People who are autistic and transgender or gender diverse receive poorer health care, according to a study published in the journal Molecular Autism. The authors from the Autism Research Centre at Cambridge University, UK, highlight that these findings have important implications for the healthcare and support of autistic transgender/gender diverse (TGD) individuals.
Previous work already shows that autistic people and people of diverse genders have poorer healthcare experiences and are more likely to be diagnosed with mental health conditions compared to other people. In addition, multiple studies show that TGD people are more likely to be autistic or have autistic traits, and people with autism are more likely to experience gender dysphoria. Despite these results, no studies are looking at the risk of developing mental health problems and the quality of healthcare received among autistic TGD people.
In the most extensive study to date, the researchers conducted a survey to compare the experiences of 174 autistic TGD individuals, 1,094 autistic cisgender individuals, and 1,295 non-autistic cisgender individuals. The answers were kept anonymous.
The questions covered mental and physical symptoms as well as quality of care, including communication, anxiety, access and advocacy, system-level issues, and sensory experiences.
The survey covered fundamental aspects of healthcare, including asking participants if they felt they could seek medical help, if they felt at ease talking to their doctor, and if they understood what the healthcare professional was saying.
Both autistic TGD and autistic cisgender adults reported poorer experiences compared with non-autistic cisgender people. This confirms that autistic people receive poorer quality healthcare compared to non-autistic individuals, regardless of their gender identity. However, autistic TGD people were much more likely to report anxiety, shutdowns, and meltdowns as a result of their healthcare experiences.
Worryingly, it is now established that autistic people and TGD people are at a much higher risk of suicide and suicide-related behaviours than other people. In 2023, the Department of Health and Social Care recognised that autistic people should be seen as a priority group in their Suicide prevention strategy for England: 2023 to 2028. Autistic cisgender people are 4.6 times more likely, and autistic TGD people are 5.8 times more likely to report self-harm.
“These findings add to the growing body of evidence that many autistic people experience unacceptably poor mental health and are at a very high risk of suicide-related behaviours. We need to consider how other aspects of identity, including gender, influence these risks,” said Dr Elizabeth Weir, a postdoctoral scientist at the Autism Research Centre.
The authors warn about the need to consider intersectionality in clinical settings, including health risks for patients with multiple minoritised identities. Clinicians should be aware of these risks and the unique barriers to healthcare that autistic TGD people may experience when seeking medical help.
“We need to consider how to adapt healthcare systems and individual care to meet the needs of autistic transgender/gender diverse people. Policymakers, clinicians, and researchers should work collaboratively with autistic people to improve existing systems and reduce barriers to healthcare,” concluded Professor Sir Simon Baron-Cohen, Director of the Autism Research Centre.
Green, K.*, Weir, E.*, Wright, L.*, Allison, C., & Baron-Cohen, S. Autistic and transgender/gender diverse people’s experiences of health and healthcare. Molecular Autism; 21 Jan 2025; DOI: 10.1186/s13229-024-00634-0