No, trans people are not just autistic. Being trans and being autistic are two different parts of who someone is, and some people are both. One does not cancel out or explain the other, and neither is a reason to withhold care or doubt someone's gender.
Where does the idea that trans people are just autistic come from?
It starts with a real observation. Autism is a form of neurodiversity, which means a brain that works differently from the majority. People on the autistic spectrum may find social interaction harder than people without that label. That might be reading how society works, understanding how most people function, or blending into a group and mixing in with everybody else.
Now think about a trans child. Many have spent their whole lives being put in the boy box when they should have been in the girl box, or the other way round. They want to play with a group and are shut out of it, because everyone around them has decided who they are supposed to be. That can cause difficulties with social interaction, with forming friendships and with simply blending into the ordinary group. So if you put a neurodiverse child and a trans child side by side, some of what you see on the surface can look similar. A child who is isolating, struggling to fit in, and seems sad.
Similar-looking difficulties can have different causes, and sometimes more than one cause at once. That is where the trouble begins.
Why do doctors sometimes reach for autism first?
Picture a parent who cannot, or does not want to, see that their child might be trans. They take the child to the doctor and describe what they can see: my child is sad, my child is depressed, my child is not fitting in, my child is isolating and not socialising the way other children do. Many doctors do not understand gender diversity. So the first idea on the table is often autism, or ADHD, because there are some similarities and those are the explanations the doctor knows.
This makes me wonder whether some children who carry an autism label would have had their difficulties traced to gender identity, if somebody had listened properly. I can't point you to a specific paper for that, so take it as my general understanding from many conversations with trans people rather than a citation. What I am sure of is that a label can go wrong. A person can be given a diagnosis of autism when gender incongruence, the mismatch between the gender they are and the one assumed for them, would have described their experience better, if someone had given them the chance to speak and be believed. A misdiagnosis like that costs years.
I am not saying that no autistic child is trans, or that every autism diagnosis is wrong. I am saying that listening comes before labelling.
Are autistic people more likely to come out as trans?
I think there is another side to this, and it runs the other way.
Think about a child everyone assumes is a boy. They are in the boy class, wearing the uniform, on the rugby team, doing all the things boys are supposed to do, and inside they are thinking: I am a girl. Who can they tell? Mum did not listen the first time. The best friend was not having it. Can you imagine standing up in a school and saying that you are not a boy, that you want to wear a skirt and try make-up? Society is not that accepting, so very often trans people hide who they are. That is difficult, and it causes its own problems.
Now take a child who is neurodiverse, for whom the world can be simpler and honesty is key. They may say it flat out: I am not a boy, I am a girl, stop it, why am I being made to wear trousers when I should be wearing a skirt? Some autistic people are more truthful, or simply find it harder to hide their true identity. So it may be that more neurodiverse people come forward honestly and say that their gender identity is different, and ask what anyone is going to do about it.
That is not a sign that their gender is less real. If anything it is a sign of clarity, in a world that makes most of us hide.
Can you be autistic and trans?
Yes. Just because you are autistic does not mean you cannot be trans, and just because you are trans does not mean you cannot be autistic. There are trans people who are not neurodiverse, and there are neurodiverse people who are trans. The two are not mutually exclusive.
That has practical consequences, and they run in both directions. Nobody should be refused treatment they want simply because they are on the autistic spectrum. An autistic person is the expert in their own life, and the right to decide about your own body does not depend on how you socialise. Equally, being trans should never be a reason for a doctor to ignore someone's neurodiversity. Both deserve support, and both are part of the same whole person.
If you are autistic, have been told that this is the reason you cannot start treatment, and want to explore the medical side, GenderGP can help with access to affirming medical care, including hormones, blockers, prescribing and monitoring.
Why is "they are just autistic" used against trans people?
Because it works as a way of saying that gender diversity is not real. I have watched the list of explanations grow. It is autism. It is childhood trauma. It is girls watching pornography and deciding they should have been boys. It is people who were always going to turn out gay and are running away from it. Each one reaches for another reason, any reason, why a trans person cannot mean what they say.
None of it holds up, and it is not true that trans kids are just autistic, or just anything else. Autistic people are not too confused to know their own gender. They are not a loophole in the argument. They are not people whose word can be set aside. Most of the time, I think, the person making the claim has simply never learned about gender diversity, and that is fine, because that can be put right by learning. But once somebody has learned, the search for another explanation has to stop.
Gender diversity exists. Trans people have always existed. It is not an error to be corrected or a symptom to be managed.
What does good support look like for autistic trans people?
It starts with listening, and with believing what the person says. Then it supports both parts of them together: the autistic needs and the gender needs, with neither used to dismiss the other. It means doctors who take the time to understand gender diversity before they reach for a label, and it means schools and families who treat a child's honesty about who they are as a gift rather than a problem.
This is something we all need to understand better, as a society and, for sure, as doctors. People are beautifully diverse in many different ways. Some of us are neurodiverse and some of us are trans. Some are Black and some are white, some are tall, some are gay, some have bodies that work differently. All of that is fine. The aim is a world where everybody can exist.
If you are autistic and trans, or you love someone who is, and you want to talk it through, you can do that with Sammy here. Whether it is how to explain yourself to a doctor, how to raise it at home, or just working out what you feel, bring whatever you have.
If there is a topic that you would like me to cover, just let Sammy know.
Dr Helen Webberley
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