Comorbidity is when two or more chronic diseases affect one person at the same time. There is some evidence out there prompting many scientists and clinicians to labelautismandgender dysphoria(also known as gender incongruence) as co-comorbidities, but the relationship is unclear.
The biological relationship between gender dysphoria and autism is not well understood. And there’s a possibility that tying gender dysphoria to autism could lead to discrimination.
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Gender Dysphoria Plus Autism
In recent years, the understanding, diagnosis, and terminology of both gender dysphoria and autism have evolved.
Gender Dysphoria
Previously referred to as transsexualism and gender-identity disorder (GID), gender dysphoria is the most recent terminology referring to a condition in which a person feels distress due to a perceived incongruence between assigned gender and experienced gender.
Sometimes, people with gender dysphoria wish to be another gender and often take steps to satisfy this desire.
For instance, a person with gender dysphoria who was assigned the male gender at birth may feel distressed with this assignment because it feels wrong and instead desires to be a woman.
Gender Dysphoria vs. Gender IncongruenceThe termsgender dysphoriaandgender incongruenceare used interchangeably, but there are subtle differences. Gender incongruence describes a mismatch between one’s assigned and experienced gender. Gender dysphoria is when gender incongruence causes significant distress and impairment.In May 2019,gender incongruencereplacedgender dysphoriain the International Classification of Diseases (ICD-11) used for insurance billing purposes. However, the termgender dysphoriais still used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which mental health professionals use for diagnostic purposes.
Gender Dysphoria vs. Gender Incongruence
The termsgender dysphoriaandgender incongruenceare used interchangeably, but there are subtle differences. Gender incongruence describes a mismatch between one’s assigned and experienced gender. Gender dysphoria is when gender incongruence causes significant distress and impairment.In May 2019,gender incongruencereplacedgender dysphoriain the International Classification of Diseases (ICD-11) used for insurance billing purposes. However, the termgender dysphoriais still used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which mental health professionals use for diagnostic purposes.
The termsgender dysphoriaandgender incongruenceare used interchangeably, but there are subtle differences. Gender incongruence describes a mismatch between one’s assigned and experienced gender. Gender dysphoria is when gender incongruence causes significant distress and impairment.
In May 2019,gender incongruencereplacedgender dysphoriain the International Classification of Diseases (ICD-11) used for insurance billing purposes. However, the termgender dysphoriais still used in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which mental health professionals use for diagnostic purposes.
Autism Spectrum Disorder
Autism spectrum disorder(ASD) includes conditions with a wide range oftraits, skills, and abilities that affect socialization, behavior, and independence. Autistic people often display repetitive behaviors and limited interests, and can have difficulty in social situations, at school, and at work.
According to the Centers for Disease Control and Prevention, one in 36 children has ASD.
Co-Occurrence of Autism and Gender Dysphoria
A few small studies have been done to attempt to quantify the association between autism and gender dysphoria.
Hypotheses Connecting Autism and Gender Dysphoria
Several hypotheses have been proposed to causally link autism to gender dysphoria, but there is no consensus regarding a clear link or a reason for a link.
Let’s look at some of these hypotheses:
Treatment Implications
The treatment or lack of treatment of gender dysphoria is fraught with the potential for unintended and irreversible consequences.
As of yet, there is no consensus opinion nor formal clinical guidelines on how to treat gender dysphoria in autistic people. In 2016, researchers published an initial set of clinical guidelines in theJournal of Clinical Child & Adolescent Psychologybased on the input of various experts.
Here are some of the recommendations:
Cisgenderism
At the 2012 Psychology of Women Section (POWS) conference, Natacha Kennedy delivered a keynote address that makes a strong argument that delineating a causal relationship between autism and gender dysphoria is actually a form ofcisgenderismor discrimination.
According to Kennedy, cultural cisgenderism is defined as follows:
Cultural cisgenderism enables and empowers the observer to characterize an individual with gender, without the input of the individual.
Adolescents with gender dysphoria pick up on this cisgenderism and realize that it’s usually socially unacceptable for them to make nonconforming decisions with respect to gender. Consequently, these adolescents suppress non-gender-conforming decisions for fear of judgment and ridicule.
Cisgenderism Impacts Autistic Children
It’s plausible that gender dysphoria is just as common in children and adolescents both with and without autism. However, autistic people won’t suppress themselves in light of prevailing mores that perpetuate cisgenderism. By not hiding their preferences, autistic children are more likely to be identified as also having gender dysphoria.
Summary
Although documented, we still understand little about the co-occurrence of gender dysphoria and autism. Attempts to pinpoint causality between these two things are poorly substantiated. Experts also don’t understand how best to treat these two conditions when they present at the same time.
It’s possible that the frequency of gender dysphoria among autistic children is equal to that of neurotypical children. However, autistic children will more often suppress the desire to act in a gender-nonconforming way because of society’s gender expectations; whereas, autistic children are sometimes less likely to recognize these expectations or might not care.
Society expects that people fit nicely into one of two gender boxes, which is why there are separate male and female bathrooms, changing rooms, sports teams, and so forth. It’s possible that the distress that a trans child feels may stem from the universal expectation that gender is binary. Perhaps, if society better accepted and accommodated the fluidity of gender, then many kids would feel more comfortable and less distressed.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organisation.Gender incongruence and transgender health in the ICD.Centers for Disease Control and Prevention.Data and statistics on autism spectrum disorder.de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA.Autism spectrum disorders in gender dysphoric children and adolescents.J Autism Dev Disord.2010 Aug;40(8):930-6. doi:10.1007/s10803-010-0935-9Pasterski V, Gilligan L, Curtis R.Traits of autism spectrum disorders in adults with gender dysphoria.Arch Sex Behav.2014 Feb;43(2):387-93. doi:10.1007/s10508-013-0154-5Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A.Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic.LGBT Health.2016 Oct;3(5):387-90. doi:10.1089/lgbt.2015.0070Additional ReadingAnna, I.R., et al. Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry. 2016; 28(1):70-80.Baron-Cohen, S. The Extreme Male Brain Theory of Autism. TRENDS in Cognitive Sciences. 2002; 6(6):248-254.George, R, and Stokes, M. “Gender Is Not on My Agenda!”: Gender Dysphoria and Autism Spectrum Disorder. In: Mazzone, L, and Vitiello, B. Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder. Switzerland: Springer; 2016.Kennedy, N. Cultural cisgenderism: Consequences of the imperceptible. Psychology of Women Section Review. 2013; 15(2):3-11.Strang, JF, et al. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. Journal of Clinical Child & Adolescent Psychology. 2016; 1-11.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organisation.Gender incongruence and transgender health in the ICD.Centers for Disease Control and Prevention.Data and statistics on autism spectrum disorder.de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA.Autism spectrum disorders in gender dysphoric children and adolescents.J Autism Dev Disord.2010 Aug;40(8):930-6. doi:10.1007/s10803-010-0935-9Pasterski V, Gilligan L, Curtis R.Traits of autism spectrum disorders in adults with gender dysphoria.Arch Sex Behav.2014 Feb;43(2):387-93. doi:10.1007/s10508-013-0154-5Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A.Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic.LGBT Health.2016 Oct;3(5):387-90. doi:10.1089/lgbt.2015.0070Additional ReadingAnna, I.R., et al. Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry. 2016; 28(1):70-80.Baron-Cohen, S. The Extreme Male Brain Theory of Autism. TRENDS in Cognitive Sciences. 2002; 6(6):248-254.George, R, and Stokes, M. “Gender Is Not on My Agenda!”: Gender Dysphoria and Autism Spectrum Disorder. In: Mazzone, L, and Vitiello, B. Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder. Switzerland: Springer; 2016.Kennedy, N. Cultural cisgenderism: Consequences of the imperceptible. Psychology of Women Section Review. 2013; 15(2):3-11.Strang, JF, et al. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. Journal of Clinical Child & Adolescent Psychology. 2016; 1-11.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organisation.Gender incongruence and transgender health in the ICD.Centers for Disease Control and Prevention.Data and statistics on autism spectrum disorder.de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA.Autism spectrum disorders in gender dysphoric children and adolescents.J Autism Dev Disord.2010 Aug;40(8):930-6. doi:10.1007/s10803-010-0935-9Pasterski V, Gilligan L, Curtis R.Traits of autism spectrum disorders in adults with gender dysphoria.Arch Sex Behav.2014 Feb;43(2):387-93. doi:10.1007/s10508-013-0154-5Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A.Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic.LGBT Health.2016 Oct;3(5):387-90. doi:10.1089/lgbt.2015.0070
World Health Organisation.Gender incongruence and transgender health in the ICD.
Centers for Disease Control and Prevention.Data and statistics on autism spectrum disorder.
de Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA.Autism spectrum disorders in gender dysphoric children and adolescents.J Autism Dev Disord.2010 Aug;40(8):930-6. doi:10.1007/s10803-010-0935-9
Pasterski V, Gilligan L, Curtis R.Traits of autism spectrum disorders in adults with gender dysphoria.Arch Sex Behav.2014 Feb;43(2):387-93. doi:10.1007/s10508-013-0154-5
Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385
Shumer DE, Reisner SL, Edwards-Leeper L, Tishelman A.Evaluation of Asperger syndrome in youth presenting to a gender dysphoria clinic.LGBT Health.2016 Oct;3(5):387-90. doi:10.1089/lgbt.2015.0070
Anna, I.R., et al. Gender dysphoria and autism spectrum disorder: A narrative review. International Review of Psychiatry. 2016; 28(1):70-80.Baron-Cohen, S. The Extreme Male Brain Theory of Autism. TRENDS in Cognitive Sciences. 2002; 6(6):248-254.George, R, and Stokes, M. “Gender Is Not on My Agenda!”: Gender Dysphoria and Autism Spectrum Disorder. In: Mazzone, L, and Vitiello, B. Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder. Switzerland: Springer; 2016.Kennedy, N. Cultural cisgenderism: Consequences of the imperceptible. Psychology of Women Section Review. 2013; 15(2):3-11.Strang, JF, et al. Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. Journal of Clinical Child & Adolescent Psychology. 2016; 1-11.
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