Autism and Gender Incongruence: Both Real, Both Misunderstood

The research shows a connection. But the story behind the numbers is more complicated than it first appears.

There is a question that comes up again and again in the debate about transgender healthcare, and it usually isn’t asked with kindness. It goes something like this: ‘But what about autism? Aren’t these children just autistic?’ I want to answer that question properly, because it deserves a proper answer - not a dismissal and not a deflection.

Here is what I said when it came up recently in a conversation about the barriers young trans people face:

That clip captures it well. Autism is almost never raised in these conversations as a way of helping autistic children, or of helping transgender children. It is raised as a way of casting doubt. And that is worth examining, because the research is actually far more nuanced and far more interesting than the way it is being used in public debate.

What the research actually says

There is a growing body of peer-reviewed literature on the co-occurrence of autism and gender incongruence. A 2022 systematic review and meta-analysis by Kallitsounaki and Williams found that around 11% of people with gender dysphoria or gender incongruence had a formal autism diagnosis, and that autistic traits were significantly more common in gender-diverse people than in the general population. Two further scoping reviews published in 2024 reviewed nearly 100 empirical studies on this intersection and confirmed that the field has expanded rapidly, and that the link is real.

So yes, there is an overlap. The question is what it means.

People can be autistic. People can be gender incongruent. People can be both.

This sounds obvious, but it needs saying clearly, because the way this overlap is discussed in public often implies that one explains the other, or that having both somehow makes a person’s gender identity less trustworthy. It does not.

Autism is a neurodevelopmental condition. Gender incongruence is the experience of your gender identity not aligning with the sex you were assigned at birth. They are different things. They can exist independently, and they can exist together. One does not cause the other, and one does not cancel the other out.

What they share is something important: neither can be confirmed with a blood test or a brain scan. Both are diagnosed through observation, through self-report, through the accounts of people close to the individual, and through clinical judgement. They are, by their nature, subjective diagnoses. And that matters enormously when we try to understand what the numbers are really telling us.

What gender incongruence can look like from the outside

I have sat with many young people who are struggling with their gender identity, and I have watched how that struggle shapes them socially. When you are a boy growing up in a girl’s body, how do you join in with the girls? When your dysphoria is constant, pulling at you from the inside, when your voice and your body feel like they are betraying you, when shame sits on your chest every single day, how do you show up in the world with ease and confidence?

In many cases, the honest answer is that you cannot. A young person carrying unrecognised gender incongruence can appear socially withdrawn, socially awkward, literal in their responses, unable to engage easily in the normal back-and-forth of peer relationships. These are also traits we associate with autism.

I am not saying that clinicians are getting it wrong. I am saying that when a child is in distress and the source of that distress is not understood, the distress shows up in their behaviour. And behaviour is what we observe when we diagnose.

The conversation people actually have about this

When this came up in a radio conversation on LBC, the question was framed, as it often is, as a concern. The suggestion was that autism was somehow being overlooked, that trans children were being fast-tracked onto treatment rather than properly assessed. Here is how that conversation went:

What I said then, and what I still believe, is that for transgender children in the current climate, getting onto any pathway of care is not fast or easy. It is incredibly difficult. And the idea that autism and gender incongruence are interchangeable — that one explains or replaces the other — is not supported by clinical reality.

Why autistic young people may be identified earlier

Many people with gender incongruence spend years, sometimes decades, hiding it. The stigma attached to being transgender is still significant. The ability to mask, to suppress, to perform the gender you were assigned at birth as a protective strategy, is something many people develop and sustain for a very long time.

Autistic people, in my experience and that of many clinicians, are often less able or less willing to mask in this way. They may find it harder to suppress their authentic self in order to conform to what society expects. If they are assigned female at birth but know themselves to be male, they may simply be less able to perform femininity continuously and convincingly. And so they may come forward, or be referred, earlier.

This means that autistic people with gender incongruence are likely to be over-represented in clinical data — not because the co-occurrence is more common in reality, but because they are more visible in services. Our data reflects who reaches care, not necessarily who has the experience.

Which diagnosis is more acceptable in 2026?

This is a question I find myself returning to, and I think it deserves to be asked out loud.

Autism, in 2026, is increasingly understood and accommodated. There are school support structures, workplace adjustments, communities of shared experience, and a growing acceptance that neurological difference is part of human diversity. An autism diagnosis, in most settings, opens doors to support.

A gender incongruence diagnosis, in 2026, is a different experience. It may open the door to treatment, but it also opens the door to scrutiny, hostility, and public debate about whether your identity is real. It carries a social cost that an autism diagnosis, in most settings, does not.

If a young person is experiencing both, and a clinician is assessing them, in which direction is the clinical eye more likely to settle? I am not suggesting deliberate bias. But we are all human, and we operate within a social context, and it is worth asking whether the discomfort around gender diagnosis is leading some clinicians towards a more comfortable explanation.

Autism should never be used as a barrier to gender care

Here is what I want to say directly to any clinician, any parent, any young person reading this:

That is the heart of it. Autistic people often know themselves very deeply. They can be less influenced by social expectations and more willing to express who they truly are. That is not a reason to doubt their gender identity. It is, if anything, a reason to trust it.

A person can be autistic and gender incongruent, and the presence of one should never delay or deny support for the other. If a young person has an autism diagnosis and is also telling you about their gender, the autism does not explain away the gender. It is a separate part of who they are, and it deserves a separate and thoughtful response.

A father who understands both

While I was working on this piece, I came across something that stopped me in my tracks. Chris Benson, a father and educator, wrote about his son — who is both transgender and autistic — with a clarity and a love that I think captures everything I have been trying to say here far better than any clinical framing can.

His son navigated both. His son was seen, supported, and celebrated by his father. And his son, having watched how people like him are spoken about in this country, chose to study abroad — somewhere he felt safer. Not for political reasons. For protective ones.

I have published a companion piece here on Dr Webberley Responds sharing Chris’s writing and my own response to it. If the research and clinical perspective I have offered above means something to you, I think his words will mean something too.

Are the numbers in the research accurate?

Probably not entirely, and the researchers themselves acknowledge this. Studies use different screening tools, different definitions, and different populations. Most data comes from clinical services rather than the general population. When you add in the diagnostic dynamics I have described — where autistic people may be less able to hide their gender incongruence, where gender-incongruent young people in distress may be more likely to receive an autism assessment, and where the social acceptability of the two diagnoses is so different — it becomes clear why the numbers vary so widely across studies.

The research is valuable and growing more rigorous. But we should hold the specific figures lightly. The human truth underneath them is this: both autistic people and gender-incongruent people are navigating a world that was not built with them in mind. That shared experience of difference deserves compassion, careful assessment, and support for every part of who a person is.

What I hope for

I hope that as our understanding of both autism and gender incongruence deepens, we will get better at seeing people clearly — as whole, complex human beings rather than as a collection of diagnoses to be sorted. I hope that clinicians will feel confident assessing and supporting both conditions without one becoming a barrier to accessing care for the other. And I hope that the social climate will, in time, allow every person to receive the support they need without their identity being turned into a political football.

The variation in human experience is not a problem to be solved. It is part of what makes us human. It deserves to be met with curiosity, with care, and with the understanding that two things can be true at the same time.

What are your thoughts? Have you or someone you love navigated both autism and gender incongruence? I would love to hear from you in the comments below.

If this piece was useful to you, please share it with someone who might need to read it.

Dr Helen Webberley
Gender Specialist and Medical Educator
www.helenwebberley.com