Autistic symptoms in adults with gender dysphoria: Are we observing reality?

There is an increasing clinical and research interest in co-occurring gender dysphoria (GD) and autism spectrum disorder (ASD). Only a few studies have investigated the co-occurrence of GD and symptoms of ASD in adults, and a... [ view full abstract ]

There is an increasing clinical and research interest in co-occurring gender dysphoria (GD) and autism spectrum disorder (ASD). Only a few studies have investigated the co-occurrence of GD and symptoms of ASD in adults, and a study in a large non-internet sample of adults with GD is lacking.

This study aimed to investigate symptoms of ASD in a sample of adults referred for GD compared to a norm population, to provide a comparison between males assigned at birth (MAB) and females assigned at birth (FAB) with GD... [ view full abstract ]

This study aimed to investigate symptoms of ASD in a sample of adults referred for GD compared to a norm population, to provide a comparison between males assigned at birth (MAB) and females assigned at birth (FAB) with GD regarding symptoms of ASD, and to investigate if there was a correlation between the level of symptoms of ASD and the level of symptoms of GD.

Score patterns for symptoms of ASD of 326 adults referred for GD (191 MAB and 135 FAB) were compared to a norm population (454 males and 386 females). [ view full abstract ]

Score patterns for symptoms of ASD of 326 adults referred for GD (191 MAB and 135 FAB) were compared to a norm population (454 males and 386 females).

The Autism-Spectrum Quotient (AQ) was used to measure symptoms of ASD. The Utrecht Gender Dysphoria Scale (UGDS) was used to measure the severity of GD in the population referred for GD. [ view full abstract ]

The Autism-Spectrum Quotient (AQ) was used to measure symptoms of ASD. The Utrecht Gender Dysphoria Scale (UGDS) was used to measure the severity of GD in the population referred for GD.

The prevalence of symptoms of ASD consistent with a cut-off score for a clinical diagnosis was 2.11%, significantly different from the AQ mean score in the norm population (p [ view full abstract ]

The prevalence of symptoms of ASD consistent with a cut-off score for a clinical diagnosis was 2.11%, significantly different from the AQ mean score in the norm population (p <. 005). FAB showed increased symptom levels of ASD compared to MAB (p <.005). No significant correlation was found between the AQ total mean score and the total UGDS score (p = .091). Using the cut-off of the UGDS for a diagnosis of GD, a positive correlation between AQ total mean score and total UGDS score was found (p = .042).

Although we found increased symptoms of ASD compared to the norm population, these symptom levels were lower compared to the previous studies in adults with GD. One of the possible reasons for the lower AQ scores reported... [ view full abstract ]

Although we found increased symptoms of ASD compared to the norm population, these symptom levels were lower compared to the previous studies in adults with GD. One of the possible reasons for the lower AQ scores reported might be that individuals have been worried that it could influence their eligibility for gender reassignment. The differences in total score for FAB and MAB on the AQ could be in line with the extreme male brain (EMB) theory but evidence for this hypothesis varies in the literature. From the perspective of the gender identity clinic, we sometimes see that individuals with both GD and ASD have a more extreme presentation of GD, which might be caused by rigid thinking. This could be a possible explanation for the positive correlation found between the increased symptom level of ASD and the severity of GD symptoms. All our conclusions along with other explanations will be discussed. Do our findings reflect reality or are we observing a non-existent phenomenon?