Uncovering The Connection Between Autism And Gender Dysphoria

A growing body of research suggests theres a link between having a non-binary gender identity and being on the autistic spectrum.

More than 3.5 million Americans live with autism spectrum disorder, a condition we're only now beginning to understand. But new research suggests a connection between being on the spectrum and identifying as transgender or non-gender binary.

One recent study out of Cambridge found that trans men exhibited more autistic traits than trans women or cisgender men and women. Another, from the NIH, reported that 7.8% of children and adolescents who reported gender dysphoria were on the autistic spectrum.

That’s compared to 1.47% in the general U.S. population.

In broad terms, autism is a neurological condition that affects social skills, communication and theory of mind (the ability to understand how other people feel and think). It can also involve repetitive behaviors or patterns.

But the condition doesn't manifest the same way—or to the same degree—in different people, which is why it's referred to as a "spectrum."

In fact those with Asperger's syndrome, a high-functioning form of autism, may never be diagnosed.

In her private practice in Montreal, Dr. Isabelle Hénault has seen many clients who are, as she puts it, "more flexible with their gender than the general public."

"It's not so much 'trans' or 'cisgender,'" explains Hénault, author of Asperger's Syndrome and Sexuality. "I say 'gender flexibility' because they can integrate both masculine and feminine traits in different ways."

Based on her practice and discussions with other experts worldwide, she estimates between 15% and 20% of adults on the autistic spectrum are gender-flexible. What's not yet clear, though, is what's causing that intersection. Is it genetic? Environmental?

Neurotypical people can be preoccupied with presenting as male or female, but "aspys" already have trouble deciphering social expectations, so they're less likely to fixate on gender norms.

"Some clients may cross dress, because they identify with the complexity of gender identity," says Hénault. "Others may get partial surgery—or total."

Because of their impairment, Hénault works with clients to determine if their gender identity is just flexible or a source of conflict. "If it's a conflict, we try to figure it out," she says. "Some clients think if they become a woman, 'other women will be nicer to me and Ill make more friends.' So we try to resolve that rather than urge surgery. I've had patients who believe, 'If I become a girl I won’t have autism anymore.'"

She admits that aspys who present a non-binary gender identity can be dismissed by the medical community. "Doctors may not understand what they're trying to convey or just think it's part of their neurological impairment."

Ironically, says Hénault, people on the spectrum are likely to be more accepting of differences in gender and sexuality in others. "They're usually more open-minded, because they know what it's like to be judged."

Standing at the intersection of gender identity and the autistic spectrum is Martine Stonehouse, the subject of the new documentary Transfixed, which premiered this week in New York City.

Martine is transgender and a staunch advocate for trans rights in Canada. (It was her activism, in fact, that got the government of Ontario to re-list gender confirmation surgery after it had be cut from the list of covered procedures.)

Stonehouse also lives with Asperger's Syndrome, as does her husband, John Gelman.

"When I first met Martine, I was drawn to her passion for various social issues," say Transfixed director Alon Kol. "She was such an inspiring advocate for transgender rights, but also those for the autism spectrum community."

After getting to know Martine and John—and witnessing their authentic (sometimes blunt) interactions, Kol was convinced he had to tell their story. Transfixed came together over a period of five years.

"I have a strong interest in psychological conditions and people who are not 'neurotypical.'" he says. "I feel that the idea of a completely neurotypical person is a myth... Each of us contains a blend of complexities of varying degrees. By expressing some of the more severe forms of atypicality in individuals like John and Martine, I make visible what is already in all of us."

As a gay man, a Jew born in the former Soviet Union, and someone with a learning disability, Kol is acutely aware of how society can force individuals to fit a constrictive mold.

"Not all people can be bothered with seeing the world in anything other than black and white," he says.

"Many of us seek safety instead of adventure. And others put up with discomfort instead of discovering who they really are."

But if Transfixed teaches us anything, it's that love is love, and human is human, no matter what gender or race or neurological pattern we are assigned.

And whether Martine's Asperger's is connected to her being transgender or not, Kol says it's "ultimately a story about freedom—the freedom to be perfectly ourselves."

Transfixed screens at the Village Cinema in New York through Thursday, May 5. For more info and details on future screenings visit the film's website.