What Is the Connection Between My Gender Identity and Autism Spectrum Disorder?

Since coming out as non-binary and getting diagnosed with ASD, I’ve realised that the feelings relating to my gender identity and autism are connected to each other. This realization is affirmed by research done by, among others, VU Amsterdam, which shows that a remarkable amount of gender non-conforming people are neurodivergent. How does this connection work? In this article I turn to both myself and others to better understand the relationship.

Temper tantrums

When I was a little kid I had many temper tantrums. I insisted on having that one piece of candy, which my mother wouldn’t give me, resulting in me screaming. Children all react to that in this way, of course, but my tantrums went yet a bit further. There was a year where nearly every night I’d stand next to my parents’ bed crying, would not go with them and leave the supermarket when things didn’t go my way, and wouldn’t look up once when reading a book. In elementary school I finished reading every book from every bookcase, because of which I constantly had to go to different classrooms when I wanted a new book.

Eventually, during that time we never looked into what caused this behaviour. I learned rather quickly what I could and could not do, socially speaking. I learned to say yes and no, to ask how someone is doing, I learned to push myself into the box of what a person who is born a woman is supposed to do.

That didn’t go well for very long. I was often sad, I didn’t understand the world. Despite the fact that I kept learning new things about how I should behave socially, it was never fully good enough. I was different from others, and others noticed this as well. I always felt like the odd one out, and could not find the right connection with the friend groups I was a part of.

Cis-heteronormative rules

Beside these often confusing and uncomfortable social interactions there were other rules that had a big influence on me: the cis-heteronormative rules. I come from a traditional family in which there are no queer relationships and where there are no gender non-conforming people around. I learned that I had a binary gender that I couldn’t change, and that I was supposed to start a relationship with someone from the other binary gender. For people with autism these kinds of rules are crucial within their upbringing. Because social rules are hard to interpret I clamped onto the rules I did understand. I knew from a fairly young age that I found women very interesting to look at; I liked being around them, felt much more for them than I felt for the men around me. When I was around eighteen I had the courage to give into this a little bit and would from time to time kiss a girl at parties, but I didn’t date; I had learned that I was supposed to do this with a man.

There was always a discrepancy between my behaviour and that of the girls in my class. I didn’t like the typical things that girls in high school do together. In my third year there was a lipgloss mania which all girls’ pencil cases were stuffed with; I didn’t touch it. The clothes of girls around me were composed of soft colours and were skintight; for me clothes were allowed to be baggy and drape over everything, preferably black or way too colourful. Here too there was this inconceivable distance that I just couldn’t understand. 

Because of this weird mix of feelings in the social, sexual and individual area, I was often confused and very depressed. At twenty-three I burst and went to investigate what caused me to feel so bad about myself for so long. I realised that social rules are not difficult for everyone, that I was not solely attracted to men, and that I did not belong to the gender I was born into. Within the time span of about a year I’ve thrown three coming-outs out of the closet: I turned out to be queer, I have ASD, and I am non-binary.

Self-acceptance

By now I am twenty-six years old, and I can say with certainty that I’ve never felt this sure about myself. I know who I am, I understand how I work. I’ve accepted myself and am finally, every once in a while, really happy with myself. By now I’ve been registered with a gender clinic in Groningen for two years, with the prospect of being able to start my transition at some point. The only block in the road to becoming the person I want to be is the fear I have about being assigned to a gender team that sees ASD as a contraindication to the treatment of gender dysphoria.

During the spring of 2021 VUgendermistreatment launched its Instagram page to address the problems within the gender clinic. Beside endless queues and the process of directing people toward binary transitions, it was also often addressed that having ASD was a well-grounded reason to make the transition process much longer or sometimes even to retain people from transitioning at all. In posts on Instagram, trans people say that the reason that the practitioners at the VUmc offer for this, is that they fear that gender identity for people with ASD could be a consequence of fixation behaviour; that we have a hyperfocus on gender, transitioning, and afterwards regret the treatment. This is a notable fact, especially because research shows that many trans people are diagnosed with ASD.

I myself also feel like there is a connection between autism and gender identity. I’ve personally never experienced it as something negative, but actually as two parts of me that neatly fit together. It’s bothersome that this connection isn’t always viewed as something positive. In conversations with friends I sometimes try to explain that the two are connected, but I often lack the words to describe why the interconnectedness is so logical. To understand how other gender non-conforming ASD-ers think of this connection I’ve spoken to them about it. How do they experience the relation between the two? And how does the gender clinic deal with the wish to transition when you’ve been diagnosed with ASD?

Jo

First, I spoke to Jo (they/them). Jo is thirty years old and is agender. Since about five years Jo also knows they’re autistic*.

‘The entire idea of gender is something I don’t relate to, it conveys nothing in my mind. I’ve never felt female or male. I’ve tried to feel it in all sorts of ways, by dressing very femininely and masculinely, but I don’t feel a connection to any of it. It bothers me when people call me girl or ma’am; that’s when I feel dysphoric. Other than that it’s thankfully not too bad, so I don’t have to go to a gender clinic.

Five years ago I went to a psychologist at a GGZ institution that was treating me for depression symptoms. She tested me for ADD, but when she was discussing the results with her colleagues they concluded that it was ASD. I’m happy with that diagnosis because now I can’t blame myself anymore for social things going wrong. Things like: why can’t I make friends, why don’t eye contact and conversation happen naturally. Now I know that I’m not stupid or dumb, but that it’s just a part of who I am and that that is fine.

I think that the link between ASD and gender identity can be explained through the fact that gender rules, too, are social rules. Because why would a person with a vagina only behave in one way and a person with a penis in another way? It’s something that we’ve made up, just like rules such as having to give each other three kisses on the cheek at a birthday. And for autistic people these are the kinds of social rules that you don’t get and that you just have to participate in because this is what you’re supposed to do. At least, that’s what it’s been like for me. I have a very analytical brain and always want to understand and sort everything out. For me my non-binarity is a predecessor of how I hope the world will work in the future: comfortably being yourself without putting a label on it.

I somewhat understand why the VUmc is afraid that we have a hyperfixation on gender, but if you’ve got decent psychologists shouldn’t they be able to see right through that? Practitioners seem to underestimate the intelligence and integrity of an autistic person. As if as an autistic person you don’t know what’s good for you. For me, as an educated and self-sufficient autistic person, it sort of feels like an insult that I wouldn’t be able to think for myself.

I can imagine though that for some trans people who aren’t autistic they wouldn’t always find the connection between the two very pleasant. It suggests that being trans is related to a ‘mental defect.’ And though autism isn’t an illness or something bad, the outside world presents it as such which does evoke certain stigmas.’

Jasse

Following Jo, I spoke to Jasse (they/them, he/him), thirty-one years old. Jasse has known that they’re autistic* since 2012 and has started his transition at the gender clinic at the start of 2020. Jasse tells me how the connection between ASD and gender has played a part in their life.

‘At a festival campsite I had a conversation with someone who told me about their asperger diagnosis. They commented: “But I don’t have to explain all this to you, because you have it too right”. That struck me; I started thinking about it and reading about it more and recognised a lot of it . After that I registered at the Autism Team Noord-Nederland.

I find it hard to explain how the interconnection between ASD and gender works for me, but it certainly has to do with social roles. If you deviate from the norm from a young age because of autism or whatever, this does in some way help you get to know yourself better. You break free from expectations more and from how social rules are supposed to be, you learn to authentically be yourself because you’re already different anyway. I also suspect that more people don’t necessarily feel male or female, but that they never really stop and think about it because there’s no reason to. Of course that doesn’t have to be a problem, unless there’s dysphoria involved. 

For instance this was the case for me. I’ve had much dysphoria and am transitioning toward a more masculine appearance. This past year I’ve had a double mastectomy and have started using testosterone.

I’ve experienced communication with the gender clinic as quite a struggle. It was an unclear process. For example, partly because of my autism I’ve experienced a lot of stress because the timeline, order and content of the process weren’t laid out clearly. I also experienced a lot of stress due to the switching of practitioners and because certain people within the gender team contradicted each other sometimes. Besides that the coordinating practitioner has made it difficult for me to be allowed to start my transition. According to her I had to work on my autism before I was allowed to progress within the clinic. I’ve tried to explain that I didn’t expect that a lot of progress would be able to be made in regards to that, and that I didn’t suffer from my autism but from my dysphoria. Because I was alarmed by the stance of the practitioner, I called in my parents.

Subsequently, my dad came with me to a consultation so he could emphasise how much I suffered because of my dysphoria and that I needed help with that. That probably helped make the process go faster. 

I’d have preferred it if the practitioner had openly asked me if I felt a connection between my autism and my gender identity – that is a perfectly fine question to ask and something you can work with. But fairly harshly asserting that I have to work on my autism without concretely stating what specifically I should work on or with whom, I’ve experienced as unpleasant and belittling, it detracted from my feeling of self-determination.’

Equivalent

My conversations with Jo and Jasse have given me important and pleasant insights. Their view on the connection between gender and autism helps me express and situate my own experience better. My gender dysphoria and autism go hand in hand. Thanks to my autism I’ve learned how to neatly sense which social rules fit me and which ones don’t, and in which social boxes I belong in and in which I don’t. All in all, my non-binary identity is not a consequence of my autism, but is equivalent to it.

*Jo and Jasse say about themselves that they ‘are autistic’, instead of saying they ‘have autism’,  hence me choosing this wording.