Trans and Autistic: Stories from Life at the Intersection

Executive Summary

This book presents firsthand accounts from transgender and autistic individuals navigating life at the intersection of these identities, revealing systemic barriers across healthcare, employment, and social systems. Based on extensive interviews conducted by autistic researchers with transgender and autistic participants, it challenges gatekeeping models and demonstrates how community support and harm reduction approaches produce better outcomes than compliance-based frameworks.

The work is particularly valuable for its nothing about us without us methodology—research conducted by autistic people as partners rather than subjects, producing findings that differ fundamentally from non-autistic researcher perspectives. Participants identify sources of distress in external social barriers rather than internal autistic traits, supporting neurodiversity-affirming approaches.

Identity Discovery at the Intersection

The journey to understanding autistic and transgender identities follows diverse pathways that challenge any notion of universal experience. Participants’ stories reveal how self-discovery unfolds across different timelines and contexts, often shaped by access to information, community connection, and the willingness to question social expectations.

Varied Pathways to Recognition

Autism diagnosis occurred at different life stages—some in childhood through formal assessment, others in adulthood after recognizing themselves in DSM criteria or meeting other autistic people. Similarly, gender identity exploration began early for many (some with conscious awareness from ages 4-5), but coming out and medical transition spanned from ages 21-36 among participants.

Discovery triggers were highly individual:

• Alex explored gender through MMORPGs using female characters
• Grace found certainty through My Little Pony fandom on Tumblr and reading Dreadnought (featuring a transgender girl protagonist)
• James’s reading of Dr. Simon Baron-Cohen’s work on Autism’s “extreme male brain” helped contextualize both social difficulties and gender questions

The Challenge of Late-Life Recognition

For those assigned female at birth, extensive autism masking made self-recognition extremely difficult. Professional dismissal of autism diagnoses in adulthood frequently cited eye contact ability, social success, or female gender assignment as evidence against autism—despite clear participant experience. This gatekeeping extends across both autism diagnosis and transgender healthcare, with some healthcare professionals refusing referrals or continuing prescriptions out of paternalistic concern.

Critical insight emerges: some participants withheld their autism diagnosis from themselves or others to avoid additional stigma, resulting in decades of internalized ableism where autism was understood as personal failure rather than neurological difference.

Intersection of Identity Formation

Participants consistently distinguished between autism (how they process sensory information and navigate social rules) and gender identity (what gender they are), rejecting deterministic claims that one causes the other. However, they acknowledged complex interactions:

• Isabella and Moose felt strongly they weren’t causally related, noting cisgender autistic cousins and non-autistic transgender people
• Alex posited that autism and transgender identity may feel linked due to autistic non-conformity, openness to new ideas, and proliferation of community spaces
• Nami suggested the apparent link may reflect that autistic people are less able to mimic cisgender behaviors or hide transgender identity due to difficulty reading social expectations they’re supposed to hide

Healthcare System Barriers

Accessing appropriate healthcare emerged as a central challenge across all participants’ experiences, revealing systemic patterns of discrimination and gatekeeping that extend beyond individual provider prejudice.

Transitional Care Gatekeeping

Despite clinical guidelines recommending streamlined access, participants encountered substantial gatekeeping:

• Grace’s GP reluctantly adhered to provincial standards, frustrated by inability to deviate from recommended dosages
• James (UK-based) experienced repeated GP refusals: one refused referral to a gender clinic entirely; another refused to prescribe authorized testosterone; a third refused to continue prescriptions
• Moose experienced extended gatekeeping in New Orleans where doctors claimed they needed to rule out that gender identity was an “autistic obsession or fixation”

Trans Broken Arm Syndrome

Participants experienced widespread medical discrimination where healthcare professionals blamed unrelated medical issues on transgender status or requested inappropriate genital displays. This pattern—termed “trans broken arm syndrome”—forced many to compartmentalize healthcare (keeping autism, transgender, and mental health care separate) to prevent discrimination and denial of necessary treatment.

Geographical Variation in Access

The contrast between different regions was stark:

• After moving to Chicago and accessing an LGBT-positive, harm reduction clinic, Moose received testosterone after preliminary bloodwork—the same timeline as neurotypical patients
• Isabella avoided Toronto’s Sherbourne Health Centre, known for extremely long waiting lists and historical reputation for traumatizing approaches with approval rates below 10%

Harm Reduction vs. Gatekeeping Models

The book documents how harm reduction approaches—prioritizing patient autonomy and reducing harm rather than enforcing rigid standards—produced dramatically different outcomes. These clinics trust patients’ self-knowledge and provide care based on informed consent rather than extensive evaluation periods.

Applied Behavior Analysis and Its Legacy

ABA emerged repeatedly as a traumatic intervention across participants’ accounts, revealing fundamental problems with how society approaches autistic traits and socialization.

The Hidden Curriculum of ABA

ABA relies on hidden curricula that deny autistic individuals’ intelligence, manipulate participation, and operate without informed consent. Alex describes ABA as fundamentally abusive despite acknowledging some discrete interventions could have been beneficial with full knowledge and consent. Critical issues included:

• Forced eye contact training that proved actively detrimental in interactions with other autistic people
• Suppression of natural stimming and self-regulation behaviors
• Teaching compliance that increased vulnerability to abuse and manipulation
• Denying intelligence and manipulating participation through hidden agendas

Masking and Its Consequences

The broader landscape of autism masking—“feigning normality” to meet social expectations—produced profound consequences:

• Grace hid autism through extensive social performance, attributing professional success to masking but developing significant internalized ableism
• James noted that girls are pushed to develop masking strategies to perform expected feminine behaviors, making adult diagnosis difficult when camouflage has been lifelong
• Participants who accepted autism rather than masking it reported better mental health outcomes and stronger community connection

Counterintuitive Reality

Participants who masked successfully in professional contexts sometimes experienced worse long-term psychological outcomes, including burnout, depression, and disconnection from authentic identity. The irony highlighted: ABA is often the only government-funded autism treatment in many jurisdictions, despite its documented harms and lack of evidence for improving outcomes compared to acceptance-based approaches.

Sexual Vulnerability and Safety

The autistic community faces uniquely elevated risks of sexual assault stemming from multiple interconnected factors: differences in sensory processing and communication needs, lack of comprehensive sexual education designed by autistic people, and taught compliance patterns from ABA and other interventions.

Communication Differences and Risk

Reynard characterized themselves as “embarrassingly prone to getting sexually assaulted” because people misread their lack of non-verbal communication as consent. The processing lag—while analyzing what’s happening and considering responses, other people may escalate behavior—creates cycles of analysis and escalation that increase vulnerability.

Protective Strategies

Participants developed adaptive coping strategies:

• Reynard maintains “whitelist” of preapproved sexual actions
• Prefers “high protocol” spaces like BDSM and gay cruising where rules are explicit and eye contact signals clearly communicate interest (not automatically granted)
• These environments provide clear boundaries and explicit consent processes rather than relying on reading non-verbal cues

Standard Prevention Training Limitations

Standard sexual violence prevention training (teaching bystanders to intervene, emphasizing consent communication) assumes neurotypical communication abilities. For autistic people with non-verbal communication differences, these trainings can inadvertently increase risk by teaching aggressors that autistic people are “confused” or “not really saying no.”

Intersectional Discrimination

Despite no specific interview question about race, five participants spontaneously addressed how racial and ethnic identity compounds autism and transgender experiences, revealing that generic resources fundamentally fail communities of color.

Black Experiences

Black participants described distinct challenges:

• Nathan explained that Black communities prize cleanliness due to historical racism, leading to interpretation of OCD symptoms as positive rather than pathological
• Nathan and Reynard both described how Black communities interpret autistic traits (direct communication, difficulty with social nuance) as defiance or “weirdness” rather than neurodivergence
• Reynard recalled the Charles Kinsey case where an autistic Puerto Rican man’s toy truck was mistaken for a firearm, leading to police shooting his Black behavioral therapist

Asian Experiences

Moose (Asian) couldn’t access LGBT or autism supports in New Orleans due to continuous police “stop and frisk” targeting. Asian participants experienced family disownment for being transgender/autistic, attributing this to East Asian cultural expectations treating children as property/investment and family honor concerns.

Community Whiteness

All participants noted the autism and transgender communities are predominantly white, creating spaces where people of color experience tokenization or invisibility. Reynard, who facilitates a genderqueer discussion group, deliberately addressed whiteness openly and worked to increase representation through structural changes.

Workplace and Economic Challenges

Participants’ income data revealed significant underemployment: yearly incomes (USD) ranged from $0to$67,498, averaging $18,218—consistent with research on low income among transgender respondents and underemployed autistic adults.

Autism and Employment

Work history was heavily impacted by autism:

• Alex hopes to work with autistic people
• Grace credits autism with career success (ability to focus intensely, pattern recognition) but faced past difficulties finding internships due to inability to perform small talk
• Isabella worries finding work will be difficult if employers know she’s autistic
• James, Moose, and Tristan felt workplaces less accommodating of autism than gender identity

Formal Diagnosis Barriers

Formal diagnosis is often required for accommodations (unless diagnosed before age 16), creating real access barriers. Cost of neuropsychological assessment ($1,000+ without insurance) further limits access, meaning those unable to afford assessment cannot access legal accommodations regardless of need.

Family and Chosen Family

Family support varied dramatically based on class, education, cultural background, and proximity to affirming communities.

Supportive Experiences

• Alex’s affluent household advocated at school and eventually supported gender identity, though Alex was consistently excluded from healthcare and educational decision-making
• Grace’s parents initially didn’t understand her transition but educated themselves through materials she provided and PFLAG attendance
• James’s immediate family was nearly unanimously supportive of his transition except one extended family member

Rejection and Disownment

In stark contrast:

• Moose was formally disowned as a teenager due to his autism and gender identity, related to his family’s Japanese samurai lineage and conservative values
• Isabella’s parents remain unsupportive despite extended family becoming more understanding

Chosen Family as Necessity

Most participants developed tightly knit “chosen families”—people they selected and who selected them, sometimes replacing or supplementing biological family. This wasn’t optional enhancement but survival necessity. Participants rejected by biological families would not have survived without deliberately chosen communities.

Community Participation and Leadership

Community involvement was transformative for all participants, yet access required resources many lacked.

Geographic Requirements

Both Moose and Reynard relocated to access stronger autism and transgender communities:

• Moose moved from New Orleans to Chicago for better LGBT legal protections and autism support access
• Reynard moved from Alabama to Chicago specifically for accessible transit infrastructure

Community Contributions

Participants made significant contributions:

• Alex co-founded an autistic support group and serves on the Ontario Autism Program advisory panel
• Reynard revived and diversified a genderqueer discussion group by implementing structural changes addressing ableism and racism
• Nathan manages an academic transgender health lab and organizes an annual Gender Infinity conference

Media Representation and Self-Creation

All participants noted insufficient authentic representation, forcing communities to create their own cultural touchstones.

Mainstream Media Gaps

Mainstream media rarely depicts people who are both transgender and autistic; existing representations are often inaccurate, sensationalist, or used for comic relief.

Alternative Media Creation

Participants turned to:

• Fanfiction, fanart, and indie comics
• MMORPGs (Guild Wars 2, World of Warcraft, etc.)
• Books like Dreadnought and Female Masculinity
• Tumblr blogs and Facebook groups

Several used “head canon”—interpreting fictional characters through personal lens to claim them as autistic/transgender based on implicit traits.

Religion and Spiritual Identity

Though not directly asked, religion emerged as meaningful for participants.

Affirming Religious Experiences

• Alex is heavily involved in their local Jewish community and found meaning in traditional Jewish observations on gender: the Talmud historically recognizes multiple gender identities
• Alex’s rabbi provided emotional support, expressing pride in pride parade attendance
• Sherry, who identifies as observant Jewish, found meaning in her experience as transgender, autistic, and Jewish

Religious Rejection

Moose is Catholic and was deeply involved in church leadership until his priest outed him, parishioners sent threatening emails, and he lost his job.

Mental Health and Suicidality

Alex expresses concern about suicidality in autistic communities, noting elevated suicide rates attributed partly to depression and abuse. Grace was suicidal for “a long time” before seeking mental healthcare.

Harmful Mental Healthcare

Mental healthcare itself can become harmful when providers apply neurotypical frameworks dismissively. Grace’s psychiatrist held the “standing theory” that she wanted to be straight despite her explicit statements, preventing her from disclosing gender concerns for years.

Research Ethics and “Nothing About Us Without Us”

The authors explicitly challenge conventional research approaches that exploit marginalized populations. They argue against clinical focus on “special assessment protocols” and extended gatekeeping for transgender autistic people accessing transition care.

Methodology

The research was conducted by autistic researchers interviewing transgender and autistic participants as co-researchers and partners rather than passive subjects. Interviews ranged from one to nearly seven hours, conducted primarily via text-based platforms due to autism-related accessibility needs.

Different Knowledge Production

Research designed with autistic and transgender people’s involvement produces fundamentally different findings than those designed by non-autistic, non-transgender researchers. Autistic participants identified anxiety sources in others’ hostile behavior rather than internal autistic traits.

Key Resources and Support Systems

Healthcare Navigation

• WPATH Standards of Care—Clinical guidelines for transgender healthcare
• Informed consent clinics—Increasingly common in larger cities
• Telemedicine providers—Virtual healthcare options
• Harm reduction clinics—Prioritizing patient autonomy

Community Organizations

• Autistiqueers—Peer support group for autistic and queer people
• Autistics For Autistics—Grassroots autism advocacy organization
• FTM London—Support group for transgender men
• TransBareAll—Transgender support group
• PFLAG—Support for families of LGBTQ+ people

Online Communities

• Archive of Our Own (AO3)—Fanfiction repository
• Tumblr—Social media platform for community connection
• Facebook groups for autism and transgender themes

Cultural Resources

• Steven Universe—TV series with affirming representation
• Dreadnought—Novel with transgender protagonist
• Female Masculinity—Academic text on gender expression

Practical Strategies

Healthcare Self-Advocacy

1. Educate your provider: Bring published guidelines and written summaries
2. Maintain detailed records: Document what you’ve told which providers
3. Compartmentalize strategically: Keep care relationships separate when necessary
4. Find harm-reduction oriented providers: Look for clinics explicitly describing themselves as affirmative
5. Seek second opinions: If a provider refuses care or diagnosis, seek another assessment

Community Building

1. Search for groups specifically named “autistic AND transgender” in your region
2. If none exist, consider starting one (virtual groups are lower-barrier)
3. Trial multiple communities; not all will fit
4. Look for spaces with explicit accessibility statements
5. For those considering relocation: research cities’ legal protections and infrastructure

Social Navigation

1. Social scripting: Develop prepared responses for common situations
2. High-protocol spaces: Seek situations with explicit rules
3. Selective disclosure: Disclose autism to people who need to know
4. Accepting inconsistency: Social energy varies day-to-day
5. Communicating needs explicitly: State preferences rather than expecting others to notice

Critical Warnings

Healthcare Denial Can Be Fatal

The book documents cases where autism diagnosis was used to deny transgender healthcare, with fatal outcomes. Gatekeeping under guise of “protection” can kill.

ABA Increases Vulnerability

Participants who received ABA training in compliance and suppression reported increased vulnerability to sexual assault and emotional abuse.

Self-Diagnosis Is Valid but Formal Diagnosis May Be Necessary

Several participants self-diagnosed and found this affirming. However, formal diagnosis is often required for school/work accommodations, creating barriers despite identity validity.

Relocation Isn’t Always Possible

While participants who relocated had dramatically improved outcomes, relocation requires privilege most lack. Geographic barriers are systemic problems requiring systemic solutions.