The Intersection of Autism and Gender

A suggestion by Renee Salas in a recent conversation started me thinking about how my Autism and Gender Dysphoria affect each other. It seems obvious that they will interact because both have strong neurological dimensions. In fact there does appear to be a correlation between Autism and GD in female-to-male transsexuals; however I could not find any studies investigating Autism in male-to-female transsexuals.

The primary study appears to be one published in the Journal of Autism and Developmental Disorders in 2011. One of the researchers was the well-known Prof. Simon Baron-Cohen and it is therefore not surprising that this research focused on the “Extreme Male Brain” theory. None of which helps explain Autism in female-to-male transsexuals: I can’t reconcile my own experience with this theory because GD in FtM transsexuals has been linked to prenatal exposure to estrogen, and brain structures that exhibit sexual dimorphism show similarities to cis women rather than cis men.

In the absence of any scientific evidence, all I can do is relate my own experience.

#1 Female Presentation of Autism

I remember the first time I read an article about how Autism presents differently in women because I was struck by how much of it matched my own experience. I guess it makes sense because I am a woman even though I was raised as male.

My Autism is well-masked in many situations because I have learned to mimic behaviors I observe in others. This extends to copying mannerisms, phrases and speech patterns. I am also typically a social person but I’m not one to initiate things. I rely on having one or two “gateway” friends to get me started in social situations, but I also have trouble making and maintaining friendships.

I was a hyperlexic child, learning to read before the age of two and spending many hours alone immersed in books, mostly fiction but also factual books related to my interests. At school I was always the quiet, shy one: well-behaved and academically gifted.

On top of growing up in the 70s and 80s when Autism was much less recognized, like many Autistic women of my generation there was little that indicated to anybody that I was anything more than painfully shy. Most of us were good enough at pretending to be like others that we didn’t attract attention.

#2 Gender Query

I remember being unaware of gender until I hit puberty. Of course I knew that there were girls and boys, and that girls dressed one way and played netball while boys dressed differently and played football. But that was the extent of my knowledge: I was hopelessly naive.

With puberty I became aware that my body was changing, and it affected me badly. I felt confused and conflicted: I liked the fact that it meant I fit in better with the boys at school, but didn’t like that I was a boy. I didn’t want to be, I didn’t feel like I was one of the boys, but I didn’t know that there was any such thing as Gender Dysphoria. I didn’t realize that there was another option. And I would almost certainly have been too afraid to speak about it if I had known: I used to be too self-conscious to even say the word “sex” in front of my parents.

When I was growing up there were no visible alternatives to the cis-hetero picture of gender and sexuality. I didn’t even know what “gay” meant until I was in my mid-teens: it was just an insult used by boys at school. So I had no vocabulary, no concepts to describe how I felt. Nobody to relate to. No role models with whom I could identify. Just this feeling that I was not right. And any attempt to express myself in private felt shameful.

#3 Being Different

I have always felt different to the people around me, known that I was not like them. This is a common feeling in Autism and for me has the added dimension of knowing that my body is “wrong”. I know now: it has taken a long time for me to identify why I felt the way I did.

Passing takes on extra significance for an autistic woman trying to fit in as a neurotypical man. I have been on the receiving end of homophobic bullying from time to time because of failing to act in an “appropriately” masculine way. The problem has always been that my behavior has never fitted the stereotype of masculinity. Oh, I played rugby at school but could never exhibit the aggression that the coaches wanted. I’ve always been quiet and passive, afraid of confrontation despite my physical size.

Since I discovered I am Autistic I have been less concerned with always fitting in, hiding my natural traits by aping those around me. I’ve accepted that it’s how I am; this has proved to be less stressful for me, less tiring, and I have felt happier about myself.

This openness about being myself contributed to my decision to out myself as a trans woman. Yes, I still feel different — that goes with the Autistic territory — but I’m more confident since transitioning. I no longer worry about having to “act male”: I go to work in my male shirt but I have painted nails and occasional mascara or lipstick. Whatever makes me feel good. I have fewer inhibitions about expressing how I feel. I am happy to be different, and I have been accepted for who I am.

#4 Depression

It’s no surprise I’m prone to depression since it is strongly associated with GD and is also common in Autistic people. It is something I have lived with for most of my life, causing a couple of breakdowns along the way. I am now on medication (Citalopram) and it helps but does not prevent me feeling down at times. What it does do is allow me to function, to get up in the morning and do a day’s work.

The simple fact is that I feel my body is too masculine. It does not match the way I see myself as a woman and this causes me distress. Sometimes I can look in the mirror and the face looking back at me is me, but most of the time I see a man’s face and this upsets me. One aspect of my Autism is that I focus on facial features in isolation. I look at my eyes or mouth and they are fine. But then I pay attention to the shadow of beard on my cheeks, upper lip, chin, and neck — no matter how close I shave — and it looks male. Yes, I could conceal it with makeup, but I’d still know it was there.

#5 Acceptance

One thing I have found among so many Autistic people is an open-mindedness and willingness to accept people’s differences. I believe this derives in a large part from spending our lives feeling like outsiders. It gives us an insight and understanding of how it feels to be excluded, taunted, abused just for not fitting in.

This extends beyond autism to include all manner of differences including gender and sexuality. Not only have I found it easy to accept myself for who I am, but I have received a lot of support and acceptance from other Autistic people online. This helps so much.

lbd_xmas13#6 In Summary

To round this off I’ll summarize some key points:

  • I am an Autistic trans woman. My Autistic symptoms are more similar to the typical presentation in women than in men.
  • I am not a stereotypical woman. I’m not butch or femme. I still wear jeans most days; they’re just cut a bit different from the ones I used to wear, but I also wear skirts and dresses when I feel like it. I don’t have to exaggerate my behavior, I don’t have to conform to anybody else’s expectations, I’m not acting a role: I’m just being myself. I’m different, I’m an individual and I’m OK with that.
  • I’m not OK with some of my masculine physical characteristics and this contributes in a big way to my bouts of depression.
  • I don’t have a “male” brain: being a trans woman is demonstration of that. (So much for the Extreme Male Brain theory of Autism!)
  • I believe that being Autistic has helped me come to terms with GD much more easily than would have been the case if I were neurotypical because I don’t have all that mental baggage that tells people how they ought to be.
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30 thoughts on “The Intersection of Autism and Gender

  1. The part of this that resonated most with me was acceptance. I have been heavy all my life and topped out at 370lbs (26 stone). This is way to the edge of the bell curve for weight and not something that can be hidden or worked around. People treated me differently. When I lost 170lbs that difference in how strangers treated me went away. It was a relief to not have my character judged based on my appearance but at the same time it sickened me to know that the people around me in the airport, mall theater or whatever had two ways of treating strangers. The notion that people who were generally well intentioned, thinking of themselves as essentially good, nonetheless have a social hierarchy mapped out in their head in which obese people hold an inferior station in life.

    What I’ve found is that the people in my weight loss support group are very accepting not just of people of all sizes but all sorts of differences. Same with the members of a local autism meetup. People who have been judged harshly in life either buy into that system and do the same to others (the minority in my experience) or else reject that hierarchical system of measuring human worth altogether. I didn’t have to out myself as obese but when I came out as autistic I suddenly found a whole new group of friends. The funny thing is, they’d been there all along and I hadn’t known to look until I discovered my own autism. “Oh, hi!” they seemed to say. “Welcome to our world!” Can’t express adequately how much that means to me.

  2. I’m so glad you’ve written about this, it illustrates the interaction between autism and gender dysphoria very well. I have to point out, though, that you do fall into gender stereotyping again in your own writing. It is entirely possible to be non-aggressive, shy, quiet, and non-confrontational, and still feel like you’re a man. At the opposite end, it’s entirely possible to feel like a woman and still be none of those things. Just because you are a shy and non-aggressive person and you happen to be a woman, doesn’t mean that the two go hand in hand. That’s Baron-Cohen thinking. 😛

    • Thank you. I’m pleased that I managed to describe how they affect each other.

      As to the gender stereotyping, my intention was to illustrate how symptoms of autism can be overlooked because a person simply appears to be shy and quiet. In women these traits are seen as conforming to gender expectations, and this is one factor in the under-diagnosis of female autism. (In my case, since I was raised male, my shyness was remarked on but the profile of autism — especially Asperger’s Syndrome — at that time was so low that it would never have been considered.)

  3. The extreme male brain theory worked bad against me (I am FTM), was told my gender issues were “just autism” for a long time, that I was just confused and did not understand, that autism explained everything. Left me very very confused, nearly killed me.

    My current therapist has a different opinion. She believes my autism makes my gender dysphoria much worse, more painful, harder to deal with, more severe. But that the two are otherwise separate and yes I have both. That makes sense to me.

    You mentioned the female-specific traits of autism. I fit the “normal”, male version of autistic traits better than the female-specific ones, despite being raised female. So, like you. It is interesting.

    • Thank you so much for sharing your experience, Ari. FTM gender dysphoria being dismissed as “just autism” sounds as if it might affect a significant number of people — it’s telling that the current NHS (UK) guidelines for GD diagnosis specifically mention that autism (together with some psychological illnesses) should not be a reason to discount GD.

      I don’t believe that the “Extreme Male Brain” theory is either correct or helpful, and I strongly suspect that the AQ test and others developed largely by Prof. Baron-Cohen show confirmation bias in that they are designed to back up the theory rather than test it.

      I’m glad you found a therapist who was open-minded and took your gender issues seriously instead of dismissing them. It seems like plain common sense that autism would present in a way that is consistent with a person’s gender. It’s important that one’s gender is correctly recognized.

  4. I still remember your response to one of my posts about female autism traits and how it struck me at the time that you related so closely to them.

    So much of what you’ve written here is familiar to me. I’m increasingly settling on a genderfluid identity and the universal acceptance I’ve found in the autistic community has made that shift easier than I think it would otherwise have been. I hope you’ll continue to write about autism and gender. I’m finding these posts really informative as I continue to find my own way on this path.

    • I remember that post so well. 🙂 I also remember being rather guarded in my response, unsure how much to admit at that point.

      I’m so glad you are finding these posts helpful and I wish you all the best as you explore your own path. this is a learning experience for me too, and I’m trying to document this as I progress.

      • At the time, your response made me wonder if maybe I had completely missed the mark in thinking those were female criteria. 🙂

        I’m hoping at some point to write about my own experiences of gender for my blog. I wrote a long piece for an anthology that helped me lay the groundwork of how autism and gender intersect for me and that was really helpful in framing where I am right now and how I got here. It’s fascinating to me how much we can learn about ourselves rather “late” in life.

        • I’ve found that as I’ve gotten older I’m better able to identify my feelings, which has helped me understand myself so much better. When I was younger I had a lot of confusion because I couldn’t explain why I felt the way I did. Now I have the knowledge and experience to put those feelings into some kind of context. I guess NTs pick these things up much more quickly and easily. For autistic people it takes rather longer. :/

  5. I’m thinking about these issues a lot lately, your coming out definitely has had an influence there as well, as has aspiemusings’ blog posts.
    I can definitely relate to a lot of what you write, especially the feeling of being different and how finding the autism community has changed things in that regard.
    I have always felt uncomfortable with having a female body, but I don’t remember ever feeling I really should have male bits. I am still quite unsure whether this unease is really gender related or has more to do with a general kind of unease with my body. I didn’t really ‘recognize’ myself in the mirror until about 10 years ago, and my body has always just been this thing that is there, that my brain lives in. It works. It doesn’t give me much problems, except PMS. It’s just there.
    I’ve had problems with expectations from ‘society’ and the boys I (perhaps mistakenly) have gotten involved with sexually. But is that necessarily gender related? Isn’t it just inexperience, and never really having a proper upbringing in this regard? Never learnt about my body in a context outside (hetero)sexuality? Still don’t quite know.
    So, it’s very interesting to read about your experience, it’s something to contrast/compare with, so as to more accurately find out what it is that I feel and think about these things myself.

    • I have found it such a help to read what other people have written and see which experiences I identify with.

      Feeling uncomfortable with your body can be a sign of gender dysphoria but then again it can have other causes, some physical such as hormonal imbalance. Or it can be a reaction to the constant stream of messages in the media telling us how we should look and act.

      Expectations from other people can be one of the biggest problems, and there can unfortunately be intolerance and prejudice against those who do not conform to typical expressions of gender or sexuality.

      Inexperience and lack of information while growing up do create a lot of uncertainty when you feel different but have no examples to compare yourself to, no role models to identify with. I wish you luck in learning to understand your own thoughts and feelings.

      • Feeling uncomfortable or unfamiliar with your body may also be a subset of having difficulty interpreting body signals, like pain perception, recognising you’re hungry, or sensitivity to touch (not being able to stand light touch, but at the same time not noticing when you bump into things). Body awareness in its broadest sense is something that a lot of autistic people lack. So it makes sense that the body sometimes feels like a foreign entity, some kind of weird shell around the real you.

        • That’s a very good point. Poor body awareness has made me prone to bumping into things, knocking my elbows and hands on furniture and door frames. I have long felt like my body is a kind of mask behind which I hide.

          Gender dysphoria feels different to my poor awareness of body position. It’s how I feel when I see myself, a mismatch between what I expect to see based on my self-image and what my eyes tell me. For me GD derives primarily from what I see rather than what I physically feel.

  6. My apologies if someone has already mentioned this, I have not read the comments. The particular private gender specialist I see in the UK recently (in last two or three years) published a study showing that about 10% of his patients (including me!) had an autism diagnosis and even more met the criteria for one. There was no discernable link between gender identity and rate of autism diagnosis. Both trans women and trans men were more likely to have autism than cis people. About 1 – 2% of all people are autistic whereas at least 10% of trans people are.

    • Thanks for this information. I have seen these figures before and, at least for myself, agree in that I feel my autism is separate from my gender dysphoria. However my experience of GD is that it does affect the presentation of autism.

  7. Hi Alex, I’ve read this a few times and I’ll probably read it over again. Yes, there is a difference in how we women present Autism. I have seen it between myself and my husband and my son, though I must admit, my son and I share some similarities that I would say are remarkably female Autistic qualities. I know I present differently than my husband, my son and my cousin who are all Autistic males, but I do have some qualities that seem very male. I was definitely considered a “tomboy” growing up as many Autistic girls tend to be. That said, I don’t think there is a clear cut or black and white listing of qualities and presentation that can be totally considered male or female Autism, so to speak. Gosh, I’m trying so hard to figure out the right words to say and my brain is not cooperating with me today. I am struggling to form the words from my thoughts.

    I think you’re right about acceptance from the Autistic community. Most of us know exactly what it’s like to feel different, be different and not be accepted for those differences. We’ve been kicked around, put down, abused and bullied and we’d not dream of doing that to someone else. I don’t even understand why it has to happen to begin with. Differences are just differences. They are not something to be afraid of or angered by or threatened by. They are just differences in human expression and experience. It’s sad that people have such a difficult time understanding or even believing that a person could be born a sex that doesn’t coincide with truly who they are or that someone would be homosexual or bisexual and so on. It’s also sad that people cannot be appreciated for who they are, too. Life shouldn’t fit a cookie-cutter style of living. Not everyone is the same nor should they be and if we listen to one another and honor one another a lot more can be achieved. I think life would be a much more beautiful experience.

    I’m so happy you’ve had the courage to be you. It does take a lot of courage. I’m also very happy you have found acceptance and friendship from those around you. You definitely have mine.

    Blessings and friendship,
    Bird

    • Thank you so much, Bird. I agree completely that there is no black and white distinction between male and female whether one is discussing autism symptoms or any other aspect of behavior.

      Nor should there be. You express it so beautifully: “Not everyone is the same nor should they be and if we listen to one another and honor one another a lot more can be achieved. I think life would be a much more beautiful experience.”

      You have such a good heart, and I am proud to call you a friend.

      Bright blessings,
      Alex

  8. I think I’d like to broaden the conversation slightly. I’m autistic and somewhat active in the alternative sexuality community. I’ve become a bit more aware of my own autism and better aware of other peoples autism,I was always looking but am more aware now. It is surprisingly common to find Autistic people in the various trans communities. I strongly suspect that we are more common in the asexuality community. I went to a presentation by a fairly well known Pro Dom,when she put aside her dominate persona she looked distinctly Autistic to me. Etc Etc
    If you are local to New England the Transcending Boundaries conference is coming up and might be interesting to you

    • Thank you for this, Dermott. I’d not considered alternative sexuality because it lies outside my own personal experience.

      Unfortunately I’d not be able to easily get to New England: I’m in the UK.

  9. I’d like to give you a hug! If you were not comfortable for that, then a least a big grateful smile and my friendship! ^-^
    I’m a female born Aspie, and I have a -mostly- male brain, since ever… The “mostly” is probably due to my female hormones.
    But I could identify in many things with you, and I felt close (which is a very rare thing). Thank you for posting…
    Best Wishes!! (sorry for lack of personal history and words in general, as I’m in a rush…but I really wanted to write anyway)

  10. This post really interests me and brings me into several different areas of thought in regards to my own life. I’ve read a little bit about the extreme male brain theory. I’ve always gotten on best with men and women who did not represent their gender extremes. I am put off my extreme femininity as well as extreme masculinity. Not only in that I can’t relate to it, but it makes me feel uncomfortable and distracted? I also have a hard time recognizing individual faces when a group of women are all going for the same visual look. (where I live, this is a blonde hair, tan skin, dark eyeliner, nude lip sort of look- I just can’t tell one woman from another!) I’ve always been very aware of being female, but I’ve never fit into society’s concept of the “acceptable” feminine. When I was a child, I preferred to play by myself or with boys. I’ve read that one of the reasons that female aspies may enjoy conversing with men is because men are supposedly more straightforward, but I’m not sure of the veracity of that. I’m going to be giving this a lot more thought and possibly writing about it in the future. Thank you!

    • You’re welcome. I’ve noticed myself that particular styles of clothing and makeup seem to be very common, and it does make it more difficult to tell people apart if I don’t know them very well.

      I definitely preferred to play on my own as a child, and tended to become acquainted with others through common interests. As I wrote, I generally prefer the company of women as an adult because I find dominant/aggressive aspects of behavior to be intimidating, and these traits are more commonly shown by men.

      • I think I am more inclined to friendships with more androgynous persons, because it is less intimidating to me- less of the dominant/aggressive aspects you mention, and less of the strong female characteristics that I have trouble relating to. This is all really interesting!

  11. I am an auitstic person who identefies as a Genderqueer. I just don’t feel related to any gender, and experience gender dysphoria when I have to spend too much time in over musculine or feminine enviroments.
    My preformance is androgenic (it helpes my dysphoria very well, beacuse I wear men’s clothes), althought I pass af female (really wierd one) because of my body. When I’v read about the autistic traits in males, I felt like I could relate, but it wasn’t me. The female traites hit closer to home.
    The way I act is not faminine nor musculine. Of course, men see it as faminine, and women as musculine, but it is because people are not used to see somthing else.
    The person who diagnosed me as autistic several months ago actually wasn’t too understanding about the gender-thing and just ignored it, but it is nice to know that I am not alone. In some wiered way, she wrote I am too creative for an autistic person…so her genral attatude is understsndable.

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