Autism traits in transgender and gender-diverse adults seeking gender-affirming medical treatment

Abstract

Background: Prior research has indicated a common overlap between autism traits and gender identity diversity, but studies including nonbinary/genderqueer (NBGQ) adults in clinical settings are lacking. This study therefore compared autism traits in transgender and gender-diverse (TGD) adults seeking gender-affirming medical treatment (GAMT) with autism traits in cisgender adults. It further assessed differences in autism traits among TGD subgroups, considering sex assigned at birth (comparing adults assigned male at birth (AMAB) and female at birth (AFAB)) and gender identity (comparing NBGQ adults with binary transgender and cisgender adults). Aim: The primary aim of the study was to investigate autism traits in TGD adults seeking GAMT, contrasting them with cisgender adults from the general population. Additionally, the study aimed to assess potential differences in autism traits within and between TGD subgroups, considering sex assigned at birth and gender identity. Methods: The study sample included 424 TGD adults referred to a gender identity clinic in the Netherlands (Mdn age = 22.59, 54.2% AFAB) and an age-matched sample of 424 cisgender adults from the Netherlands and Flanders. Autism traits were assessed using the Social Responsiveness Scale for Adults (SRS-A). Results: TGD adults reported significantly more autism traits on the SRS-A compared to cisgender adults. TGD adults AFAB displayed significantly more autism traits than both TGD adults AMAB and cisgender men and women. However, TGD AMAB and cisgender men did not differ significantly in autism traits. In the TGD group, 65 (15.3%) identified with a NBGQ identity, and this TGD subgroup reported significantly more autism traits compared to binary identifying TGD and cisgender adults. Conclusion & discussion: The study confirmed a higher prevalence of autism traits in TGD adults, specifically in those AFAB and those identifying as NBGQ, emphasizing the need for personalized clinical approaches in GAMT for autistic individuals.