Transgender, gender-diverse adults more likely to have autism

Transgender and gender-diverse adults are more likely to be diagnosed with autism than cisgender adults, according to research published in Nature Communications.

“This finding, using large datasets, confirms that the co-occurrence between being autistic and being transgender and gender-diverse is robust,” Varun Warrier, PhD, research associate at the Autism Research Centre in the department of psychiatry at the University of Cambridge, United Kingdom, and colleagues wrote. “We now need to understand the significance of this co-occurrence, and identify and address the factors that contribute to well-being of this group of people.”

Warrier and colleagues reviewed five cross-sectional datasets with information on more than 641,860 participants, including their gender, neurodevelopmental and psychiatric diagnoses and measures of traits related to autism such as empathy, systemizing and sensory sensitivity.

Gender identity is an individual’s sense of their gender, which may or may not correspond with their sex at birth, researchers said. In the study, they considered those whose gender coincided with their sex at birth “cisgender,” and those who were transgender or had other gender identities — including those who identified as nonbinary, genderfluid, agender, genderqueer, bigender or two-spirit — as “transgender or gender diverse.”

Across all five datasets, Warrier and colleagues found that adults who were transgender or gender-diverse were between three and six times more likely than cisgender adults to report that they were diagnosed with autism.

In a dataset of adults who responded to an online survey after watching a television program about autism on U.K.’s Channel 4, transgender and gender-diverse adults had higher rates of autism diagnoses than all cisgender adults after adjusting for age and education (OR = 4.59; 95% CI, 4.20 – 5.03).

Warrier and colleagues also reviewed data from four other independently recruited datasets: Musical Universe (MU), Investigating Mathematics and Autism using Genetics and Epigenetics (IMAGE), Autism Physical Health Survey (APHS), and LifeLines. The researchers found that transgender and gender-diverse participants had higher rates of autism diagnoses than all cisgender individuals (MU: OR = 6.07; 95% CI, 4.56-8.08; IMAGE: OR = 6.36; 95% CI, 3.34-12.13; APHS: OR = 6.28; 95% CI, 4.13-9.53; LifeLines: OR = 3.03; 95% CI, 0.72-12.76).

The researchers also found that compared with cisgender adults, transgender and gender-diverse adults had significantly higher scores on self-reported measures of autistic traits, systemizing and sensory sensitivity and had significantly lower scores on empathy traits.

In addition, transgender and gender diverse adults were more likely to have multiple neurodevelopmental and psychiatric conditions in the two datasets with information available on these conditions.

“Understanding how autism manifests in transgender and gender-diverse people will enrich our knowledge about autism in relation to gender and sex,” Meng-Chuan Lai, MD, PhD, assistant professor in the department of psychiatry at the University of Toronto and a collaborator on the study, said in a press release. “This enables clinicians to better recognize autism and provide personalized support and health care.”