems like a natural fit for young transgender people to gather online, with a thriving social justice community and fandom devotees advocating LGBTQ rights, Tumblr fosters a culture of reaching out for advice from caring, experienced strangers… Tumblr’s also important because through finding one person who is similar to you, you’ll find 10 more, because they’ll be following people like themselves. When I was first working out I was trans, I didn’t follow that many other girls, but now I follow loads… the most important thing Tumblr’s trans community can give its members may be a sense of affirmation.

How intoxicating must that be? A legion of like-minded girls, with similar interests – after so many years of feeling like you don’t fit in. And how normalizing!

In my daughter’s case, I would also add into the mix the androgyny, cosplay and cross-play associated with anime and manga, and the androgyny, parental estrangement, disassociation, and angst messages that she absorbed during her previous obsession with the “emo” scene too.

Not feeling either stereotypically male or female is fine. Androgyny is fine. Trying on many identities is fine. But how did these feelings become conflated with a transgender diagnosis, when they all fit firmly into the Asperger girls’ profile too?

Here are a few quotes from parents of girls with Asperger Syndrome, which feature in the  I am Aspiengirl  book:

 “She went from princess, to tomboy, to punk, to emo to goth. She is having trouble finding out just who she is and has gotten involved with the wrong types of people. She is not interested in dating and finds flirting very confusing. She also does not seem to have a solid gender identity.”

“She has recently given up trying to fit in. She is going through very challenging teenage years, feeling even more outcast. We are now watching her embrace opposite conventions, despise femininity, social and gender rules. She is now a tomboy and a bit confused about her gender.”

“We all thought she had gone to the “dark side”. She just didn’t fit in anywhere and had no idea who she was. She seemed to despise femininity and defined social and gender rules. When she has friends, she tends to naively and blindly follow wherever they go, their rules, taking on their traits, from the way they dress to the way they talk and act.” 

“Just a few months ago, she was wearing frilly dresses and looked like a princess. Now she’s Goth and won’t let anyone call her by her new name. She has depression and panic attacks that sneak up on her from out of nowhere.”

She really struggles with sensory sensitivities, social anxiety, panic attacks and depression. She must have gone through at least three or four different lifestyle changes.

Do any of these anecdotes sound familiar to other parents in my position?

So what now? I strongly suspect that my daughter is on the autistic spectrum. I feel that she has Asperger-related issues which are impacting on her self-diagnosis of being trans. I feel transgenderism has become a special interest/ obsession that gives her relief from anxiety. All I want is to be reassured that clinicians will take care, be cautious, give her time to experience more life, to mature.

But will they?

Until I believe they will exercise proper caution, I am too scared to lead her into a therapist’s waiting room. Because I fear that, in some medical quarters, as soon as the word “transgender” is uttered, Asperger syndrome becomes downgraded to a mere co-existing condition.

In a recent small retrospective study of children presenting to a gender clinic in Boston, it was found that 23% of the patients potentially could be given an Asperger diagnosis but instead of urging caution, the researcher Daniel Shumer seemed to imply that it merely meant these kids may need to have the transition process explained more clearly.

 Given the growth of gender programs and general awareness of gender dysphoria in the U.S., Shumer said it helps to know that there’s a link between it and Asperger syndrome. He said he hopes his work will help persuade doctors to screen transgender patients for ASD and know that they may need to take more care to explain hormonal interventions to their patients on the autism spectrum.

Aron Janssen, MD, a child psychiatrist at NYU Langone Medical Center, who was not involved in the study had this to say,

It’s really about assessing what gender means to a population that may think of gender in a different way than the way most of us do,” Janssen said, explaining that thinking differently about gender shouldn’t limit treatment options for patients with ASD. In a way, people with ASD may express their gender more authentically because they’re not as swayed by social stereotypes, Janssen said.

Aron Janssen has recently taken part in an interview with The Ackerman Institute for the Family, which he has posted to the WPATH Facebook page. In it, he gives his view that gender dysphoria is a completely separate entity from autism spectrum disorder. He states that recent research has found an overlap between individuals who have gender dysphoria and individuals who have an autism spectrum disorder but we don’t really know why that is.

One of the implications for treatment, he says, can be that patients with autism who may have a “theory of mind” impairment could have difficulty in understanding how to communicate their internal gender identity to the outside world; in other words, they may not understand that how you speak, dress, act and appear are important to how people view your gender presentation. They may need help with that.

A Reddit commentator with Asperger’s would agree with that impairment, but reaches a different conclusion on the help needed:

 I can’t speak for all people with autism (I have Asperger’s), but I think a lot of people with autism spectrum disorder are confused by the messages that society puts out about how to act and how to perform gender. I always felt like I didn’t fit in with women when I was growing up. Had I been born later, I have to wonder if I’d be picking up this trans narrative and taking it to heart. This is not the kind of help that young people with autism need. They need appropriate services, help finding their way into jobs and meaningful social connections, not hormones.

Dr Janssen, however, appears to take a different perspective.

 For too long individuals with autism who have had gender dysphoria have had that gender dysphoria dismissed as filling category 2 of autism- that restricted or repetitive interests or behaviors – and their gender identity was thought of as a symptom of autism, as opposed to something that is genuine for each individual.

As such, he believes he needs to help patients express their own autonomy and give them access to the care they say they need.

Which all sounds great, if we weren’t talking about letting children with cognitive vulnerabilities make decisions about irreversible treatments before their brains reach full maturation!

My last point is this:  So much of the research available cites case studies of patients who have experienced gender dysphoria from a very young age. Information about the clinical management of SUDDEN, LATE ONSET gender dysphoria in YOUNG TEENAGE GIRLS has been impossible for me to find on the internet. 4thwave’s blog is the only place I have found where this particular path to transgender presentation is being discussed.

More importantly, parents are also beginning to come here to tell about desistance in their daughters. These stories are important. (These stories give me hope.) If you have a similar one to tell, please share it here. My plea to clinicians is that they read these accounts and adopt a WATCHFUL WAITING approach for this group of teens and young adults.


“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.