Purpose

To discuss the relationship between autism and gender dysphoria (GD), and their co-occurrence with transgender identity, and to raise awareness of the specific needs of individuals with autism spectrum disorder (ASD) in gender-confirming clinics. PubMed, Scopus, Medline, and EBSCO databases were reviewed. Only peer-reviewed English-language articles were considered eligible. Priority was given to meta-analyses and original articles presenting quantitative results published within the last five years; For some unreplicated studies this period was extended. The databases were searched using the keywords: “ASD” and “GD”, “autism spectrum” and “transgender”, “autism spectrum” and “gender dysphoria”.

Views

An increasing number of studies show that ASD is overrepresented in people with GD as well as in gender-affirming secondary care clinics. This trend is observed in both young people and adults. People with overlapping diagnoses face higher anxiety, depression, risk of self-harm and the feeling of being a minority within a minority. Sensory disorders from ASD may cause difficulties in achieving gender congruence, while social communication deficits may delay the diagnosis of transgenderism.

Conclusions

Transgenderism is more common among the ASD population than among neurotypical individuals. The reasons for this correlation are unclear, but they may be found in the theory of mind, extreme male brain theory, cerebral cortex structure, and cognitive inflexibility. Practitioners need training to uphold the dignity and autonomy of patients with comorbid transgender and autism spectrum diagnoses, enabling shared decision-making in treatment process and in co-defining the goals of therapy.