Autism and Gender Dysphoria, Part 3
By Mary Smith
In previous installments, we covered the basics and social drivers (Part 1) and how technology and sensory attractions pull autistic youth deeper into gender ideology (Part 2). Part 3 now examines the intense challenges of puberty, the complex interplay with sexuality, and why gender nonconformity—long a trait of many autistic individuals—can be misinterpreted and medicalised today.
Puberty, Sexuality, and Gender Nonconformity
For autistic children with gender dysphoria, puberty, a trying time for all children, can bring a host of seemingly insurmountable problems. Arguably, the line between body dysmorphia and gender dysphoria gets blurred; in any case, an alarming discomfort with one’s changing body can in large part explain the wish to identify out of one’s sex.
The sensations of growing body hair and developing secondary sex characteristics can be very distressing for autistic kids, especially if this attracts unwanted attention from other people. Girls feel alienated by what Ariel Levy has termed ‘the pornification of the mainstream’ with its contingent expectation that they should dress in sexually provocative clothing. The situation is often worse for autistic girls, creating a strong desire to flee the perceived restrictions of womanhood altogether.
Add sexuality into the mix, and the situation becomes even more complicated. Autistic adolescents are more likely to be gay or bisexual in their sexual orientation than neurotypicals. Despite the ubiquity of LGBTQIA+ cheerleading in present day society, homophobia is still rife. The particular focus on transgender identities has led to a situation where, as many prominent feminists and gay rights activists have pointed out, trans could be viewed as ‘the new conversion therapy’. Gender nonconforming children who would otherwise have grown up to live well-adjusted lives as gay men or lesbians are made to feel they were ‘born in the wrong body’, a quasi-spiritual and science-defying belief, but an enduring myth in the current climate. Internalised homophobia, along with internalised misogyny, can play a large part in the decision to embrace a trans identity.
However, many autistic children are late developers when it comes to sexuality, which can be at least partly explained by the sensory issues discussed. Throughout childhood, autistic children can experience developmental delays, and this may be particularly evident when it comes to taking on the mantle of independence that comes with adolescence. Add to this the difficulty in forming relationships, and in many cases, the lack of desire to do so. A disconnect with one’s sexuality and physical self can lead to drastic measures. Medicalisation involves gender clinicians colluding with the universal mind/body dilemma by attempting to make permanent changes to what is a temporary issue. Historical research and statistics suggest that without life-changing drugs or surgeries, some 75%+ of children with early onset gender dysphoria desist during adolescence. However, this natural resolution can be skewed by social transition, alongside the use of puberty blockers, which Transgender Trend argues can rewire neural pathways.
Puberty is additionally challenging for autistic children due to a more general sensitivity to change than neurotypicals. Therefore, the notion of halting developmental growth can be very attractive as a way of stopping the suffering. (There’s a parallel to be drawn with late-diagnosed autistic women and the menopause, where HRT and antidepressants are routinely prescribed at another important developmental stage.) And so, the importance of androgyny and its statements as a remedy, offering the opportunity for individual agency during a period of great change, is utterly understandable. But it is darkly ironic that this creative impulse can be pathologised by a culture that demands discrete and sharply delineated identities – black or white, male or female – particularly during the teenage years, a time of great experimentation. By concretising what are ultimately temporary/experimental roles and ‘identities’, this true fluidity is medically pathologised and commodified. Meanwhile a generation’s imagination is stolen. This is especially criminal as we know that dysphoria is usually a temporary state.
Gender Nonconformity
This brings us onto a discussion of gender nonconformity amongst autistic people. This is a huge topic, so we’ll keep it brief. Elizabeth Hawker is an autistic, desisted woman. In this article, she writes:
Studies into the co-occurrence of autism, gender variance and gender dysphoria have returned some striking numbers. A study by John Strang in 2014 found that children with ASD were 7.59 times more likely to be gender non-conforming or “express gender variance.In Theories on the Link Between Autism Spectrum Conditions and Trans Gender Modality: a Systematic Review (Wattel, Walsh, Krabbendam) the results of the wide-reaching survey of possible reasons for autistic people being drawn to a trans identity were largely inconclusive due to methodological inconsistencies in the reviewed material. However, one finding for which there appeared to be a strong evidential base was the theory of ‘weakened sex differences’ in autistic people. According to this theory, sex differences in the brains of autistic people of both sexes are less marked than in those of neurotypical people.
But how useful is it to take such a materialist approach to the question? What we know is that autistic children are less likely to adopt gender stereotypes through the toys they play with and the clothes they choose. This could be due to a range of reasons, including the idea that they are nonconformist across the board where it comes to social mores.
Literal-mindedness can contribute to this situation. For example, to the question, ‘Would you like to come over and give your gran a kiss?’ an autistic person might answer, ‘No’, with perfect honesty, whereas the only socially acceptable answer would be ‘Yes!’ Autistic people may have difficulty understanding metaphors, nuances, idiomatic turns of phrase, facial expressions, sarcasm and jokes. The interpretative skills necessary to make sense of these strange neurotypical habits can easily be exhausting, which is why autistic kids may ‘opt out’ or not even want to conform to social norms in the first place. An unconventional dress sense, which may already have been somewhat gender nonconforming prior to the adoption of a trans identity, could be another reason why ‘finding your tribe’ is so seductive to autistic young people.
There is strong evidence to indicate that autistic people are more likely to be gay or bisexual than neurotypicals. We have also seen that autistic youth are especially prone to adopting a trans identity. This recent development clearly threatens the future of gay autistic youth, with many accusing the current global culture of affirmation of quite literally ‘transing the gay away.’
In 2016, GIDS published its most recent statistics on the number of same-sex attracted referees for treatment for gender dysphoria. 60% of boys were found to be gay or bisexual. Over 50% of girls were gay with just under 20% of female referees stating they were bisexual. These emergent LGB identities are often indicated by a lack of gender conformity in childhood. The above cited study by Strang et al. examined the experiences of clinical experts, finding that the majority of these experts reported that some gay/bisexual autistic people assume they are a different gender because of their sexual orientation.
Back in the 90s, Simon Baron-Cohen theorised that the autistic brain bears a resemblance to the ‘extreme’ male brain, in that it favours ‘systematising’ over ‘empathising’, a skill more typically associated with females. Perhaps we could turn this on its head, arguing that, since there is no blueprint, beyond basic biology, for how to be a woman, the fact that there are many autistic girls who are good at systematising rather than socialising could be viewed as a way of expanding our understanding of womanhood and neurotypicality.
Decades prior to the current obsession with all things gender-related, Jane Meyerding’s article, ‘Growing up Genderless’ in the collection Women from Another Planet: Our Lives in the Universe of Autism (1st Books, 2003) describes a profound dissatisfaction with socially ascribed gender stereotypes. Notably, despite her strong sense of disconnection with expected gender roles, there is no mention of body dysmorphia or gender dysphoria in this text, which was written long before the current trend to medicalise feelings of alienation from one’s natal sex. Instead, there is an in-depth discussion of role playing as a form of masking, which she was neither prepared nor equipped to deal with. Hilariously, she describes a school dance where her girls’ school entertained boys from a local school. Despite the fact that the girls had talked about nothing but the upcoming dance for months, on the big day, the boys and girls huddled with seeming nonchalance at different ends of the room. Jane tries to drag one of the girls over to the boys’ corner:
I had no idea what was going on. Now, more than 35 years later, I know (intellectually) that there was plenty of communication going on in that room between that pack of girls and the cluster of boys. They knew what they were doing. But I sure didn’t. Like a ship at night with no radar, I was sailing blind through a world full of gender signals invisible to my genderless self.The author describes her journey with sexuality. Despite eventually coming out as gay, the vexed issue of gender roles appears to be mostly about the difficulty of forming relationships per se, along with a profound dislike of conforming just to fit in.
Jane Meyerding’s story reminds us that feeling ‘genderless’ or alienated from stereotypes has always been part of many autistic lives—long before medical transition was offered as the solution. In Part 4 we turn to the cognitive styles that can turn that alienation into rigid certainty: black-and-white thinking and the extraordinary intensity of autistic special interests.
Mary Smith is a UK writer, researcher, and parent, engaged in resisting gender ideology and its harms.
Image: Photo by bao sabrina on Unsplash
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