Autism and Gender Dysphoria in Youth: Guidance from an LGBTQIA-Affirming Psychiatrist in NYC
As a parent, hearing your child express discomfort with their assigned gender can bring up a wave of emotions. You might feel confused, concerned, or unsure of what to do next. If your child is also on the autism spectrum, those feelings can become even more complex. You may wonder: Is this part of their autism? Is it a passing phase? Or is it something deeper that needs support?
In recent years, research has begun to clarify the connection between autism and gender dysphoria. Gender dysphoria refers to the distress that can arise when a person's internal sense of gender does not match the sex they were assigned at birth. While autism and gender identity are separate experiences, studies show that autistic individuals are more likely than their neurotypical peers to identify as transgender or gender diverse.
This post will walk you through the latest findings, explain why this overlap occurs, and offer practical advice for how to support your child through it.
Summary Points
Autistic youth are more likely to experience gender diversity compared to the general population.
Autism does not cause gender dysphoria, but it may shape how gender is experienced and expressed.
Providing affirming and thoughtful care can improve your child’s mental health and overall well-being.
Autism and gender dysphoria
A growing body of research has found that children and adolescents with autism spectrum disorder are more likely to question their gender identity or identify as transgender.
For example, a 2014 study by de Vries and colleagues at the VU University Medical Center in the Netherlands found that nearly eight percent of youth referred to a gender identity clinic met criteria for autism. This is significantly higher than the one to two percent prevalence of autism in the general population.
More recently, a 2021 study by Warrier et al. published in Nature Communications examined over 600,000 individuals and found that those who identified as gender diverse had significantly higher levels of autistic traits compared to those who identified with their assigned gender.
Similarly, a study in Pediatrics by Strang and colleagues (2018) showed that about one in four adolescents referred for gender-related care scored above the clinical threshold for autism-related traits.
These findings have been consistent across multiple countries and age groups, confirming a clear pattern of overlap between autism and gender diversity.
Why Does This Connection Exist?
Experts have proposed several theories for why autism and gender dysphoria tend to co-occur.
1. Different Processing of Social Norms
Autistic individuals often relate to the world in ways that are less influenced by social conventions. They may be less concerned about what society expects regarding gender roles and may feel freer to explore their true identity without feeling constrained by traditional labels.
As psychologist Dr. John Strang has explained, many autistic youth are simply more likely to express gender identities that differ from societal expectations because they are not as conditioned to follow social rules or norms.
2. Intense Focus and Identity Exploration
Some autistic individuals develop strong interests or preoccupations, which can include a deep and lasting focus on body image or identity. In these cases, thinking about or expressing gender identity may not be a fleeting idea but a central aspect of how they understand themselves.
This focus does not mean that the identity is less valid. In fact, persistence and consistency over time are two of the key factors that mental health providers use to determine if a person’s experience qualifies as gender dysphoria.
3. Sensory Sensitivities and Body Awareness
Many autistic youth experience heightened sensitivity to sensory input. This means that the physical changes of puberty, such as breast development or voice deepening, may cause discomfort that is both physical and emotional.
For some, this bodily discomfort overlaps with gender dysphoria. For others, it can intensify distress related to gender identity. These overlapping experiences do not invalidate each other and both deserve attention and care.
Frequently Asked Questions, answered by a psychiatrist.
Is this part of autism or is it real gender dysphoria?
This is one of the most common concerns for parents. It is natural to feel cautious, especially if your child has difficulty expressing feelings or if their interests tend to shift over time.
The truth is that many autistic individuals also experience genuine gender dysphoria. Clinicians assess whether a child’s gender identity is consistent over time, present in multiple settings, and associated with distress or a desire to live as another gender. When these signs are present, it is appropriate to take your child seriously and offer support.
My child says they are nonbinary or gender fluid. Is that valid?
Absolutely. Research shows that autistic youth are more likely than others to identify as nonbinary, gender fluid, or otherwise outside the male and female categories.
A 2022 study by George and Stokes published in Autism Research found that many autistic individuals assigned female at birth described their gender as flexible, fluid, or nonconforming. This does not mean the identity is uncertain or confused. Rather, it reflects a broader and more nuanced understanding of gender.
How to Support Your Child
1. Affirm Their Identity
Even if your child is still exploring their identity or uses different terms over time, your support and affirmation can make a profound difference in their mental health. Use their chosen name and pronouns, and let them know you are there for them no matter what.
This does NOT mean rushing into any medical interventions. Affirmation can be as simple as listening, reflecting back what you hear, and creating an emotionally safe environment for your child.
2. Find Professionals Who Understand Both Autism and Gender Identity
Not all providers are trained in working with both autistic and gender diverse youth. Look for a therapist or clinic that has experience with both. A multidisciplinary team that includes mental health providers, pediatricians, and specialists in developmental and gender care can be particularly helpful.
These providers can offer guidance around whether a child is experiencing true gender dysphoria, how to support them emotionally, and what options might be appropriate moving forward.
3. Plan Ahead for Puberty
Puberty can be a difficult time for any child, but for autistic youth, especially those experiencing gender dysphoria, it can feel overwhelming and disorienting. Many autistic children are particularly sensitive to bodily changes, new hygiene routines, and hormonal shifts that affect mood and energy. You can support your child by preparing them in advance for what to expect, using clear and concrete language. Visual aids, social stories, and step-by-step guides can help explain physical changes in a predictable and less intimidating way. Be mindful of sensory sensitivities that may arise around clothing, menstruation, or body odor. You can also explore products that align with your child’s gender identity, such as binders, menstrual cups, or compression garments, always ensuring safety and proper use. Emotional support is just as important. Normalize the confusion and distress they may feel, and offer reassurance that there is no “correct” way to experience puberty. Most importantly, let your child know that you are there to listen, to validate their experiences, and to advocate for their comfort and well-being every step of the way.
5. Address Mental Health Concerns
Autistic youth who are also gender diverse may face higher levels of anxiety, depression, and suicidal thoughts. This is often not because of their gender identity, but because of the stigma, isolation, or lack of support they may face.
Providing affirming care, peer support groups, and access to mental health services can reduce these risks and help your child build a positive sense of self.
Parting Thoughts
The connection between autism and gender diversity is complex and deeply personal. It is not about one diagnosis causing another, but rather about the rich and varied ways that people come to understand themselves and their place in the world.
As a parent, you do not have to have all the answers. What matters most is showing your child that you are willing to listen, to learn, and to love them exactly as they are.
By staying informed and open, you are helping your child thrive, not in spite of who they are, but because of it.
Gender-Affirming Care in NYC and California
At North Star Psychiatry, we provide gender-affirming medication management and therapy for transgender, non-binary, and LGBTQIA+ individuals of all ages. Our care is trauma-informed, evidence-based, and deeply respectful of your lived experience.
📍 Offices in New York City and California (via telehealth)
📞 Ready to take the next step? Contact us today to schedule your consultation.
