ESPE Yearbook of Paediatric Endocrinology

Arch Sex Behav. 2018 Nov;47(8):2307–2317.

doi: 10.1007/s10508-018-1218-3. PubMed ID: 29736809

An increased incidence of autism spectrum disorder (ASD) among adolescents and adults with gender dysphoria has been reported in many studies. This paper describes one of the rare studies taking an opposite approach, by investigating the self-reported wish to be of the opposite gender among over 1300 adolescents and adults with ASD in comparison with healthy controls. Both adolescents and adults with ASD endorsed this item significantly more than controls. In adolescents, more natal girls than natal boys reported that they wanted to be of the opposite gender; in adults, no gender differences could be detected. None of the ASD specific subdomains was associated with a more frequent wish for being the opposite gender.

The study included a very large number of individuals with ASD, and is the first to report an increased wish to be of the opposite gender in adults with ASD. Several hypotheses exist regarding this intriguing association, but for none of them there is currently sufficient evidence. The study has important limitations that are well recognized by the authors. For example, it questions the suitability of the questionnaires and the methodology of self-reporting for a clinical sample of ASD individuals, and highlight differences between demographics of the ASD and control groups. Most importantly, they acknowledge that a positive answer to the question “if you want to be of the opposite gender” does not equal a desire for formal gender change. Nevertheless, given the strength of this association, it is crucial that clinicians working with ASD patients are aware of and open to this issue.