The increased incidence of individuals who are both transgender and on the autistic spectrum as compared to the expected number of those identifying as transgender in the  general population is demonstrated by research. Understanding this is a more complex matter, and one that has given rise to hypotheses running from gender nonconformity to some overlapping genetic contribution. Just as there’s no single typical Asperger individual, it seems unlikely that one idea explains everyone.

I had a teenaged patient who was AS. I was surprised when he came out to me as a transgender male a few months after we started meeting. He had never brought up his gender identity to me before, and neither had his mother. He brought it up because he wanted help resolving a conflict with his mother; he now insisted that she now refer to him as “he” and that she should instruct his entire extended family to do the same. He was furious at her resistance, and had no understanding of any reason why she might have difficulty other than a lack of respect for him.

His parents as well as professionals struggled to understand if his insistence on being transgender was a manifestation of his tendency to obsession as well as his discomfort with age-peer girls. However, looking at the history, this boy had initially demonstrated his desire to be seen as male much earlier; he had asked to be in a boy’s health class in middle school. I felt it was critical to refer him to a specialist in transgender work for a comprehensive evaluation and to help the family decide how best to proceed. This young man is now accepted as a trans male, and the family is working with the therapist on future interventions.

There still isn’t a professional consensus about how to best help individuals like this young man because the coincidence of transgender and AS isn’t fully understood.

It’s been suggested that AS individuals’ social challenges lead them to a sense of not belonging with those typically cis male or female. (I should also add at this point that the very idea of being “typically male” or “typically female” is being challenged). Boys with motor skill challenges and a lack of interest in sports, who are less dominating and more rule-oriented may find that they don’t identify with what is typically thought of as masculine. Girls also face coping with the stereotypes of feminine behavior; the kind of logical cognitive processing typical of AS may be seen as unfeminine and “typical” interests might not be shared, although girls have more latitude in “acceptable” interests.  While many young women with AS traits can seem appropriately social (they can mimic social behavior they’ve observed), the complex social demands of “girl groups” can be nearly impossible for them to navigate.

There is research suggesting that some AS children who identify as transgender later change their minds. A defining trait of AS is having obsessions, which can be about many different things. This leads some professionals to think that sometimes a patient’s repetitive thinking around his or her gender identity is an example of an AS obsession, not necessarily an expression of the individual’s fundamental sense of gender identity. These professionals feel they should take a ‘wait and see’ approach to accepting a transgender identity in someone with AS. This can be excruciating for someone seeking acceptance as transgender. Other professionals who work with transgender youth feel that it is important to respect the identity of transgender individuals as soon as they share this information.

The fact is is that at this point, mental health professionals don’t really understand the individuals who might be considered as Asperger’s and identify as transgender. Therefore, it’s vital to respect the individual’s dignity and integrity. The work we do and advice we give give is usually based on our understanding; in this case, we need to be open-minded in our efforts to be helpful.