The Dual Spectrum: The Intersection of Autism, Gender Identity, and Sexual Orientation

This post summarizes the current research on the overlap between autism, gender identity, and sexual orientation, and discusses what this means for clinical practice.

Autism and Gender Diversity

Research consistently shows that autistic people are more likely to be gender diverse than the general population. A meta-analysis found that approximately 11% of individuals seeking care for gender dysphoria or gender incongruence also have an autism diagnosis, and that autistic traits were significantly elevated in gender-diverse groups compared to controls (Kallitsounaki & Williams, 2023). A U.S. study of nearly 920,000 adolescents found that gender dysphoria was about three times more common among autistic youth than non-autistic youth (Kahn et al., 2023a). A 2026 population-level study from New Zealand confirmed that autism rates were 2.9 times higher among transgender young people compared to cisgender peers (Fraser et al., 2026).

Autism and Sexual Orientation

The overlap also extends to sexual orientation. The largest study on this topic found that autistic adults are less likely to identify as heterosexual and more likely to identify as asexual or another diverse orientation compared to non-autistic adults. Autistic males were more likely to identify as bisexual, and autistic females were more likely to identify as homosexual, relative to non-autistic peers (Weir et al., 2021).

Possible Explanations

Several explanations have been proposed. One is that autistic people may be less influenced by social norms around gender and sexuality, which may allow for more varied expression of identity (Bouzy et al., 2023). Biological theories, such as prenatal hormone exposure, have also been explored, but the evidence for these is inconclusive. The explanation is likely multifactorial.

Limitations and Counterpoints

Not all researchers agree on the strength of this relationship, and there are legitimate methodological concerns worth noting.

Some researchers have argued that the co-occurrence may be inflated by the use of autism screening tools (such as the Autism Spectrum Quotient) that lack specificity. Elevated scores on these measures could reflect social anxiety from negative past experiences rather than true autism (Turban & van Schalkwyk, 2018). However, a rebuttal by Strang et al. (2018) pointed out that multiple studies using confirmed clinical autism diagnoses, not just screening tools, still found elevated rates of co-occurrence, and that elevations in restricted and repetitive behaviors (not just social difficulties) were inconsistent with a social anxiety explanation.

Additionally, the Kallitsounaki and Williams (2023) meta-analysis noted high heterogeneity across studies, meaning the reported strength of the association varies considerably depending on study design and sample characteristics. Most studies also draw from clinical samples (gender clinics or autism clinics), which may inflate co-occurrence rates due to referral bias (Kahn et al., 2023a). A 2025 Swedish study confirmed the high co-occurrence but found no association between autism and the degree of gender incongruence, suggesting that autism does not intensify or diminish the gender identity experience itself (Özel et al., 2025).

In short, the co-occurrence is well-supported by the larger and more rigorous studies, but the exact magnitude and the mechanisms behind it are still being investigated.

Mental Health

This intersection has mental health implications. A study of U.S. adolescents found that youth with both autism and gender dysphoria had significantly higher rates of anxiety (75%) and depression (33%) compared to youth with either condition alone (Kahn et al., 2023b). A study from the SPARK autism research cohort found that transgender and gender-diverse identity in autistic adolescents was a significant predictor of depression, with an effect size comparable to having a family history of depression (Pereira et al., 2026).

Clinical Implications

Several points are relevant for clinicians:

• Autism is not a contraindication for gender-affirming care. A systematic review of 77 studies reached this conclusion. However, cognitive and communication differences associated with autism may require adjustments in how care is delivered (Bouzy et al., 2023).

• Screening is important in both directions. Clinicians working with autistic people should be aware of the higher rates of gender and sexual diversity, and clinicians in gender clinics should be aware of the higher rates of autism (Kallitsounaki & Williams, 2023).

• Mental health support should be proactive. Given the elevated rates of anxiety and depression, mental health services should be offered as support rather than as a barrier to care (Kahn et al., 2023b; Pereira et al., 2026).

• Clinicians should use language that acknowledges diverse identities, recognizing that autistic people may experience and express identity in ways that do not fit conventional categories (Weir et al., 2021).

• Access disparities exist. Co-occurring autism and gender dysphoria diagnoses are less common among youth of color, which likely reflects barriers to diagnosis and care rather than true differences in prevalence (Kahn et al., 2023a).

Summary

Autism and gender and sexual diversity frequently co-occur. The research supports this, though the exact size of the association and the reasons behind it are still being studied. Clinicians should be aware of this overlap and ensure that their practices can support autistic individuals across the full range of gender identities and sexual orientations.

References

Bouzy, J., Brunelle, J., Cohen, D., & Condat, A. (2023). Transidentities and autism spectrum disorder: A systematic review. Psychiatry Research, 323, 115175.

Fraser, B., Saha, S., Buchanan, M., et al. (2026). Intersections of autism and sexual and gender diversity among young people in New Zealand. Autism.

Kahn, N. F., Sequeira, G. M., Garrison, M. M., et al. (2023a). Co-occurring autism spectrum disorder and gender dysphoria in adolescents. Pediatrics, 152(2), e2023061363.

Kahn, N. F., Sequeira, G. M., Reyes, V., et al. (2023b). Mental health of youth with autism spectrum disorder and gender dysphoria. Pediatrics, 152(6), e2023062224.

Kallitsounaki, A., & Williams, D. M. (2023). Autism spectrum disorder and gender dysphoria/incongruence: A systematic literature review and meta-analysis. Journal of Autism and Developmental Disorders, 53, 3103–3117.

Özel, F., White, R. A., Clark, K. D., et al. (2025). Associations between autism, gender dysphoria and gender incongruence: Insights from the Swedish Gender Dysphoria Study (SKDS). Psychiatry Research, 344, 116283.

Pereira, J., Ramos, N., Snyder, L. G., Veenstra-VanderWeele, J., & Jutla, A. (2026). Transgender and gender-diverse autistic adolescents are at elevated risk of depression. Autism.

Strang, J. F., Janssen, A., Tishelman, A., et al. (2018). Revisiting the link: Evidence of the rates of autism in studies of gender diverse individuals. Journal of the American Academy of Child and Adolescent Psychiatry, 57(11), 885–887.

Turban, J. L., & van Schalkwyk, G. I. (2018). "Gender dysphoria" and autism spectrum disorder: Is the link real? Journal of the American Academy of Child and Adolescent Psychiatry, 57(1), 8–9.

Weir, E., Allison, C., & Baron-Cohen, S. (2021). The sexual health, orientation, and activity of autistic adolescents and adults. Autism Research, 14(11), 2342–2354.