Trans and Autistic

of related interest

Gender Identity, Sexuality and Autism

Voices from Across the Spectrum
Eva Mendes and Meredith R. Maroney
ISBN 978 1 78592 754 6
eISBN 978 1 78450 585 1

Uncomfortable Labels
My Life as a Gay Autistic Trans Woman
Laura Kate Dale
ISBN 978 1 78592 587 0
eISBN 978 1 78592 588 7

Transitioning Together
One Couple’s Journey of Gender and Identity Discovery
Wenn B. Lawson and Beatrice M. Lawson
ISBN 978 1 78592 103 2
eISBN 978 1 78450 365 9

The Autism Spectrum Guide to

Sexuality and Relationships
Understand Yourself and Make Choices that are Right for You
Dr Emma Goodall
Forewords by Dr Wenn Lawson and Jeanette Purkis
ISBN 978 1 84905 705 9
eISBN 978 1 78450 226 3
TRANS AND
AUTISTIC
Stories from Life at the Intersection

NOAH ADAMS
and
BRIDGET LIANG
First published in 2020
by Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Noah Adams and Bridget Liang 2020
All rights reserved. No part of this publication may be reproduced in any
material form (including photocopying, storing in any medium by electronic
means or transmitting) without the written permission of the copyright owner
except in accordance with the provisions of the law or under terms of a licence
issued in the UK by the Copyright Licensing Agency Ltd. www.cla.co.uk or in
overseas territories by the relevant reproduction rights organisation, for details
see www.ifrro.org. Applications for the copyright owner’s written permission
to reproduce any part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work
may result in both a civil claim for damages and criminal prosecution.
Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 78592 484 2
eISBN 978 1 78450 875 3
Printed and bound in Great Britain
BRIDGET’S THANKS
Thanks to my chosen fam and community. I wouldn’t be alive
today if I didn’t have people who supported me. I wouldn’t
have found the autistic trans community without them either.
This book is the product of our desires for a world where we
can exist as autistic and trans folks. I thank the folks from
my communities who volunteered to be interviewed. Our
movement will grow and, I hope, we’ll all be treated as fully
fledged human beings someday soon.

NOAH’S THANKS
This book would never have been possible without the help
and support of my family, friends, and community. First of all,
thank you to my wonderful fiancée Katherine, who provided
a steady hand and excellent copyediting throughout. Thank
you to Reubs Walsh, who helped with designing this book and
conducting interviews. Thank you to Paul McFadden, without
whom I might still be fretting about how to start. To Dani
Castro, for influencing the way participants were recruited.
And especially to all those who shared their stories with us:
Alex, Grace, Isabella, James, Moose, Nami, Nathan, Reynard,
Sherry, and Tristan.
Contents

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . 13
ALEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
GRACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
ISABELLA . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
JAMES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
MOOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
NAMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
NATHAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
REYNARD . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
SHERRY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
TRISTAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . 141
FURTHER READING AND RESOURCES . . . . . . . . 161
Appendix 1: Informed Consent Form . . . . . . . . . . . 175
Appendix 2: Interview Questions . . . . . . . . . . . . . 181
Appendix 3: Demographic Questions . . . . . . . . . . . 183
References . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . 201
Author Index . . . . . . . . . . . . . . . . . . . . . . . . 205
Glossary

Some of the terms in the following pages will be familiar to you.

Some will not. We’ve included this glossary to provide common
definitions for terms in use by and important to the communities
we talk about. They are up to date at the time of publication.
The language used by the transgender community is rapidly
evolving and some terms may have alternate or even completely
different meanings within a short period of time.1 As a result, it
is likely, and perhaps inevitable, that they may seem woefully
out of date by the time you read this. Other terms currently
mean different things to different people and in different
cultural and geographical contexts. For instance, in Brazil
and many parts of South America, travesti (translated from
Portuguese as transvestite) is a reclaimed and preferred term
for many people who were assigned male at birth and express
a feminine gender identity.2 In most parts of North America
and Europe, however, it would be offensive. As a result, you
should take this glossary as advisory and always ask what the
individuals and communities you interact with prefer to be
called, and follow their lead when they tell you.

ABA: Applied behavioural therapy. The most commonly

researched “treatment” for autism. Its goal is to modify autistic
behaviours to be indistinguishable from neurotypicals’. It
is highly controversial and widely decried by the autism
community.

9
10 TRANS AND AUTISTIC

Allistic: Non-autistic.

Asexual: Not having sexual feelings for others. Individuals who

are asexual may still have romantic feelings.

Chosen family: Often used to draw a line between a person’s

biological family, from which they may have experienced
rejection, and the people that they have chosen, and who have
chosen them, to be in a family with.

Cisgender: Not transgender. A person whose gender assigned

at birth and their current understanding of their gender identity
match.

Greysexual: Closely related to asexual. Differs to the extent

that the person may occasionally, or in specific circumstances,
experience sexual attraction.

Head canon: The personal reinterpretation, by a fan, of a

specific media property (e.g. Steven Universe). This may include,
for example, reinterpreting the backstory to render a character
transgender or autistic. It contrasts with canon, which is the
explicitly portrayed version of the property by its creators.

Identify-first vs. person-first language: We use both identity-

first (e.g. autistic person) and person-first (e.g. person
with autism) language in this book according to individual
participants’ preference. There is, however, a great deal of
argument within the autistic community as to which is
preferable, reflecting a wider debate in the disability community.3
Though no consensus exists, and the ultimate choice is each
individual’s, there is general preference within the autistic
community towards identity-first language, because it is seen
as accepting and even celebrating “autism as an inherent part
 Glossary 11

of an individual’s identity.”4 By contrast, person-first language

is typically used by parents and professionals to humanize the
person and, perhaps subconsciously, divorce them from what
may be seen as negative aspects of being autistic.

Neurotypical: Closely related to allistic but differs to the extent

that it encompasses people who do not have attention deficit
hyperactivity disorder (ADHD), dyslexia, or other neurological
conditions.

Pansexual: People who have no sexual preference with regards

to sex assigned at birth or gender identity.

Trans broken arm syndrome: The tendency of healthcare

professionals to blame unrelated medical ailments on one’s
transgender status. 5,6 For instance, a person attends an
emergency room department for a broken limb and, on finding
out their trans status, is asked by medical professionals whether
the two are connected. More onerously, those who have
undergone gender-confirming surgeries have also been asked
to display their genitals to curious doctors and their students.7,8

Transgender: A person who experiences a different gender

identity than the one they were assigned at birth. We have
intentionally used the term transgender, rather than trans or
trans*, throughout this text.

Transmisogyny: In its simplest form, hatred of transgender

women, either explicitly, or subtly. The latter may take the form
of portraying transgender women as weak and encouraging
violence against them.

Transsexual: Closely related to transgender, which is the

umbrella term, but denotes an intention to pursue surgical
12 TRANS AND AUTISTIC

interventions to align one’s gender identity with one’s body and

may imply binary (e.g. male/female) gender.

ENDNOTES
1 Bouman et al., 2017
2 Campuzano, 2006
3 Fletcher-Watson, 2016
4 Brown, 2011
5 Knutson et al., 2016
6 Payton, 2015
7 Chisolm-Straker et al., 2017
8 Brown, 2011
INTRODUCTION

NIHIL DE NOBIS, SINE NOBIS1

We wrote this book because we’ve noticed that while there
is an increasing amount of research on the subject of gender
identity and autism, there is distressingly little from the
perspective of transgender and autistic people themselves. We
argue, as transgender and autistic academics, for an approach
that takes into account our viewpoints in the creation of this
research2 and we assert that, as the title of this section suggests,
nothing should be created about us, without us.3
We wrote this book for other transgender and autistic people,
and the researchers and clinicians with whom we interact. We
hope that other autistic and/or transgender people will see
themselves and their experiences mirrored here. We also hope
that non-autistic researchers and clinical practitioners will
read these stories, learn about this population’s diversity and
capability, and consider this when they interact with and study
us. After all, “If you’ve met one person with autism, you’ve met
one person with autism.”4 Contrary to this, much of the clinical
and research training on this subject focuses on their supposed
homogeneity and, where transitional healthcare is desired, the
need for extended assessment and gatekeeping procedures.
In fact, there is a long history of research that exploits
us as marginalized populations, with the goal of producing
knowledge that benefits the researcher, while far too often
being at best irrelevant or at worst actively harmful to members

13
14 TRANS AND AUTISTIC

of the populations themselves.5,6 Conventional research on this

subject focuses on the supposed need for special assessment
protocols and longer waiting periods to access transitional
care for autistics, at odds with the stated goals of many of our
participants.7 Our participants, far from seeing or receiving this
as helpful, respond by choosing not to disclose their autism,
avoiding healthcare, and circumventing this gatekeeping in a
myriad of ways. Indeed, individuals have been outright denied
hormones due to autism, sometimes with tragic results. One
such example is Kayden Clarke, who was killed by police during
a mental health crisis after his doctor told him she wouldn’t
“prescribe testosterone until his Asperger’s was cured.”8
By contrast, many autistics, and most of our participants,
view both their autism and transgender identity as an intrinsic
and naturally occurring part of themselves that, even if it
were possible, they would not change. Within this context,
it is abusive to subject us to longer waiting periods to access
transitional care; rather than reducing harm, such policies only
encourage us to hide parts of ourselves and/or find alternative
means to access what we need.
Our book challenges this conventional perspective and
explores issues that matter to individual transgender and autistic
people. We shine a light, in particular, on their experiences with
self-discovery, healthcare, and family and community support.
Unfortunately, and largely due to stigma and discrimination,
these experiences are often negative or at least fraught. The
majority, for instance, experienced (or self-censored for fear of
experiencing) denial of transitional healthcare due to autism.
On the flip side, many experienced various barriers around
obtaining autistic services, most notably a diagnosis, often
because they were told they “didn’t seem autistic.”
Conversely, no one individual had a simple or straightforward
experience of discovering themselves to be, and articulating
themselves as, transgender and/or autistic. While many of their
 Introduction 15

difficulties in this regard mirrored conventional transitional

narratives, several related directly to their autism. For instance,
while all felt that both autistic and transgender aspects of their
identity were inherent and immutable, several discussed how
autism made it more difficult to determine what neurotypical
people meant by gender identity, and how to articulate their
own in a way that was legible to them.
Several participants had conditional, limited, or no family
support. For some, this meant a strong relationship with
one parent and none with the other, or strong relationships
with siblings and not parents. Other participants no longer
had a relationship with any family, and several, though not a
majority, relayed stories of physically and emotionally abusive
childhoods. For most, family rejection was attributable to their
transgender identity rather than autism. In the present, most
if not all participants had formed tightly knit communities
and “chosen families,” and many were very involved, as both
participants and activists, in the transgender and/or autistic
communities.
We recognize that healthcare providers and researchers are
struggling to achieve a baseline of knowledge on what may
appear to be a new and emerging population of transgender
and autistic individuals. Too often, however, they fail to consult
with autistic and transgender people, or consider that the
people in front of them may differ from case studies. Likewise,
the issues that appeal to these professionals may have little or
no relationship with those that are important to transgender
and autistic people.
Many professionals, for instance, desire to know the number
of transgender people that are autistic, or vice versa, which has
little import to people struggling to access basic healthcare.
In any case, while there are a growing number of reports
discussing the potential overlap between transgender and
autistic experiences, it also isn’t possible to say whether this
16 TRANS AND AUTISTIC

is the result of something inherent to transgender or autistic

people.9,10,11 It may, for instance, be that transgender people
are more likely to be diagnosed with autism because they are
subject to a greater deal of assessment and diagnosis than
others. If this is true, the rate of autism among transgender
individuals will increase alongside academic calls to routinely
screen them for autism.12 Another complicating factor is that
a diagnosis of autism relies on impairment in social situations,
an area in which transgender people may be uniquely weak, or
avoidant of, due to discrimination and prejudice.13
Nevertheless, transgender and autistic people clearly
exist—if not by virtue of the many support and self-advocacy
groups, then demonstrated by the existence of this book and its
authors. We provide an introduction to the issues that matter
to this group, and explore their strength, resourcefulness, and
tenacity in pursuing them against all odds. One Japanese man,
for instance, escaped abuse at home and ultimately pursued
transition by seeking out global educational scholarships while
barely a teen. Others made similar leaps from familiar homes
and cultures to an uncertain but hopeful future. Most formed
strong and lasting relationships within the transgender and,
in some cases, autistic communities—often also becoming
activists and advocates for these causes. Another young man
established a career as a researcher in a transgender health
laboratory, and one woman even ran for political office.
The individuals interviewed in these pages have clearly
achieved a great deal, in some cases in spite of incredible
discrimination, and always as a result of the unique perspective
and worldview afforded to them by their autism and transgender
identity. These conversations and the stories that we produced
together are, however, only a beginning. We hope that they will
increase the attention paid to the diversity and lived experiences
of people who are both transgender and autistic.
 Introduction 17

PARTICIPANT SELECTION
Participants were selected through an intentional process, which
prioritized the recruitment of as diverse a group as possible,
particularly with regards to ethnicity and gender identity. We
achieved this through a multi-stage process. We first posted a
call for participants on a private Facebook group for attendees
of a yearly transgender and autistic workshop facilitated by
the first author. We then screened respondents in order to
ensure diversity. Finally, we asked individuals who had been
interviewed to recommend others whom they both thought
might be interested and would represent a typically under-
represented group. We supplemented this through our own
personal and professional networks. We checked in throughout
this process to ensure that we had interviewed a wide range of
individuals and made necessary course corrections in order to
do so.
In the end, we talked to a diverse group of ten individuals
who identified, broadly, as both transgender and autistic. While
we’ve edited and curated these interviews for each chapter,
we’ve also strained to keep them as authentic to the individual
voices as possible. Accordingly, each person interviewed has
received a copy of the final chapter for approval.

DATA COLLECTION
As noted, we collected data primarily through an open-ended
interview instrument, which we developed for this purpose
(see Appendix 2). This allowed us to engage participants
in a discussion around core issues, while not limiting their
responses, or the direction of the conversation, to these
topics. More importantly, as there is a history of research
exploitation in this population,14 our questions allowed us to
ethically and authentically represent our participants’ stories.
We also developed and applied a short, 11-item questionnaire
18 TRANS AND AUTISTIC

(see Appendix 3), which allowed us to gather basic demographic

data, such as gender identity, pronouns, sexual orientation,
income, and information about their autism diagnosis. We
compared this data in order to present a baseline snapshot of
our participants’ location.
Interviews were conducted by the authors and Reubs
Walsh, a transgender and autistic doctoral candidate who is
resident in Amsterdam. They took place between April 2018
and March 2019 and ranged from one to almost seven hours,
over one to two sessions. All participants were provided an
honorarium of $100 Canadian in respect of their time and
expertise. The open-ended interview focused on everything
from when participants first knew they were autistic, to
their perception of representation of transgender/autistic
experiences in popular media. While not a question, over the
course of the interviews, nine of the ten participants discussed
their experiences with work. This shouldn’t be surprising, as
evidence suggests that autistic people experience a number
of employment barriers.15,16,17 We have, as a result, discussed
the employment experiences of those who addressed it.
Participants were offered the choice to complete the
interview via text messenger, Skype, in person, by phone, or
another method of their devising. Seven opted to be interviewed
via text (Facebook/Skype messenger), two by video (Facebook/
Skype), and only one in person. Recorded interviews were
transcribed and analyzed, together with text-based interviews,
using Dedoose, which is a mixed-methods research platform.
Autistic symptomatology was usually cited as the reason
for selecting an online and, in particular, text interview,
with concerns about becoming non-verbal and/or needing
time to process questions being paramount to this decision.
Interestingly, there is emerging research which suggests that
text-based interviewing is indeed a more accessible interview
methodology for autistic people.18,19 Of course, the location of
 Introduction 19

the interviewee was also a consideration, as the interviewers

were located in Toronto and Amsterdam, while participants
were in the USA (n=5), Canada (n=4), and the UK (n=1).

CONSENT
All participants signed an informed consent form (see
Appendix 1) that explained our study, detailed its risks and
benefits, and requested consent for the following: participation
in the study as a whole; the interview (if in person or by voice)
to be audio recorded; the inclusion of comments and quotes
in this book; and, if they choose, to be de-anonymized in it.
We provided the latter option because the majority (six out of
ten) of participants felt strongly about attaching their name to
their story. We were able to respect this in all cases but one,
where the participant chose to be identifiable, but we opted
to obfuscate their identity due to their irregular immigration
status. The remaining three participants selected their own
pseudonym.

DEMOGRAPHIC FINDINGS
Participants ranged in age from 21 to 36 years old, averaging 29.
Seven were formally diagnosed as autistic, and the remaining
three were self-diagnosed. Six identified their diagnosis as
autism, two Asperger’s, and the other two didn’t feel able
to say, lacking a formal diagnosis. They use a wide range of
pronouns, with gender identities including, broadly, five
primarily transfeminine, four primarily transmasculine, and
three primarily genderqueer, non-binary, or agender. These
three identity categories weren’t otherwise mutually exclusive.
Participants’ assigned sex at birth was male in four cases, female
in five, with one declining to answer. All ten identified as queer
in an umbrella sense, with many selecting additional identities
20 TRANS AND AUTISTIC

of asexual, bisexual, pansexual, gay, heterosexual, greysexual,

lesbian, and homoromantic. While this was undoubtedly
influenced by our recruitment strategies, there is evidence that
autistic people are much more likely to be non-heterosexual.20,21
Three were born in Canada, three in the USA, and one in
each of Germany, Japan, Taiwan, and the UK. Participants
also represented an array of racial and ethnic identities. Five
were white (two of whom were Jewish), three Asian, and
two Black/African American. Three also explicitly identified
as bi/multiracial. In total, ethnic/racial identities included
Afro-Caribbean, Black, British/English, Canadian, Caucasian,
Chinese, German, Han Chinese, Irish, Japanese, Jewish,
Korean, Lithuanian Jew, Native, Slovenian, Taiwanese Hakka,
and Vietnamese. This was more diverse than other samples,
though ours was clearly not randomly selected, as diversity was
a central focus of recruitment.22
Yearly incomes, standardized to USD, ranged from $0 to
$67,498.40, with an average of $18,218.19. Three participants
made less than $5,000; one made $5–10,000; four made
$10–20,000; one made $20–40,000; and one made more than
$50,000. This is consistent with research findings of low income
among transgender respondents.23,24 Research on the subject
of earning and income among autistic adults is muddied by
the field’s focus on parents and lack of services and support
for adults. However, there is emerging evidence that these
individuals are underemployed,25 and that, where appropriate
support is provided, employment increases dramatically.26 This
would suggest that our findings of low income are unsurprising.
Regarding the highest level of education achieved, two
participants achieved some college/trade school; one graduated
college/trade school; five have some university education;
one completed a bachelor’s degree; and two achieved a
university graduate or professional degree. This method of
categorization, typically used in a census, was complicated
 Introduction 21

by one participant who obtained both some college or trade

school and some university education. It also reflects the
fact that the “some university” includes both people who
are currently in school and those who have been forced by
circumstance to cease their studies. Regarding transgender
participants, education is often complicated and disrupted by
discrimination from peers and educators, resulting in stunted
or late educational development.27,28 There is little research on
educational attainment among autistic adults, though that
among children emphasizes the potential for academic success
when given necessary supports.29
These are the bare facts. They don’t give you an idea of who
the people we talked to are, or what they think about the world
and their place in it. In the following pages and chapters, you
will get a chance to know them, in their own words. We hope
that it provides insight into the lived experiences of people who
are both transgender and autistic. It would be trite, and too
easy, to say that we are just like everyone else, as this is both a
true statement and one that is completely inadequate. We are
individuals, like everyone else, which makes all of us wholly
unique, and totally unpredictable.

ENDNOTES
1 Nothing about us without us, in the original Latin. Please see page
135 for more information.
2 Adams et al., 2017
3 Pellicano, 2018
4 Lime Connect, 2018
5 Tagonist, 2009
6 Smith, 1999
7 Strang et al., 2018a
8 Ellis, 2016
9 Strang et al., 2018b
10 Nobili et al., 2018
11 White, 2016
22 TRANS AND AUTISTIC

12 Janssen, Huang, & Duncan, 2016

13 Jacobs et al., 2014
14 Adams et al., 2017
15 Sarrett, 2017
16 Lorenz et al., 2016
17 Standifer, 2011a,b
18 Benford & Standen, 2011
19 Nicolaidis et al., 2019
20 George & Stokes, 2018
21 Strang, 2018
22 The Williams Institute, 2016
23 Bauer & Scheim, 2015
24 Grant et al., 2011
25 Hendricks, 2010
26 Howlin, Alcock, & Burkin, 2005
27 The Williams Institute, 2018
28 James et al., 2016
29 Keen, Webster, & Ridley, 2016
ALEX

Born in Toronto, to white South African immigrants of Lithuanian-

Jewish descent, Alex is a 21-year-old autistic self-advocate who
identifies as queer, genderfluid, and non-binary. They are currently
a student at Seneca College working towards a diploma in social
service work. Diagnosed with Asperger’s syndrome when they were
just under six years old, they only found out several years later.
Alex came out as transgender towards the end of high school and
is now very involved in the queer and autistic communities. They
use a range of pronouns and, for this chapter, will be using they/
them. Alex is their real name.

COMING OUT AS AUTISTIC

Alex was diagnosed with Asperger’s syndrome on the first day
of elementary school, five days before their sixth birthday.
However, they weren’t aware of this fact until almost three years
later, when they were placed in a special education classroom
for children with autism. Alex recalls being frustrated by the
large gap of time between first receiving a diagnosis and being
made aware of it. They had already known from a young age
that they weren’t like their peers and, lacking an explanation
for these differences, tended to blame themselves for their
social difficulties. Alex had particular difficulty understanding
why they interacted with their peers differently from the
perceived norm, struggled to make and maintain friendships,

23
24 TRANS AND AUTISTIC

and were prone to violent meltdowns. In this context, being

told they were autistic was a huge relief that helped them to
better understand themselves and the way in which they are
unique.
On being informed of their diagnosis with Asperger’s
syndrome, and to help foster their newfound sense of identity
as an autistic person, Alex was given the book Asperger’s Huh?1
This book was extremely helpful to them, first in providing
evidence that their experiences were shared by other people,
which they found comforting, then in helping them to finally
relate to their peers by giving them a language to describe
their experiences. For several years, they even referred to their
hyperfixations as “weebies,” which is a term used by a character
in the book to describe their special interest in the weather.
Alex also often lent the book to friends as a quick and easy
way to explain their disability. Unfortunately, this ultimately
resulted in it being lost and, as a result, they had to learn to
define and describe themselves without it.
Autism has become a major part of Alex’s identity by giving
them a sense of belonging with other autistic people and
culture. Ultimately, they have come to see themselves as part
of the larger neurodiversity community, which has influenced
and defined many aspects of their life. This has, in turn,
shaped the manner in which they choose to socialize. Alex
recalls, for instance, that when they were younger they often
introduced themselves to new people by proactively disclosing
their diagnoses. Prior to this expression of pride and radical
self-acceptance, however, they had tended to take out their
internalized ableism on more visibly autistic classmates. Alex
explains that this attitude was at least partially influenced by
applied behavioural analysis (ABA), the principles of which
influenced their treatment as a youth. As an adult, they had
to deliberately unlearn many of the lessons taught by ABA in
order to fully appreciate their authentic autistic self. Alex now
 Alex 25

socializes almost exclusively with other disabled people due, in

part, to being exhausted by ableism.
As a radical autistic and queer advocate, who has been
identified as such in several media interviews, Alex is very
open and outspoken about their identity. As result, they don’t
often find themselves in a position where they need to disclose
their disability and, in fact, don’t necessarily have the option
not to. However, this is a choice Alex has made consciously
and, in some ways, being so open about their disability helps
to avoid being placed in a situation where ableism might cause
an issue. They realized, shortly after being informed of their
diagnosis, that this disclosure helped others to understand
them better. However, Alex has found that some of their
peers act patronizingly and condescendingly after finding out
this information. Still, whenever they are in the company of
someone new and feel the need to disclose, they make a point
of doing so. While Alex believes strongly in the individual’s
right to choose whether to disclose, they also feel that a person’s
initial reactions to disclosure can be a good barometer for
whether they should continue to interact.

COMING OUT AS TRANSGENDER

Alex was assigned male at birth but, in many ways, always knew
they didn’t identify as male. However, they didn’t realize until
later in life that they didn’t necessarily have to. They explained
that masculinity wasn’t something that was aggressively forced
on them so much as that they were passively obligated to accept
it, simply because they didn’t know they could question it. As
a genderfluid person who fluctuates between identifying as
agender, non-binary, and transfeminine, Alex sees the entire
concept of gender as something that is “elusive, aloof, rigid,
and often unappealing, yet somehow still deeply alluring,
enigmatic, dynamic, and even magical.”
26 TRANS AND AUTISTIC

Alex recalled having difficulty relating to their male peers as

early as kindergarten. However, they also weren’t particularly
interested in seeing themselves as “one of the boys” to begin
with. Alex usually felt the greatest sense of belonging among
their female friends. Alex didn’t have a chance to actively
explore their gender identity until around the age of 13,
when they started playing the massively multiplayer online
role-playing games (MMORPGs) Clone Wars Adventures2
and Star Wars: The Old Republic.3 These games gave them the
opportunity to experiment by using female characters and
taking on feminine personas. Alex didn’t initially realize that
their gravitation towards female characters might not be a
typical cisgender experience, having rationalized that “every
boy wants to be a girl sometimes.” However, this turned out to
be a pivotal experience in helping Alex to discover their queer
identities.
Another pivotal moment in helping Alex to understand
their gender identity was when one of their friends, who is
also on the autism spectrum, came out as transgender. This act
helped them to understand that there is language to describe
their experience. This realization led Alex to learn about the
common overlap between queerness and autism through
personal blogs and academic studies. They subsequently came
out as queer, became a member of their school’s gender and
sexuality alliance, and joined several Facebook groups for
people who are queer, and/or autistic, which gave them a sense
of belonging to a huge online community.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

While acknowledging that other people’s experiences are different,
Alex feels strongly that their own autism and transgender identity
are interlinked. They’ve also noticed that many of their autistic
friends are queer and vice versa and that several of them feel
 Alex 27

that their transgender and autistic experiences are connected.

Alex posits that this may be due to autistic people’s tendency to
be non-conforming, open to new ideas, and the proliferation of
community spaces for transgender/autistic people.
However, Alex also feels that, unlike autism, assigned
binary sex is a very flimsy social construct based on arbitrarily
gendered physical traits that don’t necessarily reflect people’s
genetics; some cis women, for instance, have XY chromosomes.
They are also quite aware of the contradictions in gender role
expectations which, because they make little objective sense,
they fail to see the need to conform to. Alex does, however,
acknowledge that this reaction may be influenced by their
autistic nature to pick apart and question everything. In this
context, gender could be seen as a part of neurotypical culture
that is often inscrutable and inapplicable to many autistic
people. One could also conclude that autistic people, by their
very nature, expose the lies in universal or fixed gender identity.
Alex discusses how being autistic can make coming to terms
with your gender identity more difficult. Their own experience
of autism made it difficult to identify the language to describe
their experience. As a result, Alex accepted the name and
pronouns given to them as inevitable, if imperfect, and didn’t
automatically connect this to a transgender experience until
another friend transitioned and offered an example that they
could apply to themselves.
In Alex’s case, being autistic has also made identifying
the level of transitional healthcare they wish to pursue more
difficult. At present, they are focused on identifying their
gender identity and determining what this means for their
particular transitional pathway, as distinct from that expected
of other transgender people, particularly with regards to
medical transition. This is complicated by Alex’s non-binary
gender identity and the tendency of healthcare practitioners
to, in their words, give minimal information about transitional
28 TRANS AND AUTISTIC

options to this group. Finally, as Alex notes, autistic people—

especially those who aren’t labelled as high functioning—can be
seen to lack the capacity to make decisions regarding transition.
As they suggest, these difficulties may also be related to autistic
people’s tendency to pick apart and question everything and, by
that token, attempt to plan for every eventuality. In Alex’s case,
executive dysfunction can occur when this doesn’t happen.

FAMILY
Alex has several family members who, like them, have a variety
of disabilities, including anxiety, ADHD, depression, and
autism. They describe their family as particularly supportive
of their autism. Growing up in an affluent household and
neighbourhood, Alex had access to resources not necessarily
available to others and has, overall, benefitted from a supportive
community. Their parents, for instance, had the capacity to
advocate for them at school. Alex is also able to live at home
where their nanny, whom the family has employed since they
were four years old, prepares their meals and does their laundry.
This has allowed them to excel academically in high school and
gain admittance to college.
However, though their parents advocated for their
involvement, Alex has consistently been excluded from
healthcare and educational decision making. This has, in many
ways, deprived them of the opportunity to develop life skills that
they are only now learning in the midst of college. Alex’s grades
have suffered as a result, which led to a depressive episode and, in
turn, more difficulties in school. Making doctor’s appointments
and managing medical care have been particularly stressful,
and they struggle not to rely on their parents for help managing
these situations. Alex identifies a recent visit to get tested for
 Alex 29

sexually transmitted infections as one of the first times they’d

independently managed a medical appointment, which they
found frightening but also empowering.
Alex describes their parents as supportive, though they
sometimes struggle to understand that Alex’s abilities and
needs fluctuate and have become more complex with age. For
instance, though usually very verbal, Alex sometimes struggles
with communicating during increased stress, impacting their
ability to use full sentences without stuttering, and occasionally
being unable to talk at all. In these instances, Alex sometimes
relies on their iPhone to communicate through text. They have
also explored using American Sign Language to communicate
while non-verbal, as they find this somewhat easier than using
text. Unfortunately, Alex has found that many people in their
life are unable or unwilling to learn at least its basics. Still, they
are thankful for their father’s wisdom and the many candid
conversations they’ve had together, as well as their mother’s
dedication to her advocacy work with the autism community.
Alex’s family initially struggled to understand what it meant
for them to identify as a transfeminine, non-binary, and gender
non-conforming woman and, for instance, initially expressed
confusion that they didn’t change their wardrobe after coming
out. However, over time they have become much more
understanding and supportive. For instance, Alex shares one
occasion where their father relayed a relative’s message of being
proud of them “for being who they are and not letting other
people dictate how they live their life.” This message came not
long after a Rosh Hashanah dinner during which Alex chose
to wear a feminine outfit for the first time in front of their
extended family. Alex’s parents were particularly supportive of
this, even warning an unsupportive family member not to say
anything and agreeing to ask him to leave if he did.
30 TRANS AND AUTISTIC

COMMUNITY AND ACTIVISM

Alex is very involved in the queer and disabled communities
and chooses to socialize almost exclusively within them. As an
adolescent, Alex spent their summers at an overnight camp
for neurodivergent children.4 Alex credits this experience,
alongside other autistic community spaces, with helping them
to accept themselves as queer, disabled, and neurodivergent,
and serving as one source of inspiration to persue social service
work. More recently, while in their first year of college, they
took part in the inaugural meeting of Autistiqueers,5 which
provides peer support to queer autistic people in Toronto. Alex
later co-founded and served on the executive committee of
Autistics For Autistics,6 a grassroots organization that advocates
for governmental reform in the creation of autism policy and
services. They stepped down from this position after they were
invited to join the Centre for Addiction and Mental Health’s7
youth advisory group as its first autistic member. Soon after,
they were appointed to serve on the Ontario Autism Program8
advisory panel, another historic first for autistic Ontarians.
As noted, Alex’s involvement in the autism community
and in embracing autistic culture has meant they have had
to unlearn the tendency to mask their autistic traits, taught
to them through ABA, which was developed to make autistic
children appear “normal” through repetitive behavioural
trials. It is the most widely practiced therapy for autism and
just as widely derided as abusive by the autistic community
for both the manner in which it is conducted and its focus
on suppressing inherent traits.9 Alex found the manipulative
aspect of this therapy abusive, while they acknowledge that
those interventions, offered with their full knowledge and
consent, could have been helpful. In any case, many of the
strategies learned in these sessions, such as sustained eye
contact, have been unhelpful and even detrimental to Alex’s
interactions with other autistic people. In this sense, Alex
 Alex 31

suggests that there are a number of parallels between autistic

and Deaf culture, though they are careful to point out that the
experiences aren’t identical.10 Nevertheless, they have found
themselves to be happier and much more comfortable within
the autistic community.
Though they didn’t know him personally, Alex also attended
the same high school and was in the same special education
class as Alek Minassian, who perpetrated the Toronto van
attack. 11 Alex condemns his actions, but also found the
characterization of him as incapable of driving or uniquely
prone to violence due to autism infuriating. Thanks to their
position as an autistic advocate and connections to other figures
in the community, Alex was contacted by the Toronto Star to
offer insight into this case.12 In discussing this, they posited
that Minassian, and other socially isolated young autistic men
like him, might be particularly vulnerable to the radicalizing
ideology that proliferates on online forums like Reddit and
4chan. The lack of comprehensive social and sexual education
for disabled people might also create an environment in which
people with incel13 ideology can prey on these young men. Alex
fears for the stigma that could be cast on other autistic people
by Minassian’s actions.

RELIGION
Alex derives a lot of support from their cultural, religious, and
ethnic heritage as a Lithuanian Jew, a community they describe
as tightknit. They ascribe their propensity to think critically and
question everything, in part, to the fact that this trait is taught
and prized in the Jewish community. Alex takes inspiration
from the knowledge that the Talmud has historically been
inclusive of a multitude of gender identities. These include
Zachar (male), Nekeivah (female), Androgynos (both male
and female characteristics), Tumtum (indeterminate), Ay’lonit
32 TRANS AND AUTISTIC

(female at birth, develops male characteristics at puberty,

and/or is infertile), and Saris (male at birth, develops female
characteristics at puberty, and/or is castrated).14,15 Alex also
related the story of 14th-century Provençal rabbi, Kalonymus
ben Kalonymus, who wrote a book of poetry, known as the
Even Bochan,16 in which he expressed wishing to have been
a woman.17 They find it amusing that their religious name,
Kalman, is a Yiddish diminutive of Kalonymus.
Alex describes some especially moving instances in which
their rabbi provided emotional and spiritual support. In
particular, they recall receiving a warm hug from their rabbi
in response to coming out to them. On another occasion, Alex
received a voicemail expressing the rabbi’s pride in them for
attending their first pride parade and thankfulness that people
no longer have to hide their sexual and gender identities. Still,
they don’t always find the Jewish world so accepting, and
characterized some of the leadership of their local synagogue
as racist and queerphobic. Though Alex attended a Hasidic
congregation for most of their lives, they haven’t felt safe
enough to continue doing so since 2018. The last time they
entered their childhood synagogue was when they took part in
a mikveh18 ceremony created for transgender Jews on the day
they started hormone replacement therapy.

WORK
Alex is working towards their diploma in social service work
as a student at Seneca College. They hope to obtain a bachelor’s
degree in this field and ultimately practice as a social worker,
where they plan to act as a role model for other autistic people,
especially youth. Alex credits their rabbi, who is neurodivergent,
as having been a major source of inspiration in their decision
to go into the helping profession. They currently volunteer at
the York Federation of Students Access Centre and volunteered
 Alex 33

previously as a camp counsellor at Camp Kennebec. Alex also

worked as a camp counsellor for Autism Ontario.

HEALTHCARE
Alex has had a mixed experience with healthcare. On the one
hand, they credit early autism diagnosis and placement in
supportive learning environments as very helpful. They have
a good relationship with their cognitive behavioural therapy
practitioner, whose support was crucial to accessing academic
accommodations, especially for test-taking. They also had
a very good relationship with their pediatrician, who they
stayed with as long as possible before switching over to an adult
physician. Alex has found this transition to be more difficult
than they expected it would be.
On the other hand, Alex has had a number of problematic
healthcare experiences, particularly around neuropsychiatric
diagnoses. Several years after receiving a diagnosis of autism
they were misdiagnosed with oppositional defiant disorder
(ODD) around the same time they received diagnoses of
ADHD, generalized anxiety disorder, and a learning disability.
Fortunately, Alex’s parents were firm that the ODD label was
incorrect and it was never affirmed in another assessment. In
relation to the psycho-educational evaluation they took before
entering college, Alex opines that these assessments assume
that people know to answer questions “as if it’s their worst day,”
which may not be obvious to those with autism or who are
unfamiliar with the process.
Alex currently takes medication for ADHD, anxiety, and
depression. They were also referred to an endocrinologist when
they were 13 or 14 years old, who prescribed Lupron to correct
slow development of height. Alex described the experience of
seeing the endocrinologist as deeply uncomfortable, not just
because they were unfamiliar with them, but also because the
34 TRANS AND AUTISTIC

visits involved genital examinations. They also found visits to the

dentist difficult due to anxiety and autism-related sensory issues.
As mentioned, Alex is very critical of ABA, which they
characterize as relying on a “hidden curriculum” that denied
their intelligence and capability, manipulated them into
participating, and lacked informed consent. As they noted,
these interventions have also been linked to post-traumatic
stress disorder19 and, indeed, they struggle with internalized
ableism and stereotypes about the limited potential of autistic
people. In contrast, Alex looks back fondly on play therapy,
which was characterized by open communication, trust, and
emphasis on their needs and wants. Unfortunately, ABA is often
the only autism treatment that receives government funding in
many jurisdictions.
Alex also worries about suicidality in the autistic community.
Certainly, there is evidence that suicide, attributed partially to
depression and abuse, is increased in this population.20,21 This
would suggest that transgender people, who are already at high
risk of suicidality, are particularly impacted.22 Alex has known
a number of autistic people, including themselves, who have
experienced suicidality.
When Alex was in grade three, they frequently experienced
physical restraint in a traumatizing manner. This led to their
expulsion and subsequently to becoming suicidal. Alex relates
this trauma, and their experiences of emotional abuse in past
relationships, to undermining their bodily autonomy. By
contrast, they feel that this might have been avoided had they
received comprehensive, autism-centric education on sexual
health and consent from an early age.23
Alex’s experience with transgender healthcare has been
decidedly fraught, as they struggle to separate what healthcare
interventions they want from what is expected of them by other
transgender people, their parents, and healthcare practitioners
(who may not be familiar with non-binary options). They worry
 Alex 35

that they may end up medically transitioning for the sake of other
people’s perceptions of what a woman should look like. Alex is
not, however, overly concerned that healthcare practitioners
may deny them treatment because they are autistic, though
they worry that some of the trappings of autism, like executive
dysfunction, may interfere with their ability to navigate these
systems, or that their autism might be blamed for unrelated
things (e.g. autistic broken arm syndrome). More generally,
they express concern that their other mental health issues, like
ADHD, depression, and dissociation, might cause practitioners
to hesitate. Despite these concerns, they are currently receiving
hormone replacement therapy.

MEDIA REPRESENTATION
Alex has seen some popular media representation of autistic
people (e.g. Atypical,24 The Big Bang Theory,25 The Good
Doctor26), but other than a biopic about Temple Grandin,27
hasn’t found it to be particularly accurate or helpful. They can’t
think of any popular media representation of people who are
both transgender and autistic, and the only positive transgender
representation they mentioned was Steven Universe,28 which
features transgender and neurodivergent representation, and
has a non-binary, Jewish creator. Interestingly, Alex didn’t
characterize the absence of media as entirely negative, due to
the tendency of cisgender, heterosexual, and allistic29 people to
take any representation as universal (e.g. Rain Man30). In fact,
they have often been compared to Sheldon from The Big Bang
Theory, which they find offensive, given the character’s selfish
personality traits.
36 TRANS AND AUTISTIC

SOCIAL RULES
Alex has difficulty with social rules, particularly as they relate to
social expectations of males, females, and those who are non-
binary. They recognize that, where they live, the expectation is
that non-binary people stereotypically present in a particular
way (e.g. flat chest, multicoloured hair shaved on one side,
or an undercut). However, this is not what Alex necessarily
feels like or is comfortable presenting; on the whole, they have
never really cared about how others perceive them, despite the
existence of gender role pressure. In relation to dating and in
contrast with their experiences as a younger person, Alex finds
that people mostly respond positively to the news that they are
autistic and/or transgender. This may, however, be influenced
by their tendency to interact largely with other transgender
and/or autistic people.

FINAL THOUGHTS
Alex’s experience of being autistic and transgender has been
largely positive, though their experience with the larger
neurotypical world is more mixed. On the one hand, they take
a lot of enjoyment out of their natural state as gender non-
binary and autistic. However, the reaction of the world around
them to these aspects of their being, and efforts to change and
shape them to be more socially acceptable, has caused them
a great deal of anguish. To a lesser extent, autism-related
symptomatology, like executive dysfunction and anxiety,
have also been problematic, particularly with regard to the
expectations of the neurotypical world. Alex’s response has been
to move away from conventional understandings of autism as
a disorder and towards acceptance of it, and themselves, as
neurodiverse, transgender, and part of a community. They have
found acceptance in the disabled and queer communities and,
 Alex 37

when needed, strength and solidarity against discrimination

and pressure from the wider world.
Alex has found support from unexpected avenues as well.
Though they no longer attend the conservative synagogue in
which they were raised, their rabbi has been very supportive
of their gender identity. Alex also takes inspiration from
traditionally Jewish understandings of gender. Though not
always the case with others interviewed, their parents have
also been very supportive of both their autism and non-binary
identity.
Alex’s more positive experience, in comparison to others,
may be because, at 21, they are the youngest participant by
three years and societal expectations of gendered behaviour
and the possibilities for those with autism are relatively
more advanced. They also come from a relatively privileged
background and, while they don’t make a great deal of personal
income, family wealth and social location grants them access to
autism supports and services not available to all. Additionally,
as is often required to obtain autism services and funding, Alex
has an official diagnosis of autism. Still, Alex recalls a great
deal of frustration with not being informed of their diagnosis
until they were older, which is not uncommon among those
interviewed.
Also not uncommon, Alex first began to explore their gender
identity through MMORPGs. In fact, transgender gaming is
garnering increased attention, with explorations on the topic
including the appropriation of canonically cisgender game
characters by transgender communities (e.g. head canon)31 and
the use of MMORPGs to explore gender and build communities
that bridge the online and offline worlds.32 More unique, among
those interviewed, is Alex’s exploration of sign language as a
tool for when they are having trouble communicating. This is
not, however, unusual and there have been publications that
investigated this topic.33,34 Perhaps we didn’t hear more about
38 TRANS AND AUTISTIC

this because we failed to explicitly ask. Unfortunately, Alex was

not able to convince those around them to learn sign language
as well, though they have continued to learn it as a second
language.

ENDNOTES
1 Schnurr, 1999
2 Daybreak Game Company, 2010
3 BioWare Austin, 2011
4 Camp Kennebec, n.d.
5 Xtra, 2017
6 Autistics For Autistics, n.d.
7 The Centre for Addiction and Mental Health is a Toronto mental
health service and hospital
8 Ontario Ministry of Children, Community and Social Services, n.d.
9 Devita-Raeburn & Spectrum, 2016
10 Ringo, 2013
11 Dempsey, 2018
12 Monsebraaten, 2018
13 The word incel is a portmanteau of involuntarily celibate and an
online community of predominantly white cis men who tend to
externalize their self-identified inability “to get a romantic or sexual
partner…[to] the cruelness of women” (Mezzofiore, 2018).
14 Fonrobert, n.d.
15 Kukla, 2006
16 Qalonymous ben Qalonymous ben Me’ir & Habermann, 1956
17 Cuil Press, n.d.
18 A traditional Jewish bathing ritual.
19 Kupferstein, 2018
20 Cassidy & Rodgers, 2017
21 Richa et al., 2014
22 Adams, Hitomi, & Moody, 2017
23 Weiss & Fardella, 2018
24 Gordon, 2017
25 Cendrowski, 2007
26 Shore & DePaul, 2017
27 Ferguson & Saines, & Jackson, 2010
28 Sugar, 2013
29 Another word for non-autistic, or neurotypical.
30 Johnson & Levinson, 1988
 Alex 39

31 Dym, Brubaker, & Fiesler, 2018

32 Baume, 2016
33 Autism Canada, 2017
34 Bonvillian, Nelson, & Rhyne, 1981
GRACE

Grace is a 35-year-old Caucasian transgender woman, born in

Canada and currently living in Toronto, who identifies as queer
and bisexual/pansexual. A federal public servant, she is self-
diagnosed as autistic. Grace came out as a transgender woman
about two years ago and, due to her employment, has opted to use
a pseudonym. She uses she/her pronouns.

COMING OUT AS AUTISTIC

While never formally diagnosed with autism, Grace had
suspected there was something different about her since she
was about nine or ten years old, though she couldn’t grasp what
it might be. Her parents also noticed that there was something
odd about her interpersonal interactions around this time
and subsequently made an appointment with the school
psychologist, which she resented and resisted as a way of being
stigmatized, particularly in light of her existing diagnosis of
obsessive-compulsive disorder (OCD). In high school, Grace
started to hear and read more about autism and Asperger’s and
immediately recognized herself in the descriptions she saw. She
didn’t pursue a diagnosis though, as she was relatively content
having a small but close group of friends, while “mystifying
most of the other kids.” Grace has, over time, become more
certain that she is “somewhere on the spectrum,” but is able to
hide it by “feigning normality when necessary.”

41
42 TRANS AND AUTISTIC

This has been a double-edged sword; while Grace attributes

her success in school and work to hiding her autism, it has also
resulted in a great deal of internalized ableism. For instance,
when she recognizes similar thought processes and behaviours
in others, she can become vicariously anxious and embarrassed.
Grace often finds herself caught between identifying closely
with the other person and trying to distance herself from
them in order to avoid drawing potentially negative attention
to herself. Overall, she has always tried to “keep [her] head
down and stay in the background” in order to avoid being “put
on the spot in any way, unless exquisitely prepared.” Grace
describes her experience of coming out as autistic as, initially,
a “grudging acknowledgement of…this is one more way
[she’ll] never be normal.” She has, however, become more self-
accepting and confident in recent years, which she connects to
a better understanding of her capabilities and how autism isn’t
inherently good or bad but does impact the way she functions
in the world.

COMING OUT AS TRANSGENDER

Grace didn’t recall there being a single moment when she knew
she wasn’t cisgender. Rather, she recalls a series of “brief flashes,”
beginning when she was four or five, of uncertainty around
her gender in a manner that she retrospectively identifies as
questioning. Certainty, as she states, “came much later.”
Grace credits the television show My Little Pony1 with
helping her to realize that she is transgender. She first became
involved in this fandom via the social media blogging site
Tumblr around 2010, and gradually became more aware of
transgender issues through the blogs of others who were also
beginning to explore their gender identity. This is, in fact, a
common phenomenon.2,3 Grace notes that a common joke in
that community, many years into the fandom’s existence, is that
 Grace 43

bronies4 “end up being super gay and trans, or else outright

Nazis.”
In any case, beginning in 2010, Grace started gradually to
think about her gender identity. By 2014, though she was still
fighting to suppress these feelings, she had moved from being
certain about being cisgender to “not as certain about that as
[she] used to be.” It was around this period that Grace became
friends with more transgender people and, as a result, invested
in educating herself in order to counter the transphobic and
transmisogynist attitudes she picked up from gay cisgender
male culture.
Grace identifies “The Big Epiphany” about being transgender
as taking place during the summer of 2017. She was, at that
time, reading the science fiction novel Dreadnought,5 which is
about a closeted transgender girl who is initially unable to come
out. This character inherits superhero powers which reshape
her body to align with her internal understanding of her gender
as female. Grace recalls that she had three reactions to this in
close succession: “Man, she’s so lucky, I wish that could happen
to me”; “Holy shit, where did that come from?”; and “You know
exactly where that came from.” This moment opened the flood
gates and allowed Grace to think more about her body image
and identity. She speculated for some time about being non-
binary, before coming to the conclusion that she was in fact a
woman.
Grace subsequently came out to those closest to her,
including her long-time best friend, partner, and friends from
Tumblr, all of whom were supportive. Although she waffled a
bit, she decided to pursue medical transition by late December
2017 and told the rest of her friendship group, many of whom
she played World of Warcraft6 with, by spring 2018. She had
hesitated to do so because a couple in this group were right-
wing Christians who had expressed negative sentiments about
gay marriage and even explicitly told her that, as a queer
44 TRANS AND AUTISTIC

person, she shouldn’t have human rights. On that occasion,

the other group members hadn’t openly supported her, and
she was concerned that if she came out, something similar
would happen. Grace resolved this by coming out to everyone
but these two in a smaller group chat in order to explain why
she was uncomfortable in their presence. As it happened, her
friends agreed with her and supported her by excluding them
from the group.
In June 2018, Grace came out to her parents, in part because
she needed them to understand why she was so alarmed by
the prospect of a social conservative being elected the Premier
of her province. She reports that, while they weren’t negative,
they were ignorant. Grace was able to convince them to read
some materials7 she sent and to attend a local PFLAG (Parents
and Friends of Lesbians and Gays) group that they have since
come to enjoy. Overall, she appreciates the effort that they are
making, though they continue occasionally to have difficulty
with pronouns.
In November 2018, after informing her boss and two former
co-workers and receiving a legal name change, Grace came
out officially at work. While her co-workers have been fairly
supportive, her boss has been incredibly, almost surprisingly,
helpful. Before coming out, she joined an employee lesbian,
gay, bisexual, transgender, queer (or sometimes questioning),
and two-spirited (LGBTQ2+) advisory group at the human
resources department of the federal government agency she
works for. As a member of this group, she was able to advocate
that a higher priority be given to policies relating to transgender
employees. When nothing had been done by early 2018, Grace
chaired a committee working group on this issue. She wrote
much of this policy, which was subsequently adopted by the
advisory group and has become a draft for others to draw on.
When she came out to her boss, she was able to reference this
policy which was, at the time, being sent to senior management
 Grace 45

for approval. Grace relays that her boss, “without being

prompted and without having dealt with a trans employee ever
before,” unknowingly followed her policy exactly.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Though she isn’t sure of the cause and effect, Grace observes
that most of the transgender people she knows identify as being
on the autism spectrum. She notes, however, that this may be
the result of choosing to interact with people with whom she is
naturally more comfortable. Grace also wonders whether autism
affected her ability to explore her gender identity; for instance,
did her difficulties with relating to other people interfere with
thinking about her gender identity? Or, alternatively, does
she have difficulty understanding or empathizing with others
because she didn’t fully understand herself until recently?

FAMILY
Grace is an only child and has a good relationship with her
parents and grandfather, who lives with them. She does not,
however, have any contact with her extended family, who
she finds small-minded and ignorant. Her parents have been
largely supportive of her female identity, though they continue
to have trouble with things like pronouns. Nevertheless, her
mother has been very happy to reconnect with her as a woman,
including shopping for clothing with her, and, recently, telling
her that she’d always wanted a daughter. Grace is not aware of
any other out transgender people in her family and feels sure
that her parents would have mentioned this if it was the case.
She does, however, have a vague sense that some extended and
long-deceased family members might have been autistic.
46 TRANS AND AUTISTIC

COMMUNITY AND ACTIVISM

Grace is not very involved in the autism or transgender
communities, largely because she sees herself as a homebody
who is not brave enough for activism. She does follow the
issues that are important in the broader community and tends
to participate vicariously through her partner, who is involved
in the transgender and autistic community both professionally
and as an activist. She wouldn’t, for instance, have attended the
Philadelphia Transgender Wellness Conference8 for two years
in a row were it not for accompanying her partner. Likewise,
she has met a number of other transgender activists through
her partner.

WORK
As noted, Grace works for the Federal Government of Canada
in a professional capacity. Despite this being an “enforcement-
minded” agency with gendered social conventions, she
has found her workplace, and, in particular, her boss, to be
incredibly supportive of her transition. Nevertheless, Grace’s
workplace experience is relatively unusual among those
interviewed, and the greater economic power afforded by her
professional role may be a factor in this.
While Grace’s current workplace is a good fit with regards to
her autism, this has not always been the case. Her profession,
for instance, requires a post-degree internship. Unfortunately,
between gendered and neurotypical social expectations and
conventions, she had a great deal of trouble obtaining one and
was frequently told she was, euphemistically, not “the right fit.”
Grace attributes this, in part, to not being able to feign small
talk with potential employers, “appreciate fancy suits, or talk
sports.” As a result, she was forced to accept an internship with
an unscrupulous employer who exploited and underpaid her.
 Grace 47

HEALTHCARE
In addition to autism and gender identity disorder, Grace
has received diagnoses of OCD, social anxiety, and clinical
depression. Like most others interviewed, her healthcare
experiences have been mixed. She recalls, for instance,
that even the prospect of an autism diagnosis made her feel
potentially stigmatized when she was younger, a fear that her
school’s psychologist did little to assuage. She resisted treatment
for OCD for similar reasons, though it had begun to seriously
affect her quality of life by high school.
Grace didn’t pursue mental healthcare of her own volition
until the last year of her degree, when she visited her university’s
healthcare service because she was depressed and had been
suicidal for a long time. She was seen by a GP who immediately
put her on a high dose of Escitalopram and referred her to
further mental healthcare services. Grace attended two
appointments through this service before receiving a further
referral to a psychiatrist who practiced Freudian psychoanalysis.
Grace saw him for psychoanalytically oriented therapy four
times a week for four years, largely because he was covered
by her public health insurance, and it gave her an excuse to
miss work at a job she hated. However, he “irritated [Grace]
for a number of reasons.” He tended, for instance, to fall asleep
while she was talking to him, which she suspects was due
to narcolepsy and his advanced age. He also lacked a basic
understanding of modern technology, including the internet,
where much of her social life was based, and dismissed her
online friends as not truly real. On the whole, Grace found that,
while he would have been considered very progressive in the
past, his understanding of gender and sexuality halted around
1990. For example, “his standing theory was that [she] wanted
to be straight, no matter what [she] said” and, as a result, she
never felt comfortable bringing up her concerns around gender
with him.
48 TRANS AND AUTISTIC

Grace also continued to see this psychiatrist because he

helped her to find a psychiatric medication regimen that worked
for her and continued to prescribe it without question, which
many others were hesitant to do. For instance, when she briefly
moved from Ontario to British Columbia, which she described
as having a “crisis-level shortage of family doctors,” she was
forced to accept a GP listed as available through the provincial
College of Physicians and Surgeons. This GP complained about
and refused to prescribe half of the medication she was on. She
continued, as a result, to rely on the aforementioned psychiatrist
for prescriptions until returning to Ontario, when she found a
GP who would continue to prescribe her medication regimen.
Overall, Grace has not been thrilled by the quality of mental
healthcare she has received. She would, for instance, have
preferred to have pursued therapy that wasn’t (as she termed it)
“Freudian bullshit.” Coverage for the services of therapists and
psychologists, however, is severely limited by both provincial
healthcare and her federal employee health insurance, which
left her with few options. Grace has, as a result, resigned herself
to accepting as good enough the quality of healthcare that
is available to her and, in general, feels “more or less stable
most of the time.” In any case, she reports that her mood has
significantly improved since meeting her partner and starting
the process of transition.
Grace is currently receiving transitional healthcare from her
GP, who initially wanted to refer her to Toronto’s Sherbourne
Health Centre,9 which is known for providing transgender-
specific healthcare. Grace didn’t want to accept this referral
because she was aware that this clinic has a very long waiting
list. Instead, she chose to educate her GP about providing
transgender healthcare, starting by introducing her to the
provincially accepted guidelines for this area of practice.10
Grace describes this experience as a “mixed bag,” as her GP
has been rigid in following the proffered guidelines. As a result,
 Grace 49

while she has agreed to provide hormone replacement therapy

(estrogen), she has also been very reluctant to deviate from
the recommended dosages and protocols, even when Grace’s
individual circumstances recommend it. She has had a similar
experience with the psychologist she is seeing for a surgery
recommendation letter. Though Grace is generally happy with
her, she is also frustrated by the psychologist’s insistence on
strictly adhering to the Standards of Care11 for fear of sanction
from her professional college or provincial healthcare provider.
Grace relayed another incident where she had an issue
with her genitals which she had thought might be related to
hormone replacement therapy. Her GP initially considered
referring her to a men’s clinic and, when Grace visibly grimaced
at this suggestion, recalled a new urologist heading the local
transgender surgery program. Grace subsequently saw this
specialist a few times and, while he was pleasant and informative
about the forthcoming transgender surgery program, she found
him unhelpful and only superficially concerned with her
particular medical concern. She’s since heard similar concerns
from other transgender people. Otherwise, Grace is generally
satisfied with her healthcare, though she was frustrated by her
dentist, who for some time misgendered her and demanded to
know what her medication was for.

MEDIA REPRESENTATION
Grace hasn’t seen much representation of transgender or
autistic people in the mainstream media beyond “horrific,
simplified, and/or sensationalist exaggerations” that don’t
reflect her own experience. As a result, she tends to seek out
“good queer content” in non-mainstream media like fanworks,
indie comics, and podcasts, which she has found to have more
realistic depictions of queer relationships. Grace is particularly
drawn to romance, and it is in this genre of fanfiction and fanart
50 TRANS AND AUTISTIC

that she first saw herself represented. She has since created
fanart herself to work out and explore different feelings.

SOCIAL RULES
Long before exploring her gender identity, Grace realized
that she had no interest in the stereotypical trappings of
masculinity, like sports, cars, and “bro culture.” Rather, as a
member of her school’s gifted program from grade two through
graduation, she and her friends were “nerds” and largely
outside the “normative expectations” regarding, for instance,
dating. More broadly, Grace relates that she is often treated
as “weird” in an undefinable way, though she doubts others
suspect her specifically of being autistic. She believes that it is
probably difficult for others to tell because she has become so
accustomed to performing neurotypical behaviour in public
and doesn’t openly identify as autistic to anyone but her friends
and other autistic people.
Grace does relate having difficulty making new friendships
to her autism. For instance, she often relies heavily on shared
interests or participation in events (such as board game nights
at a local pub) to acclimatize herself to new people. Even then,
she only feels capable of joining a new social group by “low-key
insinuating [herself] into it” over a long period of time. For
Grace, this means arriving early to events in order to interact
with other attendees prior to a crowd or in-groups forming,
which she finds intimidating.
Grace compares her experiences in making active efforts at
socialization to playing the computer game The Sims,12 which
allows players to create human-like characters (Sims) in a
virtual “dollhouse,” and watch them engage in relationships,
jobs, and hobbies. Sims’s need for social contact is expressed
in an onscreen meter that tracks their mood. The player can
direct individual Sims to take specific actions in order to refill
 Grace 51

this meter and therefore improve and maintain a positive

mood. While these actions sometimes backfire and deplete the
meter, the player can determine which actions always achieve
a positive result through trial and error. In contrast with The
Sims, Grace feels that real-world social rules and expectations
are a lot less predictable and more arbitrary, and she is often
uncertain about the results of her actions in social settings.

FINAL THOUGHTS
Grace is a 35-year-old Caucasian transgender woman who
lives in Toronto. Resourceful and intelligent, she has a close
circle of friends and family who love and support her. Though
she doesn’t consider herself “brave enough” to be an activist,
she nonetheless advocates for herself and others through the
creation of policies and provision of educational resources.
Grace has experienced some success in using games and
gaming of various types as both a medium of communication
and a metaphor for navigating a world with seemingly arbitrary,
invisible rules.
Though both Grace and her family suspected she was
neurodevelopmentally “atypical” as a child, she has resisted
diagnosis or treatment for fear of being further stigmatized.
She revisited this in high school, and while she ultimately
hasn’t pursued a formal diagnosis, she has accepted herself as a
member of the autistic community. However, she still struggles
with internalized ableism.
Grace was similarly reluctant to accept mental healthcare
until forced, due to OCD, long-standing depression, and
suicidality, near the end of her university education. While she
has ultimately found a medication regime that works for her,
she had to navigate an unsympathetic and, at times, hostile
healthcare landscape in the process. Grace has had particular
difficulties finding a GP who will continue to prescribe her
52 TRANS AND AUTISTIC

medication and, as a result of this and restrictions on health

insurance coverage, has had to rely on a narcoleptic and
homophobic psychoanalyst for many years.
Grace’s pathway to accepting herself as a woman had a
similar trajectory. There was no single moment when she
“knew” she was transgender. Instead, Grace had complicated
feelings about gender from a very young age and, though she
tried to suppress them, ultimately came to terms with her
gender identity. She partially credits the My Little Pony fandom,
which has a large transfeminine component, as crucial in
prompting her to explore her gender more closely. Through it
she learned of several blogs by other transfeminine people who
shared similar narratives. Grace also consumes a large amount
of non-mainstream queer and transgender media and even
participates in making some.
Grace ultimately came out as transgender in stages; first
to her partner and close friends, then to her larger friendship
group, parents, and work. Despite some hiccups along the
way, she has been largely supported, especially by her mother
and boss. Grace has, in fact, written a policy for transgender
employees that she has been able to rely on through this
process. In this sense, she was able to, quite literally, dictate
how her workplace managed and supported her. This is in
contrast with her profession more generally, which has not
always been accommodating of her disabilities, and isn’t
known for having a nuanced understanding of gendered social
norms. Grace feels more mixed about her experiences with
transgender healthcare as, while she has been able to have
many of her needs met through persistent self-advocacy, she is
often frustrated by nonsensical gatekeeping and overreliance
on medical guidelines. She is, however, generally satisfied so far.
 Grace 53

ENDNOTES
1 Thiessen et al., 2010
2 Sidney, n.d.
3 Faraday, 2014
4 Male-identified fans of My Little Pony.
5 Daniel, 2017
6 Blizzard Entertainment, 2004
7 Brill, 2016
8 Philadelphia Transgender Wellness Conference, n.d.
9 Sherbourne Health Centre, n.d.
10 Bourns, 2016
11 Coleman et al., 2012
12 Maxis, 2000
ISABELLA

Isabella is a 29-year-old transgender woman, who identifies as

asexual and homoromantic.1 She was born and currently lives
in Toronto, and is of Chinese and Vietnamese descent. She was
diagnosed as autistic when she was quite young and has been
out as transgender for a number of years. Isabella opted to be
identifiable in this interview. She uses she/her pronouns.

COMING OUT AS AUTISTIC

Isabella was formally diagnosed with Asperger’s syndrome by
her school therapist when she was four years old. It was, at this
time, considered to be a less severe form of autism2 and she
was offended when it was merged with autism, as she considers
herself to be a person with a “mental variation,” rather than like
these “more extreme cases.” Isabella was also diagnosed with
ADHD (predominantly inattentive) and dyslexia, the latter of
which makes reading difficult, particularly Chinese characters.
Isabella dismisses the possibility that ADHD and Asperger’s
are directly related and is similarly frustrated by the degree to
which her gender dysphoria is falsely attributed to Asperger’s.
She does, however, see both ADHD and Asperger’s as
neurodiversities and aspects of herself that she, due to stigma,
has had difficulty coming to terms with. Nevertheless, Isabella
is somewhat skeptical of the different labels given to her and
their basis in, or relevance to, her lived experience.

55
56 TRANS AND AUTISTIC

While her parents have always known she has Asperger’s,

and her cousins and siblings have been largely supportive,
Isabella has had a difficult time “coming out” to her aunts and
uncles. She worried that, while these relatives knew she was
“different,” they wouldn’t understand what Asperger’s was and
would see it as “adding shame to the family.” As a result, Isabella
felt immense pressure to hide her Asperger’s by trying not to
talk too much, or about things she was passionate about, which
was largely unsuccessful. On one occasion, for example, she
was watching sports with her relatives and, while they focused
on who was winning, she couldn’t stop fixating on and talking
about the players’ uniforms.
After some of Isabella’s younger cousins and older relatives
on her mother’s side were diagnosed with autism, however,
their parents became more understanding and sympathetic.
One aunt in particular has one son with autism and another
with a physical disability, and is considered to be a “second
mom to everyone.” Still, Isabella finds it frustrating when people
treat her differently after becoming aware of her Asperger’s,
particularly because, though the judgment is often mild, it is
expressed through non-verbal behaviour.

COMING OUT AS TRANSGENDER

While Isabella identifies as a transgender female, she has also
been called “bianxing”3 (變性) by other Taiwanese-Canadian
and Chinese-Canadian queer youths. She has also been
called two-spirited4 by some Ojibwe friends. The path to self-
acceptance has been long, starting when she first realized, at
four years old, that something about her was “odd…[and]
not right.” Isabella was aware, at the time, that she related
more to girls than boys and was confused about how they
differed physically. “The first symptom of being a trans girl”
occurred when she was four-and-a-half and showered with her
 Isabella 57

female-bodied cousin. Isabella recalls seeing her cousin’s vulva

and thinking that, as she grew older, her “package would shrink
and fall off ” to reveal one.
Isabella’s next memory is of puberty and “overcompensating
for [the female identity] she was afraid of.” She recalls, for
instance, hearing the term “trans” in grade eight and, realizing
both that she identified with it on some level and that it might
be used to target her, she “became a bully” pre-emptively.
Between 12 and 18 years old she was “a total jerk ass…[who]
indulged in toxic masculinity” and is grateful that she wasn’t
aware of incels5 or other similarly toxic groups. Fortunately,
over time, she realized that this attitude was a product of her
own insecurity.
After starting college, Isabella began to identify as a
“feminine man” and realized that she was, in some way, “trans.”
After this revelation she slowly became more aware of gender
dysphoria and, in 2013, realized that she had to try and explore,
rather than continue to “shove away,” her femininity. Isabella
characterized the following year as “kind of amazing” in that
she was, for the first time, able to feel freer in her self-expression
and explore a part “of the world that she had been blinded to.”
Overall, she is glad that she has had the opportunity to explore
who she is and is now in the process of slowly transitioning.
However, in losing male privilege, Isabella began to
experience sexual harassment, like being catcalled and solicited
publicly. She also experiences a great deal of anxiety around the
potential for violent transphobia, and is aware that anything
can happen “the moment she walks out her door” if people so
much as suspect she is transgender. It is difficult, as a result, for
her to go “outside her safe bubble.”
Isabella worried that she “would lose most of her friends
and be shunned by her family” if she came out as transgender.
As a result, she tested the water by coming out to those she felt
would be the most accepting first. For instance, Isabella told
58 TRANS AND AUTISTIC

her brothers and, when they responded positively, informed

her cousins by Facebook messenger. She then told her younger
aunts and uncles and, while some had trouble accepting it, all
were ultimately supportive. However, Isabella has not yet told
her parents or all of her older relatives. Her difficulties in this
regard include the emotional labour involved, and linguistic
barriers that make it difficult to accurately describe the concepts
of gender dysphoria and non-conformity. Isabella did attempt to
come out to her parents, which they unfortunately took poorly.
Her mother didn’t say anything, finished cleaning the dishes
before walking out of the room, and has since pretended that
the conversation didn’t happen. Her father, however, responded
by ignorantly conflating being queer to mental illness, which
made her very angry.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Isabella strongly disagreed when asked whether autism and
gender identity are linked and expressed frustration that
people conflate the two. She notes, for instance, that she has
cousins who are cisgender and autistic, and knows others
who are transgender and not autistic. Isabella opines that they
may appear to be connected because a lot of autistic people
are more open to exploring gendered aspects of themselves
than neurotypical people constrained by social rules and
expectations. She likens this to the “false parallel” between
borderline personality disorder and gender dysphoria,6
which she attributes to misunderstanding and mental health
stigma. Isabella also points out that queer youth have a
heightened awareness of and exposure to mental health
issues, compared to their cisgender and straight counterparts,
due to stigma and trauma. In the absence of this trauma and
“bullshit…we wouldn’t need all these safe spaces, [or] have so
much depression.”
 Isabella 59

FAMILY
As noted, Isabella’s family have been very supportive of her as
a person with Asperger’s, particularly after several other family
members received similar diagnoses. But while her extended
family and brothers have been supportive of her identity as
female, it is still an area of conflict for her parents. In fact,
Isabella’s mother refuses to address the issue, while her father
has rejected it as a deviance.

COMMUNITY AND ACTIVISM

Isabella used to participate in a transgender youth group7
and drop-in,8 and volunteer with a program9 that provides
counselling, homelessness, and suicide crisis services to LGBT
youth. Though she has never participated in any solely autistic
communities, she did meet several autistic people in these groups.
Currently, however, she is working longer hours in order to save
towards an apartment and is now busy when these groups meet.
Still, she is involved in online communities and continues to chat
with friends from several Toronto area queer spaces. Isabella is
also worried that she will have a difficult time in the dating world
if others know she is neurodivergent, particularly in light of the
issues she already experiences as an asexual, homoromantic,
transgender woman. Indeed, she often finds that “the only people
who want to date [her] are cis straight guys.”

WORK
As noted, Isabella works quite a bit—on average, eight to ten-
hour shifts. She recently began working more in order to save
money towards her own apartment, which she hopes will
launch her towards future job goals. While she is currently
quite successful in this arena, Isabella worries that she may
have trouble finding work if employers know she is Asperger’s.
60 TRANS AND AUTISTIC

HEALTHCARE
Isabella openly identifies as “non-op,” meaning that she is
“not interested in ever getting bottom surgery.” On the whole,
Isabella characterizes her healthcare experience, as a person
who is both transgender and autistic, as “not a big deal.” She
does, however, find that hospitals are challenging because, when
there, she frequently has to correct people on her name and
pronouns. Prior to beginning hormone replacement therapy,
Isabella took the opportunity to bank her sperm with a local
fertility clinic as she plans to become a mother in the future. She
was particularly glad that she didn’t have to rely on the Centre
for Addiction and Mental Health’s (CAMH) gender clinic to
begin hormone replace therapy and was instead able to attain
this through her regular doctor and endocrinologist, both of
whom she describes as “very supportive and easy going.”
With the exception of the ten-year period (1998–2008)
in which transgender surgery was delisted from the public
insurer,10 and between 2016 and the present day,11 the Clarke
Institute of Psychiatry, and later CAMH, was “the only way
to access [publicly insured] transition-related healthcare.”12
Though it has improved significantly since the public insurer13
relisted services, particularly since they ceased to be the sole
point of access in 2016, its historical reputation is abysmal. It
was, in particular, notorious for its traumatizing, sexist, and
overly rigid approach and characterized by exceptionally low
rates of approval for transitional healthcare (less than 10% by
some accounts).14,15
Isabella attended a special education class from kindergarten
to grade seven. She described the program as providing
a substandard education that caused her to fall behind,
especially in science and English. For this reason, and while
she appreciated the opportunity to interact with other students
with learning disabilities, she opted for the academic stream
in grade eight. Aside from an academic accommodation
 Isabella 61

assessment in college, she hasn’t received support for Asperger’s

since high school.

MEDIA REPRESENTATION
Isabella almost never sees media representation of people
who, like herself, are “homoromantic, asexual, and moderately
conservative.” What she does see are straight and “white-
passing” transgender people who share the typical narrative
of “a boy trapped in a girl’s body.” In contrast to popular
media, which also shows hardly any people of colour and
focuses on celebrities, the transgender community contains
a “huge constellation” of individuals and experiences. Non-
binary people and intersex people are, for example, left almost
entirely out of the conversation and, when represented, their
experiences are conflated with those of transgender people.

SOCIAL RULES
Isabella’s experience with social rules varies according to the
environment she’s in. She is, for example, more likely to be open
about her identity when she feels safe, as she does with store
employees in downtown Toronto, and her friends who see her
as two-spirit on the reserve where she goes fishing. In these
circumstances, Isabella will confidently correct people on her
gender identity and pronouns. She doesn’t correct people in
rural areas, which she sees as “white dominated,” because she
worries men will assault her for being too effeminate.

FINAL THOUGHTS
Isabella is a 29-year-old, transgender, asexual, and homo-
romantic woman of Chinese and Vietnamese heritage. Born and
currently living in Toronto, she was diagnosed with Asperger’s
62 TRANS AND AUTISTIC

when she was four years old, prior to its inclusion within the
larger autism spectrum. As a result, Isabella sees her experience
with Asperger’s as different from, and less severe than, those
with autism. She has also considered the relationship between
autism and gender identity and concluded that, though
unrelated in origin, they do interact in manifestation. Autistic
people may, for instance, be more inclined to question their
gender identity due to being less constrained by social rules
and limitations.
Isabella first suspected that she was transgender when she
was about four years old, though she lacked the words for it. She
broached the issue, over the ensuing years, slowly and cautiously,
always aware of the stigma attached to this kind of difference.
Indeed, there was a long period of time during Isabella’s teens
in which she described her reactionary behaviour against this
aspect of herself as “toxic” and “bullying.” Fortunately, after
entering college, she was able to explore her gender identity
more fully, embrace herself as a woman, and come out, in
stages, to her friends and family. In the process, Isabella has
tried on and had applied to her a variety of culturally specific
gender identity labels, like bianxing and two-spirit.
Isabella has since been involved in several groups and
organizations for LGBT people. However, because of work
commitments, she no longer has time to attend them. As
a result, though she still keeps in touch with friends from
these groups, Isabella now largely participates in discussions
with transgender communities online. She is, on the whole,
satisfied with her social life, though she worries about dating as
a neurodiverse, asexual, homoromantic, transgender woman.
Despite the many positives of coming out as transgender,
Isabella talked a lot about dealing with transphobic violence and
misogyny, particularly on the street. This is a relatively recent
experience for her and has a big impact on her decisions to stay
close to home, where she feels safer, rather than venture into
 Isabella 63

less urban environments. And while Isabella has a supportive

primary medical team, she also experiences transphobic
discrimination when forced to deal with unfamiliar healthcare
providers, as at hospitals. She is particularly glad that her
experience of transgender healthcare never involved gender
clinics.
Isabella’s family is large, multi-generational, and close knit.
In addition to her parents and brothers, she has several aunts,
uncles, and cousins, most of whom she sees or interacts with, at
least online, regularly. Their support and acceptance of Isabella,
with regards to Asperger’s and as a transgender woman, has
been mixed. On the one hand, while difficult for older family
members to understand initially, they are supportive of her
Asperger’s, especially since several of her cousins received
similar diagnoses. Isabella’s brothers and extended family had
a similar reaction to her gender identity, despite some concerns
about linguistic barriers, and ultimately came to accept it. On
the other hand, her parents have been unable to incorporate
this information into their lives and, as yet, are unwilling to
accept her gender identity.
Isabella’s description of special education was especially
astute. In her eight-year tenure in this program, she benefitted
from meeting other students like herself, but received a
substandard education. Fortunately, she had the option to
choose a regular academic stream in grade eight. In fact, much
has been written about the tendency of special education
classrooms to isolate learners rather than prepare them for
academic achievement.16,17

ENDNOTES
1 Homoromantic defines people who are romantically, though
not necessarily sexually, attracted to people of the same gender
as themselves, while asexual delineates a person who does not
experience sexual attraction (Paramo, 2016).
64 TRANS AND AUTISTIC

2 Barahona-Correa & Filipe, 2015

3 A Mandarin word, bianxing translates literally to “changed heart” and
figuratively to “change sex” (Koetse, 2015).
4 “Two-spirit refers to a person who identifies as having both a
masculine and a feminine spirit, and is used by some indigenous
people to describe their sexual, gender and/or spiritual identity”
(Re:searching for LGBTQ2S+ Health, n.d.).
5 See definition in note 13 for “Alex” above.
6 Thom, 2016
7 Supporting Our Youth, n.d.
8 The 519, n.d.
9 Egale Canadian Human Rights Trust, n.d.
10 Graffeo, Brown, & Freeman, 2019
11 Centre for Addiction and Mental Health, n.d.
12 Hitomi, 2018, p.81
13 Ontario Health Insurance Plan
14 Rowe, 2009
15 Withers, n.d.
16 Aviv, 2018
17 Butrymowicz, 2017
JAMES

James is a 36-year-old Caucasian transgender man from England,

who identifies as gay, and currently lives in London. He first
suspected that he was autistic about eight years ago, after reading
literature on the subject, and shortly before starting to question
his gender identity. James is now awaiting an official assessment
for autism. James is a pseudonym and his pronouns are he/him.

COMING OUT AS AUTISTIC

James first suspected that he was autistic when he was 28 years
old, shortly before he began questioning his gender identity.
He subsequently read a book that posits that autism is linked
with “male” traits like systematizing, rather than those assigned
female, like “empathizing,” and that autistics have “extreme male
brains.”1 James identified deeply with this concept, as it helped
him to place his struggles with relationship empathy in context
and understand that there wasn’t anything inherently wrong with
him. Dr. Baron-Cohen’s book2 also prompted him to explore his
gender identity and, at first, whether his autistic traits might be
due to being transgender. For instance, James initially questioned
whether his desire to be male was because men are supposed to
be less socially competent, though he ultimately came to realize
that he was both autistic and transgender.
James scored very high on the online Autism Quotient
test,3 developed by Dr. Baron-Cohen,4 and is continuing to

65
66 TRANS AND AUTISTIC

read about autistic traits and behaviours in order to better

understand himself. He has, however, had difficulty “coming
out” as autistic, especially to his family and those closest to him.
When he does disclose his autism, he has found that the term
itself provides a helpful shorthand for others to understand his
behaviour and mannerisms.
James has struggled for a long time to get an autism
diagnosis through the National Health Service (NHS). He
wonders if being assigned female is interfering with this
process and notes that female children in particular are pushed
to develop strategies to mask autistic traits, in order to perform
expected feminine behaviours.5 It may, as a result, be difficult
for family to accept that their children are autistic as adults
when they have camouflaged their autism so well and for so
long. With regard to seeking a diagnosis, James has found
that diagnosticians and other medical professionals often take
his ability to make eye contact as evidence that he cannot be
autistic. His family has also made similar statements, and he
hasn’t felt comfortable speaking to them about autism again.
James is hopeful that a diagnosis will help him to broach this
topic with his family again.

COMING OUT AS TRANSGENDER

Although James had suspected that he was transgender for
some time, it wasn’t until watching the documentary The Boy
Who Was Born a Girl6 that things really “clicked.” The story
immediately resonated with him, though he still needed to
think about and process the idea for a number of years. It was
in this period that James struggled with shame, internalized
transphobia, and concern for family and friends’ reactions.
James decided that he needed to transition after ending a
long-term relationship in 2013. He had identified as a butch
lesbian during this period, because he assumed that his
 James 67

masculine traits meant he must be and had also suspected that

his strongly lesbian-identified partner wouldn’t have accepted
him coming out as or transitioning to male. In retrospect,
James wonders whether shame prevented him from giving her
the benefit of the doubt. He began to see a therapist following
the break-up, which gave him the chance to explore his gender
identity in a safe environment and led to his decision to do what
“feels right.” In the process of transitioning to male, James made
a whole new group of friends in the transgender community
and at groups like FTM London7 and TransBareAll.8 He also,
unexpectedly, reconnected with a childhood friend who was
coming out as a transgender woman. James characterizes the
process of transitioning, though very stressful, as the best thing
he ever did for himself.
James describes the period of his life in which he identified
as a lesbian as “almost asexual.” He continued to identify as
asexual for a long time after starting transition, before coming
to realize that he is “90 percent gay.” While he wonders
if this is due to something intrinsic that would lead him to
be homosexual in any gender, he partially ascribes it to a
heightened sex drive after beginning testosterone,9 in which he
found himself watching largely gay porn, despite never having
viewed porn at all before. His understanding of himself as a gay
man developed further during a long-term relationship with a
non-binary person. There is, in fact, a growing body of research
supporting change in sexual identity around transition.10,11 One
study found that 64 percent of those who transitioned reported
a change in sexual attractions post transition.12

LINKS BETWEEN AUTISM AND GENDER IDENTITY

James is aware of research showing a link between gender
identity and autism and wonders if transgender and autistic
people may be more likely to use hormones and other medical
68 TRANS AND AUTISTIC

interventions to bring their gender presentation and identity

into alignment. For instance, he had a hard time when his
therapist encouraged him to explore and be comfortable with
uncertainty around gender identity and presentation, as it ran
counter to his own need to categorize and see things in black
and white. When James first started transitioning he wanted to
be as like a cisgender man as possible and, for a long time, to
have lower surgery. He found, however, that the rigid thinking
that characterized his autism led him to need a “perfect”
result, which he did not feel was possible. James also expressed
concern with the idea of giving over control of his body to a
surgeon. Over time, he has come to embrace his identity as
both transgender and male, and no longer wants lower surgery.

FAMILY
Though James had worried that his family would react
negatively when he came out as transgender, they were almost
unanimously supportive. The only person who reacted poorly
was an extended family member, who wrote an email to him
accusing him of lying to them. James attributed this to their
personality, which differs from the rest of his family’s more
laid-back and liberal attitudes. He hasn’t come out to them
as gay yet, largely because, after coming out to them so many
other times, he feels it’s redundant.
In light of their acceptance of his gender identity, James
finds his family’s dismissiveness towards his autism strange,
particularly since many are mental health professionals.
Nevertheless, he was met with dismissal and told not to be silly
when he talked to them about this. Others have opined that
James “doesn’t seem to be autistic” and that it is, in any case, a
negative trait. He finds this both invalidating and reflective of
the taboos and stereotypes surrounding autism.
 James 69

COMMUNITY AND ACTIVISM

James is involved in several online and in-person groups for
transgender, autistic, and kinky people and, as a result, most
of his friends are transgender, or otherwise involved in these
communities. They are a source of support and solidarity,
helping him to navigate common problems, rather than
continuing to do so on his own. Groups associated with the
autistic community, in particular, have helped him to identify
repetitive behaviours and patterns and whether they are
changeable, or inherent due to autism.

WORK
James worked as a research assistant for a veterinary college on a
project involving close collaboration with Chinese researchers.
His job required frequent travel to China and networking
with these researchers and their institutions. James initially
worried that coming out as transgender, in order to transition,
would put the project and his job in jeopardy. However, he
was unexpectedly contacted by a stealth13 transgender man
at work, who, having seen him at transgender community
events, was able to provide support and advice to him in this
situation. This man put James in touch with a counsellor, who
helped him process the situation, and ultimately to arrange
a meeting with his employer. Despite his fears, his employer
was immediately supportive of his need to transition in the
workplace, accommodating him by reassigning him to another
project within the same working group and sending an email
to all employees affirming his support.
James’s experiences of employment as an autistic person
have been more mixed. Overall, a scientific career has been a
good fit, because it utilizes his autistic traits and he is able to
work with others who also appreciate a structured environment.
70 TRANS AND AUTISTIC

Even in this environment, however, James still struggles to

understand social expectations and cues. For instance, he often
needs to read work emails several times in order to unearth
nuances and construct a neurotypical reply. James finds this
process exhausting and anxiety-inducing, but also necessary in
order to avoid issues with co-workers, as in the past he has been
accused of being “terse.” He has found that adding seemingly
purposeless and “flowery” language to work communication
helps to avoid this. Perhaps surprisingly, James’s work has been
far more accommodating of his gender identity than his autism.

HEALTHCARE
James’s counsellor is very supportive and has helped him both at
work and, more generally, to feel comfortable as a transgender
man. However, he has been met with a great deal of gatekeeping
when attempting to access transitional services, such as when
his GP refused to refer him to a gender clinic which, in the UK,
is necessary to receive transitional care. Though James received
this referral after writing a letter of complaint to the practice
manager, his GP refused to continue to prescribe or administer
the testosterone authorized by the gender clinic, arguing that he
had no experience and was concerned that James might regret
it. James again complained to the practice manager, leading to
a meeting between all five GPs, wherein they decided they were
not prepared to follow through prescribing or administering
the medication. James was then forced to find another GP,
who has also resisted refilling prescriptions and forced James
to shoulder the burden of tracking the need for blood work
to monitor his hormone levels. He attributed this to, among
other issues, a lack of experience with transgender people that
is common across the medical professions.14
James’s one positive experience with a GP, as regards
transitional healthcare, was with a doctor who was a gay man
 James 71

and very senior in his practice. This GP was very supportive,

despite James being his first transgender patient, and amenable
to prescribing the contraception pill to stop his periods, while
acknowledging that it wasn’t a typical use and might have side
effects. This was the first time he had felt that a doctor respected
his agency.
James’s experience of autism healthcare has also been quite
challenging. Despite letters of support from his therapist,
both his GP and psychologists have refused either to refer
him for an autism assessment or to conduct the assessment
because, for instance, he “makes too much eye contact” and
their belief that, even if he were autistic, he would be on the
mild end and not need a diagnosis. James disagrees, arguing
that it is stressful and frustrating to be constantly told his
experience is not what he says it is, and that a diagnosis would
affirm his conception of himself and the world around him,
while giving him access to needed supports. He suspects this
gatekeeping may be partially because these practitioners are
hesitant to “burden” the country’s public health service.15 In
spite of medical gatekeeping, however, James finds autism
has been a largely positive force in his life, particularly in
the realms of healthcare navigation and self-advocacy. As a
diligent, organized, and detail-oriented person, he is able to
self-advocate more effectively by making lists, researching
diagnoses, and preparing for medical appointments ahead
of time.
James also has chronic fatigue syndrome and fibromyalgia.
He traces the onset of both to the stress he was under leading up
to top surgery, from which he never fully recovered. He relates
that this spiralled into a debilitating illness in 2017, and that he
has been on medical leave from work since. Unfortunately, this
has isolated him from his friendships at work and has impacted
the coping strategies he uses to manage his autism, like working
out with friends and running when stressed.
72 TRANS AND AUTISTIC

MEDIA REPRESENTATION
Although James has seen some representations of transgender
people in the media, with the exception of The Boy Who Was
Born a Girl, he hasn’t seen much reflecting his experience
as a transgender man. He is aware of a recent Channel 4
documentary,16 but hasn’t watched it and understands that it
doesn’t have a large representation of transmasculine people.
James also noted that the BBC series Boy Meets Girl17 had some
positive and groundbreaking characterizations of transgender
people.
Regarding autistic people, James has only ever seen
media that portrays them as severely disabled and no media
about those who are transgender as well, though he draws a
connection between how they are both portrayed as tragic or
comic figures. He is aware of a number of programs with more
“capable” characters like Sheldon, from The Big Bang Theory,18
who are autistic coded without being explicitly named as such.
James notes that, despite being more visible, the autistic traits of
these characters tend to be used for comic relief, while autistic
people in everyday situations are never seen.

SOCIAL RULES
James has had a lot of difficulty in identifying and differentiating
between the social rules that used to apply to him as someone
assigned female and someone now perceived to be cismale.
For instance, he notes that there are many unspoken rules
regarding how men interact when they’re together and even
in mixed groups. James has also had difficulty dating women
and found himself wondering, for instance, if he should open
the door for his date or put his arm around them. He recalls
disliking this when he was seen as female but is unsure what
other women might want. Similarly, though he has always done
so, James now makes a point of noting and stopping himself
 James 73

from sitting with his legs widely spread, as men are seen as rude
and taking up too much space for doing so. Ironically, he has
had more trouble with these issues post transition, as before he
saw himself as “just one of the guys,” though he was also teased
quite a bit in school for “acting mannish.” Perhaps this speaks
to the tension between being seen as masculine but not male
and being seen as male but not masculine.
James recalls, in general, “never being very good at being
female” and also wonders whether his dislike for “girly”
clothes had something to do with an autistic preference for
more comfortable clothing. He finds that he sometimes walks
into dangerous situations because of his lack of perception.
For instance, there have been quite a few instances where
he has been alerted by his partner that strangers are hurling
homophobic abuse at them. James relates this to his general
obliviousness and wonders if this is related to his autism, to his
tendency to see the best in people, or both.

FINAL THOUGHTS
James’s journey to accepting and celebrating his autism and
identity as a transgender man is a long and, ultimately, fulfilling
one. Currently located in London, England, he is, at 36, the
oldest of our, admittedly young, sample. James began actively
exploring the possibility of being autistic, then transgender, in
his late twenties, which he was prompted to do after reading
a book on autism by Dr. Simon Baron-Cohen. Many autistic
and transgender people find Baron-Cohen’s extreme male brain
and systematizing theories of autism problematic and even
offensive. James, however, found them revelatory in accurately
describing parts of his own experiences and helping him to
better understand himself.
James assumed, before coming out as and transitioning to
male, that his masculine traits meant that he was a butch lesbian,
74 TRANS AND AUTISTIC

and though he did have a number of lesbian relationships, he

never felt comfortable with his sexuality until after transitioning
and coming out as “90 percent gay.” Despite this, he has some
regret for ending the relationship he was in just prior to transition.
James did so because he assumed that his strongly lesbian-
identified partner wouldn’t be supportive. He now wonders
whether this decision was influenced by his own internalized
transphobia and shame.
James’s immediate family and workplace, unlike many of
those in the other interviews, have been quite supportive and
accommodating of his transition. He has also made a number
of connections within the local transgender community and
with other transgender men since coming out as transgender.
Unfortunately, James’s experience of transitional healthcare,
like many of those interviewed, has been somewhat lacking.
He has, for instance, had difficulty finding a GP who will
provide the necessary referrals and prescribe transitional care,
for fear of his “regretting it,” or due to the GP’s professed lack of
experience. James’s one positive experience, in this regard, was
with a GP who was senior in his practice and gay.
James’s family were less supportive when he told them he
suspected that he was autistic, and even his brother, who is a
neuropsychologist, told him he was being “silly.” He has had
similar problems with getting an official diagnosis and has been
told, for example, that he makes too much eye contact to be
autistic. Though not an uncommon experience among others
interviewed, James’s situation may be uniquely impacted by the
NHS, which has been documented attempting to cut costs by
limiting autism diagnoses to the “most severe cases.” He has,
regardless, found a lot of support and solidarity from online
and in-person autistic groups.
Perhaps surprisingly, given their support of his transition,
James’s work colleagues have been largely unsupportive of his
autism by failing to understand or accommodate his difficulties
 James 75

with navigating workplace social expectations. He is now on

disability leave, due to developing chronic fatigue syndrome and
fibromyalgia, which he attributes to stress leading up to having
top surgery. Unfortunately, this has isolated James from his
usual support networks and routine, though he has developed
some new friendships through the autism, transgender, and
kink communities.
James is a very insightful and deeply contemplative man
who has given a lot of thought to the overlap between his
experience of autism and gender identity. He finds that, as an
autistic person transitioning to male, he wanted to accomplish
as binary a transition as possible and found it difficult to accept
uncertainty in his own transition. He has also explored the
causative relationship between his autism and gender identity
and, while he has no firm conclusion on this, regards transition
as the right decision for him.

ENDNOTES
1 Baron-Cohen, 2003
2 Baron-Cohen, 2003
3 Wired Staff, 2001
4 Baron-Cohen et al., 2002
5 Russo, 2018
6 Channel 4, 2009
7 FTM London, n.d.
8 TransBareAll, n.d.
9 Vrangalova, 2018
10 Auer et al., 2014
11 Meier et al., 2013
12 Katz-Wise et al., 2016
13 The word stealth refers to a person who is transgender, but is not out
as such in their everyday life. In this case, it refers to a transgender
man who “passes” as a cisgender man at work.
14 Davis, 2019
15 Draeper, 2017
16 Channel 4, n.d.
17 Kerrigan et al., 2015
18 Cendrowski, 2007
MOOSE

Moose is a Japanese and Korean gay transgender man in his

late twenties. Born in Japan, he came to the US as a youth and
currently lives in Chicago. Though Moose opted to use his real
name, due to his irregular status in the US, we have chosen to
obscure some identifying details and employ a pseudonym. He
uses he/him pronouns.

COMING OUT AS AUTISTIC

Moose was formally diagnosed with jiheishou1 when he was
four years old. His parents rejected the diagnosis (which they
saw as shameful to the family name) and sought, without
success, to have it removed by five different doctors. They
also stopped celebrating his birthday afterwards and, on one
occasion, his mother even tried to strangle him. Moose saw this
as understandable given their social status and the tendency
in Japan at that time to attribute autism to bad parenting,
particularly from mothers. He pointed out that there is also a lot
of stigma around mental illness in Japan and, more generally,
within Asian families.
Moose has had a much more positive experience in Chicago.
For instance, though he initially hid his autism from friends
after moving there, he ultimately came out both because his
symptoms had become too pronounced to hide, due to starting
testosterone, and he no longer had the desire to. By contrast,

77
78 TRANS AND AUTISTIC

Moose wasn’t able to access autism supports when he was in

New Orleans due to “stop and frisk” actions by police that
targeted him as a person of colour. This impeded his ability to
be “out” about this aspect of his identity.

COMING OUT AS TRANSGENDER

Moose knew he was transgender before he was five years old.
His experience is, however, made unique by gendered linguistic
characteristics specific to Japanese. For instance, in Japanese
there is a specific “I” for boys, girls, teens, and “when males
want to appear tough.” Moose recalled that he never used the
“I” for girls and, even when his teacher called his parents,
refused to change his male sentence structure.
Moose’s parents initially dismissed this behaviour as a
phase. However, his persistence, combined with an inability
to navigate the social conventions necessary to hide it, made
this untenable. Moose was adamant, for instance, that he would
grow a penis when he got older, constantly told his parents
he was a boy, and refused to wear the female school uniform,
which required a skirt, until junior high. Over time, his parents
became concerned that there might be something “mentally
wrong with him” and, ultimately, responded to his being
different by disowning him.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Moose feels strongly that gender identity and autism aren’t
related. He specifies that, while the former establishes what he
identifies as, the latter indicates the way in which he processes
sensory inputs differently from neurotypicals. Moose indicates
that he is not autistic because he is transgender, or transgender
because he is autistic, and that his gender identity is not an
autistic obsession, as has sometimes been assumed.2
 Moose 79

Nevertheless, while Moose’s autistic symptoms, like rocking,

stimming,3 and echolalia, were present and controllable before
starting testosterone, he found that they increased afterwards,
leading him to “overload.” In particular, his sense of sound,
smell, and awareness of his body became much more intense.
Moose feels that these changes might be due to interactions
between his brain chemistry, autism, and testosterone, but
also to having moved to a more accepting city, where he didn’t
have to suppress his autistic traits as much. While he stims
more post transition, he is also more self-confident and less
personally inclined to hide his transgender identity or expend
effort on hiding autistic traits to please others. In any case,
Moose feels that publicly stimming isn’t as bad as denying his
gender identity. Although his transition caused him to lose
the ability to hide his autistic symptoms, he gained the ability
to live without shame. In fact, as his body and voice started
to match his gender identity, resulting in less misgendering,
he experienced less dysphoria and misgendering-related
sensory overload.

FAMILY
Moose was formally disowned by his family due to being autistic
and transgender when he was a teenager and has not had any
contact with them in the many years since. He relates this
primarily to his family’s cultural heritage and social conservatism
due to their samurai lineage. Moose clarifies that, as his father is
a first-born son of the main family lineage, his is the root family
(本家). As the sole daughter, or “heiress,” he was expected to
marry a man under the family name and produce another heir or
heiress. His autism, and later his transgender identity, were seen
as shameful abnormalities that disrupted these plans.
Overall, Moose found his parents to be very exacting,
especially academically. He was, for example, beaten with an
80 TRANS AND AUTISTIC

open hand for A-grades and attacked with fists and stabbed
with pens for anything less. As abuse from his mother got
worse, Moose, fearing for his safety, sought out overseas
academic scholarships as an escape route. He first applied to
an exchange program at 11 and since then has attended schools
in four different countries. Moose has not been back to Japan in
15 years, though he initially returned for summer vacations.

COMMUNITY AND ACTIVISM

Moose is a Catholic and was very involved in the young adult
leadership and board of his local church. He had, in this and
other roles, been working to further transgender inclusivity,
which resulted in local and national media coverage.
Unfortunately, this led his priest to out him, fellow parishioners
to send him threatening emails, and he lost a well-paying job.
Moose relates that race was also a factor in preventing his
accessing LGBT and autism supports in New Orleans. This was
largely because police continuously “stopped and frisked”4,5
him when he attempted to attend the suburban LGBT centre.
Conversely, although he thought the urban LGBT centre might
be more welcoming, he was prevented from attending by police
officers who told him he wasn’t “dark enough” to live in that
neighbourhood.
Moose moved to Chicago after his friend noted that it had
better access to transgender healthcare, was safer due to LGBT
protection laws, and he could access supports there as an Asian.
Still, while it takes a somewhat different form, he has continued
to experience racism and prejudice. For instance, as a person
of colour, Moose was “harassed for three days straight” when
Donald Trump was elected and has continued to experience
more racism than before “for being Asian and yellow.” However,
he “felt so lucky that,” unlike New Orleans, he could access the
LGBT centre without being deterred by police or needing a
 Moose 81

“white friend to take” him. Moose speculates that this may be

because Chicago police are more used to seeing Asians and that
he has some privilege as a person with relatively light skin.6,7
Since moving to Chicago, Moose has felt safe enough to
seek community supports and has become more involved in
both the autism and transgender communities. Nevertheless,
he has found the autistic community to be very white and,
while meetings occur for people of colour, they are rare and
tend to take place in restaurants, which he can’t afford. Moose’s
work schedule has also impeded his ability to participate
in transgender community groups in person. As a result,
he primarily interacts with the autism and transgender
communities online, especially on Facebook, where he is the
moderator of several groups. Moose also gives talks about
autism inclusivity in the transgender community.
Despite being openly autistic on several dating profiles,
Moose has found that many people need to be explicitly
informed of this and will stop responding when he does so.
He worries that being seen as having a developmental disorder
or disability leads others to see him as “undateable” and fears
that he won’t ever find a partner. However, Moose values his
independence and, as the autism community has shared with
him that love and dating are very difficult, feels that he may be
better off without a partner.

WORK
Moose works part-time at a gay bar and full-time in an
administrative job. After moving to Illinois, which has strong
LGBT anti-discrimination laws, he was able to be openly autistic
in job interviews and at work. Moose’s experiences with this
have been mostly positive, though he finds that people at the
bar sometimes talk down to him by speaking slowly or bending
down in a patronizing manner, which makes him angry.
82 TRANS AND AUTISTIC

By contrast, his full-time job is very understanding and offers

accommodations, like turning off fluorescent lighting, while
encouraging and supporting him to develop a workplace policy
on autism and disability.

HEALTHCARE
Moose has found it much more difficult to access transgender
healthcare as someone who is autistic. In fact, one of the reasons
he moved to Chicago was because, in his former city, autistic
people were subjected to extended gatekeeping, including wait
times, before being prescribed hormones.8 Moose inadvertently
subjected himself to this system when he told his doctor he had
autism and, as a result, was never able to access testosterone
there.
Moose later learned of the extended gatekeeping process for
autistic people from other transgender people. When he asked
his doctor about it, he couldn’t get clarification as to whether
it was this practitioner’s personal policy or that of the hospital
clinic in which he worked. Moose learned only that his doctor
attributed it to a need to determine that his gender identity was
not an autistic obsession or fixation. However, while intended
to protect vulnerable populations, this policy, which pressured
him to hide his autism and withheld much-needed transitional
healthcare, had the opposite effect. Moose specifically felt that,
by prolonging the waiting period for autistics, his doctor failed
to care for his gender dysphoria and abandoned the medical
oath to “do no harm.”
After moving to Chicago, Moose sought healthcare at an
LGBT positive clinic, which operates on a sliding payment
scale, practices harm reduction, and has expertise in
transgender health. As a result of earlier experiences, he didn’t
tell his doctor about having autism. He received testosterone
right after obtaining preliminary blood work, as is the case with
 Moose 83

neurotypical patients. He later came out to his doctor about

having autism and learned that she knew about both his autism
and the medical biases against people who are both transgender
and autistic in his former city.
It is also important to note that Moose has limited ability
to pay for healthcare. While he initially received healthcare
coverage through his university, he exhausted his educational
savings paying for asthma treatment when it was determined
to be a pre-existing condition.9 This left Moose without enough
funds to finish his degree and, as a result, he lost all healthcare
coverage. Now, as an undocumented immigrant with no
recourse to Medicare or Medicaid,10 his access to healthcare is
limited by his ability to pay for it in cash. Moose cannot afford
“top surgery,” although he would like to. He has struggled
with pressure, in some transmasculine communities, to “pass”
and access particular medical procedures. He attributes this
tendency to toxic masculinity, immaturity, and the assumption
that all procedures are affordable through either personal
finances or insurance.

MEDIA REPRESENTATION
Moose identifies several examples of transgender and autistic
inclusion in popular media. However, he has never seen
someone who is both transgender and autistic represented.
Moose explains that, in US media, autism is always portrayed
by, and reflected in the experience of, white people. He further
explains that (while it may have changed since he was last there)
media in Japan tends to reflect what is produced overseas,
with similarly little representation of people of colour. A few
programs stood out for Moose, however; one in the 21st century
about Satoshi Tajiri, who attributed his creation of Pokémon
to autism;11 a YouTube channel about adults with Asperger’s
in the workplace; and a drama with a neurotypical boy band
84 TRANS AND AUTISTIC

singer in the role of an autistic person.12 He disliked the last

performance, which he felt was very similar to Rain Man.13

SOCIAL RULES
While many autistic people have difficulty determining
and adjusting to unwritten and unspoken social rules and
conventions, Moose’s experience as Japanese, transgender,
and autistic is unique. This seemed to be especially true with
gendered social expectations and rules, as what is considered
masculine in Eastern Asian culture isn’t always masculine
in the US. In Japan, for instance, “endurance in silence” is a
central characteristic of masculinity, whereas in the US, vocally
“standing your ground” is praised. Moose also notes that, in
contrast to the US, Japanese men stand closer together and
even talk while at urinals. As a result, he has found that he
may appear to be acting feminine in a Western context, while
simultaneously performing masculinity in an Eastern one.
Moose attributed his being perceived as a feminine gay man to
these cultural differences and noted that this can make it harder
for him to be perceived as male.

FINAL THOUGHTS
Moose is a Japanese/Korean, gay, transgender man, in his late
twenties. Currently living in Chicago, he immigrated to the US
from Japan several years ago. While Moose opted to use his
real name, because of his irregular immigration status, we have
made the decision to protect his identity by using a pseudonym
and obscuring some other details.
Moose has experienced a number of obstacles in his path to
recognition and self-acceptance as an autistic and transgender
man. These include, most notably, if not exhaustively, family
rejection, healthcare gatekeeping, and racism. Many of the
 Moose 85

individuals interviewed for this book share some or all of these

concerns. Moose’s situation is, however, unique in the manner
in which these experiences interact.
Moose’s family is the main line of a very traditional Japanese
family. As such, his existence, as both autistic and transgender,
defies the plans and roles expected of him. Moose’s family
steadfastly refused to accept either multiple autism diagnoses
or his clearly voiced male identity, and ultimately abused and
disowned him. His family’s exacting standards, particularly
regarding academic and social roles, were also mirrored in
other interviewees’ narratives.
By contrast, once out of Japan, Moose was able to connect
with other autistic people and communities, which was critical
to both accepting himself as autistic, and accessing care for
it. He was similarly able to explore his gender identity, meet
others doing so, and decide to transition medically. He did
note, however, that the difference between gendered social role
expectations in Japan and the US made this process somewhat
more complicated. For instance, he is perceived as a feminine
gay man in the US for engaging in the same behaviour that is
seen as very masculine in Japan.
Moose has experienced a number of barriers in accessing
healthcare. As a student in the US, he initially had healthcare
insurance through his university; however, he exhausted his
educational savings on asthma treatment, after it was classified
as a pre-existing condition, and was forced to drop out of
school, leaving him completely without insurance. Now, as
an undocumented immigrant, he has no access to healthcare
beyond what he can pay for out of his own pocket and cannot,
therefore, afford more costly procedures like top surgery.
Moose has on several occasions been denied transitional
healthcare due to being autistic. This was especially the case
in New Orleans, where those with autism were subjected to
an extended waiting period, in order to rule out the possibility
86 TRANS AND AUTISTIC

that their desire to transition was somehow an “autistic

fixation.” Moose ultimately moved to Chicago, in part to obtain
unbiased healthcare, and, in doing so, succeeded in obtaining
a prescription for testosterone within the same timeframe as a
neurotypical person. Interestingly, he reports that testosterone
has made his autistic symptoms more pronounced, limiting
his ability to hide them, which he fortunately no longer feels
the need to do. In fact, the law in Illinois protects him from
discrimination due to race, disability, or gender identity and, as
a result, he is able to work as an openly autistic and transgender
person.
Moose has also experienced a great deal of racism. While
he considers Chicago to be better in this regard, he has been
subjected to regular prejudice there since Trump was elected.
In New Orleans, however, police prevented him from accessing
autism or LGBT supports in the suburbs by “stopping and
frisking” and redirecting him because he was not white. He
was similarly prevented from attending LGBT services in urban
neighbourhoods for being “too light.” By contrast, Moose
has been able to access autism and transgender community
supports in Chicago, although he finds that members of the
autism groups, at least, are still largely white.
Moose’s life has included a number of hardships, not least
in the form of family abuse, racism, and ableism. Nevertheless,
while we may be tempted to view Moose’s story as largely
negative, it is also, above all, a narrative of resilience, self-
reliance, and community. In recognizing the need to escape
his abusive family situation, and fully realize himself as
autistic and transgender, at 11 years old Moose concocted and
carried out a plan to apply to successive boarding schools in
the US. While this option is clearly not open to everyone, it
demonstrates his resourcefulness and self-reliance. Though
Moose continues to experience challenges, he also has the
support of a wide-reaching network of friends and community
 Moose 87

and, above all, has found a way to forge his own unique path,
regardless of the obstacles in his way.

ENDNOTES
1 The Japanese term for autism.
2 Strang et al., 2018b
3 Short for self-stimulating behaviour, stimming is used by autistics
and can consist of repetitive movements like hand flapping, to
self-regulate when overwhelmed by sensory input, or purely for
enjoyment (Bakan, 2015).
4 Morgan, 2013
5 The Williams Institute, 2015
6 Ramirez, 2018
7 Chen, 2017
8 This is not an uncommon experience (Burns, 2017).
9 In many healthcare insurance regimes, particularly in the US,
pre-existing conditions are defined as existing before the onset of
insurance coverage, and thus are not paid for.
10 Medicare and Medicaid are US government programs that provide
limited medical coverage to people who are over 65, disabled, and/
or on a low income.
11 Eldred-Cohen, 2018
12 Myeong-hong, Seung-yeop, & Chang-hwan, 2005
13 Johnson & Levinson, 1988
NAMI

Nami is a 33-year-old Taiwanese Hakka Han woman living in

Toronto, who identifies as asexual/pansexual. Born in Taipei,
she has identified as female for as long as she can remember.
She first suspected that she was autistic in elementary school
and now considers herself part of the larger autistic community.
Nami’s experience of diagnosis, however, has been murkier and,
as a result, she isn’t sure whether she currently has an “official”
diagnosis of autism. She uses she/her pronouns and has also
chosen the pseudonym “Nami.”

COMING OUT AS AUTISTIC

Nami first suspected that she was autistic, or, in her words,
“broken,” around grade three and subsequently received
a preliminary autism diagnosis and treatment for autistic
symptomology while growing up in Taiwan. She has since
received a disorienting number of labels, including high-
functioning autism, low-functioning autism, and, now,
neurotypical with overlapping autistic-like symptoms due to
developmental trauma. This last diagnosis, however, was made
informally by a psychiatrist, who is also a close friend.
Nevertheless, Nami claims an autistic identity, which she
first took up on entering university. She was, in part, prompted
to do so by a transfeminine and autistic friend with whom she
felt a strong kinship. Both had a delay between experiencing

89
90 TRANS AND AUTISTIC

and processing events, lacked object constancy, and didn’t

expect regular connection during each other’s absence. She
describes their friendship as “something frozen that only
required defrosting” and, as a result, they were able to pick up
their friendship right where they’d left it, despite not having
seen or heard from each other since they were children. Nami’s
understanding of this as an autistic trait helped her to begin
to understand herself as autistic,1 though her psychiatrist has
attributed this, and other autistic behaviours, to developmental
trauma.
Nami sees herself as part of the Mad Movement which,
arising out of the anti-psychiatry movement, rejects and
resists over-pathologization of what they view as neurological
difference, rather than mental illness.2 Accordingly, she rejects
diagnostic labels that serve no practical purpose and has a
general distrust of psychiatric pathologization. Nami likens the
Mad Movement’s fight to decriminalize mental health to the
neurodiversity movement’s3 efforts to de-pathologize autism.
She notes that, despite the rise of terms like neuroplasticity,4
“normalcy” remains the arbitrary standard on which everyone
is measured, with those deviating from it seen as “lesser than.”
Despite this, Nami attests that everyone has autistic traits,
making the concept of “normal” impossible, and observes that
we would not have science without them.

COMING OUT AS TRANSGENDER

Nami first expressed “crossdressing behaviour” when she was
seven years old. Some years later, she mimicked menstruation
using her mother’s underwear, sanitary products, and red
watercolour paint. Nami was largely unaware of transgender
people at the time, outside stereotypes of transsexual sex
workers, and prejudices about Thai Kathoey5 workers who
performed “vulgar and hypersexualized” shows in Taiwan.
 Nami 91

When she was very young, Nami’s mother asked her if

she wanted to be a girl, and though she very much did, she
responded “no.” She did so, in part, because she did not wish
to emulate her mother who, as the only female member of her
family, was her sole example of womanhood. This effectively
(if temporarily) halted her exploration of her gender identity.
Nevertheless, Nami now realizes that she has, consciously or
not, tended to mirror her mother’s values and mindset, and
wonders whether this might be a reflection of her autism.
Nami’s ability to come to terms with her identity as female
was further complicated by experiencing years of sexual abuse
at the hands of her “uncle.”6 To cope with the trauma, she told
herself that only women get assaulted and therefore she must not
be a woman. It took her a long time to overcome this internalized
misogyny and accept her female identity. In fact, Nami did not
come out voluntarily. She had initially planned to commit suicide
after her parents passed away, reasoning that, at this point, her
duty to them would be at an end, leaving her to “join the ring
of reincarnation and maybe have better luck in her next life.”
Nami’s mother’s constant criticism, however, led to a different
outcome. Her mother relentlessly criticized the way she dressed,
as well as her long hair and nails, even taking a sadistic pleasure
in cutting them short. This culminated during a family breakfast,
while she was home from university, when she was relentlessly
interrogated and accused of being gay and dating a man. Nami
deliberated on this incident for a few days before deciding to
come out as a woman to her family, which they took badly.7
Nami observes that her orientation towards transgender
diagnosis mirrors her approach to autism in that, unless related
to a practical purpose, she doesn’t see the need. Unfortunately,
without a diagnosis, it is often difficult or impossible for
transgender people to move forward with medical and
social transition. Nami finds this type of gatekeeping
deeply problematic.
92 TRANS AND AUTISTIC

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Nami feels that, while there may be a link between transgender
identity and autism, it could result from correlation rather than
causation. They may, for instance, appear connected because
autistic people are inherently more visible due to being less able
to mimic cisgender behaviours or lie about their transgender
identity. More broadly, she wonders whether the neurodiversity
model could be applied to both autism and gender variance.

FAMILY
Nami’s mother was very invasive of her privacy and demanding
of her academic and social performance while she was growing
up. She set unreasonably high standards, and when Nami failed
to meet them, Nami was blamed and told to “try harder.” Nami
was sent to boarding school in the US at age 12 in an attempt
to improve her academic achievement. Ultimately, her mother
reacted with disapproval and disgust when Nami came out
as female. Nami’s revelation of being autistic, though largely
insignificant in the wake of coming out as female, was met with
a similar reaction and the assertion that it wasn’t true because
“my son couldn’t be such.” She knows of no others with autism
in her family, though she understands that it may be heritable.8
According to Nami, this is consistent with East Asian
culture, in which children tend to be seen as property and an
investment, rather than human beings with their own sense
of self. She wryly observes, however, that reparative therapy
for transgender children wouldn’t be legal9 in North America
if they didn’t share the same perspective. Nevertheless, in the
eyes of her mother, Nami’s failure as a son who can carry on
the family name reflects her own social failure. Though she had
until that point managed the family finances, this duty, along
with other privileges and family support, were stripped from
 Nami 93

her after coming out as transgender. Her mother’s logic is that

Nami is a failed investment that she must now sell at a loss.

COMMUNITY AND ACTIVISM

Nami has been more involved with the transgender than
the autism community. She has, for instance, participated in
programs through Toronto’s 519 Community Centre.10 Nami
has also mentored a few autistic people, and worked with the
LGBTQ community as both a sexual health educator and
advocate, and with migrants seeking refuge in Canada.

WORK
While she is able bodied, Nami considers herself to be less
“able minded,” which limits her ability to do intense mental
work for more than a few days without experiencing severe
fatigue and “crashing.” This is largely due to her autism, which
impairs her ability to multi-task, or interact with others without
putting a great deal of effort into anticipating and managing
social interactions. Though she worries that it is overly rigid
and ineffective, Nami copes, in part, by using social scripts.11
This strategy enables her to better communicate, reduces her
anxiety, and gives her mental space to watch for social cues
like blink frequency and changes in facial expression, which is
especially difficult, as she experiences facial blindness.12 Nami
notes, for instance, that she isn’t able to identify a smile, even if
it is very rigid, but that she can “intellectually” register a sudden
change from a neutral facial expression to a smile as a positive
sign. She is, as a result, extremely capable at tasks that require
planning and considered bursts of energy, like event planning
and management, but less able to manage a nine-to-five job.
94 TRANS AND AUTISTIC

HEALTHCARE
In addition to autism, Nami has a number of degenerative
autoimmune disorders, which, fortunately, are currently well
managed. Her experience of healthcare has, however, been
largely negative. For instance, she recalls that, in elementary
school, she was forced to see a counsellor who violated her
confidentiality by disclosing the content of their sessions to
her mother. This has subsequently impacted her ability
to trust healthcare practitioners and, in particular, mental
healthcare providers.
Though she has never been subjected to ABA, the treatment
that she did undergo for autistic symptomology was traumatic
nevertheless. As a child, she experienced difficulty with small
muscle control and hand–eye coordination, which made it
difficult for her to perform tasks like balancing or catching a
ball. Nami’s therapist proposed to treat issues like poor balance
by prescribing exercises where she practiced moving along the
ground while lying face down on a board. While it was intended
to be an indoor activity, her mother moved it outside, requiring
Nami to brake the momentum of the board while it went down
the steep hills near their home.
Nami’s parents felt comfortable modifying the therapists’
treatment protocols because they both worked in the healthcare
field, though neither possessed any expertise in occupational
therapy or autism. They believed that they would be able to
achieve better and faster success by making the exercises more
difficult, but only succeeded in risking Nami’s health, and
causing her mental and physical trauma. In fact, in the process,
she sustained a number of physical injuries and even, by her
description, near death experiences. Nami sees this as reckless
and perhaps intentionally malicious. While she acknowledges
that the prescribed therapy helped to some extent, particularly
in fine motor skills like holding a pencil, the constant pressure
from her parents pushed her into a “failure narrative.”
 Nami 95

Nami reflects that she is not very in tune with her emotions
and has, for as long as she can remember, experienced
dissociation. As a result, her emotions are often isolated from
the world around her, and she must put a great deal of effort
and intention into thinking, reading, and planning for social
interactions. Nami’s demeanour, while outwardly apathetic,
hides a wealth of emotions; however, her experience of them
is often delayed, sometimes by weeks or even months. She also
intentionally uses “thick skin” as a coping mechanism to deal
with dissociation and the world around her.
Nami isn’t usually aware of being treated differently by
healthcare practitioners for her female identity or autism,
though largely because she fails to notice, rather than a lack of
discrimination. When she does notice, it is because the incident
has become very obvious, in which case, her female identity
is usually the point of contention. Nami relayed one incident
in which she saw a Chinese eye specialist in Scarborough for
rheumatic iritis. During this visit, her transgender history was
announced in the waiting room and the doctor asked when she
would be having “the surgery.”

MEDIA REPRESENTATION
Nami hasn’t seen her own experiences reflected in popular
media. She declined to comment on autistic-only representation.
Nami did address transgender-only representation, though
only to note that she finds it strange that transgender roles are
usually filled by cisgender actors.

SOCIAL RULES
Nami studies social situations as if they were textbooks,
analyzing every possible scenario, and predicting outcomes.
She sees this as typical of transfeminine individuals, who
96 TRANS AND AUTISTIC

may seek to avoid conflict, due to the extraordinary degree

of transphobic violence they face.13,14 Nami largely passes as
female now and, as such, doesn’t really experience confusion
from others as to what social role she should fill. However, she
shared that people sometimes respond with violence when
she does fail to pass. Nami relayed a story from about 2011 in
which she was approached by a white man in his early twenties
outside a subway station. The man approached her from behind
and tapped on her shoulder while she was on the phone. Nami
turned around and asked if she could help him and the man,
whose face “turned red,” started pointing at her and yelling
“You are a man, you are a fucking man!” She was able to extract
herself from the situation by staying on her phone while quickly
turning around and walking away but worries that it could have
turned out much worse. Nami shared that this is one of the
reasons why she always exerts a lot of effort to pass as female.

FINAL THOUGHTS
Nami is a 33-year-old Hakka Han woman who was born in
Taiwan and currently lives in Toronto. She has had a dizzying
array of neurodevelopmental diagnoses following a prospective
diagnosis of autism as a young child in Taiwan and, though she
was recently informally diagnosed as “not autistic,” continues to
see herself as part of the autistic community. As a result, Nami
aligns herself with the Mad Movement, in “defying diagnosis,”
and the neurodiversity movement, in seeing autism as a natural
human variation. Her approach to transgender diagnosis and
gatekeeping is similarly influenced.
Nami first started “crossdressing” when she was very young,
but her ability to further explore her gender identity at that
time was cut short by a lack of positive transgender or female
role models. In fact, though she has always “felt female,” she did
not intend to come out. Rather, she had planned to kill herself
 Nami 97

after her parents passed away. It was only when her parents
forced her out of the closet that she began to fully explore and
accept her gender identity. Her parents, however, did not react
positively and were not supportive of either her autism or
gender identity. Nami’s experience here parallels Moose’s (in
the previous chapter), in that both come from Asian families
that demanded they perform beyond their capacities, sent them
to US boarding schools when attempts to “fix” their autism
failed, and rejected them completely as transgender. Nami
relates this to her view that East Asian culture sees children as
property and an investment.
Nami recounted a number of negative healthcare
experiences. Those that stand out include ethics violations
from medical specialists and therapists and her parents’
dangerous modification of autism treatment protocols. These
incidents have understandably made it difficult for Nami to
approach and trust medical professionals. Nevertheless, Nami
is resilient. She is very active in the transgender and autistic
communities, even acting as a mentor to other autistic people
on several occasions. Nami has also contributed to the LGBTQ
community as a sexual health educator and an advocate for
queer migrants. While autism (in particular, facial blindness)
sometimes makes this difficult, her experiences have taught
her to manage anxiety and communication by studying social
situations closely and using social scripts. Nami has also found
that autism makes her a uniquely capable event planner and,
overall, her experiences have helped her to develop a valuable
criticism of psychiatry and pathologization.

ENDNOTES
1 Bertilsdotter Rosqvist, Brownlow, & O’Dell, 2015
2 Jackson, 2013
3 Crow, 2017
98 TRANS AND AUTISTIC

4 “A general umbrella term that refers to the brain’s ability to modify,

change, and adapt both structure and function throughout life and
in response to experience” (Voss et al., 2017, p.1).
5 A culturally specific gender identity, broadly comparable to
“transgender woman,” used in Thailand (Winter, 2006).
6 In Chinese and Taiwanese culture, older friends of the family are
often referred to as uncle or aunt.
7 Nami doesn’t strictly identify as transgender. Her general stance is
that gender is and should be respected as self-declared.
8 Autism does, in fact, appear to be highly heritable (Sandin et al.,
2017), with recent large-scale research demonstrating that 80 percent
is inherited (Bai et al., 2019).
9 Parallels with treatments for autistics should also be drawn here, as
with the Judge Rotenberg Center in Massachusetts, US, which uses
powerful electric shocks to control the behaviour of autistic children
(Pilkington, 2018).
10 The 519 Community Centre, n.d.
11 Social scripts are a strategy where a person develops and uses set
responses to typical questions and scenarios. They are also sometimes
referred to as “social stories” or “comic strip conversations” (National
Autistic Society, 2018).
12 Formally known as prosopagnosia, and not uncommon among those
with autism, it denotes the inability to recognize faces (Davis, 2006).
13 Perry & Dyck, 2014
14 Human Rights Campaign, n.d.
NATHAN

Nathan is a 26-year-old queer and transgender man from Houston,

Texas, of Black and multiracial (white, native) heritage. He
currently manages the Transgender Health Lab at the University
of Houston, and has a formal diagnosis of autism. Nathan has
opted to use his real name and uses he/him pronouns.

COMING OUT AS AUTISTIC

Nathan first suspected that he was autistic in 2011. He was,
at the time, a regular watcher of the shows Parenthood1 and
Degrassi,2 both of which have characters with Asperger’s,
and subsequently became interested in reading more on the
subject. He chanced on the book Look Me in the Eye, by John
Elder Robinson,3 which he found closely described his own
experiences. Nathan was then prompted to talk with his mother
about the possibility of being autistic. He largely kept his
suspicions to himself until late 2017, when he chose to discuss
some executive functioning difficulties with his employer, who,
as a clinical psychologist, had suspected Nathan was autistic
and was waiting for him to disclose this on his own.
Executive function refers to the capacity to self-regulate
and direct behaviours towards a goal. It allows us “to break
our habits, make decisions and evaluate risks, plan for the
future, prioritize and sequence our actions, and cope with
novel situations.”4 Though investigations into the incidence

99
100 TRANS AND AUTISTIC

of executive dysfunction in autistics are mixed, many studies

do demonstrate a significant and consistent impairment in
this area.5
Nathan has had difficulty obtaining a formal diagnosis. His
psychologist initially “shut him down” when he brought it up,
because Nathan didn’t fit his image of a person with autism,
which prompted him to stop seeing this professional for a
period. Nathan only recently started seeing this psychologist
again after he committed to learn more about autism and
explore the issue with him. Despite worrying that he might
appear to be taking something away from or invalidating
those with a diagnosis, Nathan is nonetheless largely at peace
with not having one.6 This is, in part, because the school and
work accommodations that might help him are typically only
available to those who received a diagnosis prior to age 16.

COMING OUT AS TRANSGENDER

Nathan first came out to himself as transgender in March 2010.
He was, at the time, attending a transgender support group as
part of a senior project during his last semester of high school.
Nathan described how he deeply identified with aspects of other
participants’ “gender journeys” and, as with autism, “something
just clicked.” In terms of coming out, he first tested the waters
by asking friends, “What would you think if I said I was really
a guy?” Nathan subsequently spoke with his school therapist
and told his friends that he did, in fact, identify as a man. He
informed his family last. Overall, Nathan characterizes his
coming out experience as “pretty smooth.”

LINKS BETWEEN AUTISM AND GENDER IDENTITY

When asked, Nathan indicated that he didn’t feel that autism
and gender identity were intrinsically related, though they can
 Nathan 101

share common factors and influence each other, depending

on the person. For instance, his autism impaired his ability to
pick up on unspoken gender norms and rules and, ultimately,
to evade female socialization. Nathan related that it also
influences how he interacts with the world as a man. Though
he is intellectually aware of the clothing expectations for men,
he nevertheless chooses to select clothes according to his own
preference and comfort, and without regard to gender.

FAMILY
Nathan’s family has largely been supportive of both his autism
and gender identity. As regards his gender identity, the first
person he came out to in his family was his oldest brother,
whom he felt would be supportive as a gay man. In fact, though
his brother eventually came to accept it, he initially “questioned
it quite a bit.” Nathan then wrote a coming out letter to his
parents. He describes their reaction as “not unsupportive,”
and primarily characterized by needing time to process
the information. Nathan’s parents now attend all the events
he organizes and volunteers at and “are as involved in the
transgender community as [he] is.”
Overall, Nathan’s parents are also accepting of his autism,
though they have had difficulty reconciling their need to show
physical affection with his for limited physical contact. This has
been particularly difficult for his father. His mother is more
understanding in this regard, possibly due to her long career in
special education and psychology. She does, nevertheless, find
it difficult not to share physical affection with him, especially
since they are quite close. Nathan also shared that his mother
may be broadly autistic and, according to her, his grandmother
likely was.
102 TRANS AND AUTISTIC

COMMUNITY AND ACTIVISM

Nathan is very active as both a participant and organizer in
the transgender community. For instance, he manages the
University of Houston’s Transgender Health Lab7 and helps
to organize an annual conference, called Gender Infinity,8 for
transgender youth and their parents. With regards to the latter,
Nathan has worked hard to increase programs for people of
colour, Spanish speakers, and those who are disabled.
More recently, Nathan has used his skills to address issues
important to the transgender and autistic community. He is,
for example, currently working on research which challenges
other publications9 that posit that “transgender men…are just
autistic women who [became masculinized because they]
weren’t able to socialize with female peers.” To date, Nathan
has presented this research at the Philadelphia Transgender
Wellness Conference10 and at the biannual conference of
the World Professional Association for Transgender Health
(WPATH) in Buenos Aires, Argentina.11

WORK
As noted, Nathan manages the Transgender Health Lab at the
University of Houston, which has undertaken a longitudinal
investigation into the mental health impacts of testosterone
on transgender men12 and investigated the impacts of social
transition on youth. 13 The lab is heavily involved in the
transgender community and the creation of transgender
health-related infographics. As part of his duties, Nathan has
presented their research at both the 2018 WPATH and Gender
Infinity conferences.
 Nathan 103

HEALTHCARE
In addition to autism, Nathan is diagnosed with generalized
anxiety disorder (GAD), OCD, agoraphobia, hoarding, and
chronic migraines, which he characterizes as symptoms or
traits of his autism. When seeking healthcare, he goes either
to Houston’s main transgender healthcare provider or to the
private practice of a doctor recommended through word of
mouth as competent in transgender healthcare. Overall, and
despite his psychologist’s initial dismissal of his autism, he sees
his healthcare experience as uneventful.
Nathan receives a number of disability-related educational
accommodations. These include (but are not limited to) priority
seating near the exit, supplemental class notes, an allowance
for greater absences, increased exam time, and permission
to record lectures. There is no official channel for receiving
accommodations in his workplace, but he has found that they
make a point of supporting people in whatever way is needed.
Nathan wants people, especially those who are autistic
and transgender, to know that autism doesn’t preclude being
transgender, or vice versa. Nevertheless, those who wish
to medically transition may need to consider things that
neurotypicals do not, like the need to articulate and present
gender in a manner accessible to neurotypical healthcare
professionals. Some will also need to navigate challenges to
their capacity to decide on and direct transitional healthcare.
Nathan recommends that transgender and autistic people fight
the temptation to internalize these barriers.

MEDIA REPRESENTATION
Nathan has seen media representations of transgender and
autistic people separately, but never in the same person,
or central to the plot. He notes that while there are many
characters who are coded as autistic, it is not usually explicitly
104 TRANS AND AUTISTIC

stated, and that negative or biased portrayals can influence

public misconceptions about autistic people. Nevertheless,
Nathan feels that as visibility has grown, transgender people are
increasingly being presented positively and even given more
opportunities to play these roles themselves.

SOCIAL RULES
Nathan is grateful that his autism made him somewhat
impervious to gender role expectations growing up. He tries to
acknowledge this privilege by undermining those expectations
whenever he can. Nathan also commented extensively on
how the unique cultural and social expectations in the Black
community impacted him as an autistic person—for instance,
that these cultural expectations, which in some cases are borne
out of racism, can mask and provide an alternative explanation
for autistic symptomatology. One example Nathan gave was
the prizing of cleanliness as a response to the historically racist
perception that Black people are unclean. As a result, obsession
with cleanliness might be seen as positive, rather than a
symptom of OCD. Similarly, Nathan described how the Black
community’s emphasis on respect, especially for one’s elders,
may lead some to see autistic behaviour as defiance. He adds
that, “since physical punishment is still seen as acceptable in a
lot of communities of colour, adults may believe they can whip
it out of their kids.” Nathan himself is often seen as rude or
disrespectful within Black communities and, as a result, tends
to avoid conversations with Black elders he doesn’t know.

FINAL THOUGHTS
Nathan is a 26-year-old queer, transgender man, of Black
and multiracial heritage. His experience as an autistic person
is deeply entwined with his experience as a Black man from
 Nathan 105

the southern United States. As the manager of a transgender

research lab at a major university, Nathan also has a unique
perspective on the topic and the ability to pursue research on
the intersection of transgender and autistic experiences.
Nathan’s exposure to autistic characters on television, and
the published narratives of autistics, had a big impact on
his recognition of himself as autistic. In the same vein, his
participation in transgender community groups, as an observer
for a school project, led him to an awareness of himself as a
transgender man. Nathan observes that while gender identity
and autism are not intrinsically related, they can share common
factors and influence each other. In his case, the latter may
have impacted his ability to pick up on and internalize female
socialization.
Nathan’s experiences of coming out, first as transgender and
then autistic, have been somewhat different. For instance, in
coming out as transgender, he first tested the waters by asking
friends what they would do if he said he was and, with the
support of the school counsellor, proceeded to inform them
that this was the case. Nathan told his family last and, while
they initially had some difficulty accepting this information,
they have since become big supporters. His parents in
particular never miss one of the transgender community events
he organizes or volunteers at.
Nathan took a somewhat different tack when he came
out as autistic. He initially broached the topic with his
parents who, while accepting and supportive, had difficulty
understanding and respecting his need for minimal physical
contact. Otherwise, Nathan largely kept this information to
himself until 2017, when he told his employer because he
needed workplace accommodations. To his surprise, his boss,
a clinical psychologist, had already intuited that he was autistic.
Nathan ultimately received a formal autism diagnosis after his
106 TRANS AND AUTISTIC

psychologist committed to research and explore the issue with

him having previously refused to entertain the possibility.
Nathan has several physical and mental health diagnoses
that he sees as symptoms of autism. He has two local options
for competent and supportive transgender healthcare and
has successfully negotiated disability accommodations at
both his workplace and school. As a result, he describes his
healthcare experience in largely positive terms. Nevertheless,
Nathan cautions that other transgender autistics may need
to be strategic in articulating their gender identity in a way
that is legible to neurotypical professionals and consider how
they would navigate challenges to their decision-making
capacity. He notes that it can be difficult for people not to
internalize this.
As an autistic Black man, Nathan has a unique perspective
on the role that social rules and expectations have played in his
life, both individually and culturally. He notes, for instance, that
respect is highly emphasized in Black southern communities
and that, as an autistic man, he is sometimes seen as rude,
or disrespectful, especially by elders. Nathan posits that his
community may tend to see autistic behaviour as indicative of
defiance and respond with physical punishment. His personal
response to this is to limit interactions with Black elders that
he doesn’t know. Similarly, Nathan finds that his cleanliness-
related OCD symptoms tend to be seen as positive in the
Black community, which he attributes to the historically racist
stereotype that they are unclean.

ENDNOTES
1 Howard et al., 2010
2 Schuyler, Stohn, & Yorke, 2002
3 Robinson, 2007
4 Craig et al., 2016, p.1191
5 Demetriou et al., 2017
 Nathan 107

6 Nathan ultimately received a diagnosis of autism spectrum disorder

from his psychologist a few weeks after our interview. Autism is now
his primary diagnosis, with his others listed as symptoms.
7 Keo-Meier, n.d.
8 Gender Infinity Conference, n.d.
9 Jones et al., 2012
10 Philadelphia Transgender Wellness Conference, n.d.
11 World Professional Association for Transgender Health, n.d.
12 Meier et al., 2011
13 Ehrensaft et al., 2018
REYNARD

Reynard is a 26-year-old, Afro-Caribbean and Slovenian, gender-

queer and non-binary individual. Born in Germany, they previously
lived in Alabama, before moving to Chicago, where they currently
reside. Reynard was formally diagnosed with autism in their first
year of college and is now deeply involved in both the transgender
and autistic communities. They have opted to be identified by
their real name. They use they/them pronouns.

COMING OUT AS AUTISTIC

Reynard always knew they “weren’t on the same wavelength” as
other people. However, without the language to identify why,
or an awareness that others might have similar struggles, they
were isolated. Reynard’s differences were, nevertheless, clear
to the adults around them. For instance, they had difficulty
with inflection, reading, and making facial expressions. In fact,
Reynard’s teachers would sometimes remark on their similarity
to autistic relatives, though they unfortunately never considered
this a diagnostic possibility.
While Reynard’s regular teachers developed an
understanding and even affection for their quirks, without
an official diagnosis, they were vulnerable when faced with
unfamiliar instructors. To substitute teachers, for example, they
sounded “too smart” to be confused and their many questions
were seen as an act of defiance and disruption. This issue was

109
110 TRANS AND AUTISTIC

exacerbated by the fact that, because Reynard is Black, they

were viewed as “prone to intentionally disrupting the class.”
Reynard mentioned one case in which a substitute teacher
called the school resource officer (SRO)1 on him. As they
recalled, she ran out of copies of a test and, when given the last
copy, Reynard offered it to another student who had trouble
with the subject and needed more time. This instructor then
accused them of refusing to take the test and demanded that
they start immediately. When Reynard tried to explain that
they couldn’t start until more copies were made, she told them
“not to tell her what to do” and asked “if [they] thought she
was stupid.” She ultimately alleged to the SRO that Reynard
had attempted to “incite a riot” and, though it was cleared up
by teachers familiar with them, it could have gone disastrously
wrong.2 They are acutely aware that, had they been diagnosed
earlier, oppositional defiance disorder, or a similar conduct-
based disorder, would have been likely due to their race.3,4,5
Reynard also recalled the case of Charles Kinsey, in which
the African-American behavioural therapist of a Puerto-
Rican autistic man was shot by police, because they mistook
the autistic man’s toy truck for a firearm.6,7 Reynard worries
that, in a situation like this, they or a friend would be shot
because they wouldn’t be able to explain or understand police
instructions quickly enough. Reynard has even practiced
looking and sounding non-threatening in anticipation of just
such an event. They are, furthermore, aware that their race gives
them less leeway in this type of misunderstanding and that
protective measures taken by other (white) autistic people aren’t
practical for them. For instance, there are cards autistic people
can use to explain their autism to police,8 some of which are
developed and endorsed by individual states.9 Reynard doesn’t
bother with these, however, “because [as a Black, masculine
person, they] don’t feel safe reaching into [their] pocket for
anything around police.”
 Reynard 111

Reynard stumbled across a diagnostic inventory for autism

while researching ADHD in their senior year of high school.
In fact, ADHD and autism share symptoms, such as difficulty
with organization, and executive dysfunction, and there is
some evidence of a link between them.10 Reynard’s first reaction
on reading about autism was an immediate recognition of its
similarity to their own difficulties. Still, they found it hard to
accept that they were autistic and not “just weird” due to early
childhood trauma, and the fact that their parents came from
two different cultures.
Reynard had a neuropsychiatric evaluation in their first
year of college, at which they received a diagnosis of autism,
despite going in for an ADHD assessment. They recall the
process as affirming and helpful, in spite of their concerns
and self-doubts, and felt fortunate to have had a diagnostician
specialized in autism. Reynard worried, for instance, that
their autistic symptoms resulted from being a person who was
fundamentally bad or dangerous. The specialist confirmed
that they were “definitely on the spectrum” and assured them
that it was a natural human variation that was not intrinsically
negative. In particular, he highlighted that Reynard’s difficulties
often resulted from living in a world that isn’t designed for
people who think like they do, which is more a reflection on
society than them. In the end, they found the diagnosis helped
to validate and learn to trust their manner of understanding
and interacting with the world.
Reynard almost immediately informed their close friends
and family about this diagnosis and found them to be affirming
and supportive. It was their larger social circle that, owing to
inaccurate assumptions and stereotypes about autism, had the
most trouble understanding and accepting this information.
Some people, for instance, couldn’t reconcile the fact that
Reynard is highly verbal with the popular stereotype of autistics
as totally disabled.
112 TRANS AND AUTISTIC

COMING OUT AS TRANSGENDER

Reynard recalls being gender non-conforming as a child. They,
for instance, experimented with gender neutral names, were
elated when people mistook them for a boy, played middle
linebacker in middle school, and insisted on singing tenor in
choir. Despite this, Reynard had difficulty seeing themselves
as transgender, because it was a term associated, in their
mind, with media stereotypes of “men who wore their wives’
underwear.”
Autism is, of course, a condition characterized by difficulty
generalizing from singular examples to broad categories.11
It may be, therefore, that autistics have difficulty connecting
their experience to the larger transgender community because
of singular and often misleading, or downright inaccurate,
media representation. Some autistic people do, nevertheless,
experience gender dysphoria and identify as transgender.
For Reynard, everything fell into perspective when they
met a transgender man at age 20. Prior to this, they assumed
that their attraction to women mandated that they be a lesbian.
Still, Reynard had a hard time separating their sensory issues
from gender dysphoria and in deciding to transition. They
also worried that they weren’t “trans enough,” or that hormone
therapy would make them sexist and abusive. Nevertheless,
Reynard described being intensely dysphoric about their
voice, name, and lack of body hair, and deeply resentful of
how uncomfortable and disruptive menstruation was. They
also once told their father that, “if I grew breasts, I would hack
them off with a rusty spoon.”
Reynard’s best friend Jose, who is an autistic transgender
man they describe as very pragmatic, helped put these concerns
into perspective. Jose reasoned that, while transition might have
downsides, it was an acceptable option if it had more positive
than negative outcomes on balance. Jose argued that Reynard
had no obligation to be miserable, it wasn’t helping anyone, and
 Reynard 113

that hormonal therapy was capable of addressing all the aspects

of gender dysphoria that made them most uncomfortable. He
helped them understand that they could be whatever kind of
transgender person they wanted, which didn’t preclude them
from wearing dresses, or oblige them to become misogynistic.
Reynard considered this and reasoned that no medications
or treatments can make someone cisgender and, even if they
could, the required brain surgery or medication would still alter
their body. They ultimately concluded that their gender identity
is foundational to their perception and experience of the world
and that, while some aspects of transition might be unpleasant,
the positive ones were, on balance, likely to outweigh them.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Reynard, when asked what they would say to someone who
argues that autism caused or impaired their ability to determine
their gender identity, responded that this is neither true nor
relevant to their life. They reasoned that, while autism may
make them more aware of and inclined to question where their
gender identity and other aspects of their being diverge from
the mainstream, it also makes them less vulnerable to distress
resulting from being seen as different. Reynard explained that
their transgender identity, even if a manifestation of autism,
isn’t going to disappear and that, in any case, there is no harm
in being transgender, since they “don’t kidnap people at the bus
stop to acquire new clothes…or harvest testosterone like some
kind of hormonal vampire.”

FAMILY
Reynard’s father is Afro-Caribbean and their mother is
Slovenian. While their father and brother are largely supportive
of them, their mother, who they describe as “cartoonishly
114 TRANS AND AUTISTIC

racist,” is not. Growing up, Reynard’s mother physically and

emotionally abused them for both being autistic, which she
interpreted as defiance and willfulness, and “too Black.” She
attributed all Reynard’s “good” characteristics, like compassion
and precociousness, to their white heritage and their “bad”
traits, such as stubbornness, to their Black heritage. As a result,
Reynard has chosen not to keep in contact with their mother,
and she is not aware of their autism or gender identity.
By contrast, their father has been very supportive of their
autism, though their extended family sees it as odd and due to
“either being part white or around white people.” Nevertheless,
Reynard has a cousin who has been diagnosed as autistic, and
suspects that other family members are also “on the spectrum.”
Their father has also been quite supportive of their gender
identity, though their first response, when told, was “but that’s
so expensive!” Reynard countered that there are coupons for
medication and describes their father as affable about it since.
Reynard’s siblings are very supportive of their gender
identity as well. Their sister, for example, is very good about
using their chosen name and pronouns. They also relayed an
extremely moving story about their brother: Reynard explained
that, when they were born female, their parents gave the name
chosen for them to their brother and, when they came out, they
told him they wanted it back. Amazingly, their brother agreed
without hesitation and proceeded to consider potential new
names for himself. Although they and their brother ultimately
did not pursue this arrangement, it was a deeply touching
gesture to Reynard.

COMMUNITY AND ACTIVISM

Reynard moved from Alabama to Chicago specifically so
that they could connect with other people in the transgender
and autistic communities. They chose Chicago in part for its
 Reynard 115

accessible transit infrastructure; Reynard explained that, in

Atlanta, the transit system was such that they had to walk to get
most places, which restricted their ability to attend community
events. It also made them more reliant on abusive people for
transportation. In Chicago, by contrast, Reynard can rely on the
transit system to enable them to find and maintain friendships
across a wider geographic and socio-economic area. They also
appreciate Chicago’s diversity and variety, which has allowed
them to find their niche while avoiding being tokenized.
Reynard has, since moving to Chicago, volunteered as a
patient advocate for transgender and autistic individuals. They
accompany people to medical appointments and the emergency
room, help them understand paperwork, make sure they aren’t
misgendered, and assist in translating concerns into language
understood and respected by doctors. Reynard also moderates
a non-binary and genderqueer discussion group, in which more
than half the participants are on the autism spectrum.12 They
support autistic participants, in part, by using social stories13
to break down the steps in navigating, for instance, doctor’s
appointments and pronouns at job interviews. Using these
and other strategies, Reynard has helped the group develop a
number of working agreements.
Reynard explained that they took over the group from
previous moderators who were burned out by its dysfunctional
nature. At the time, participants didn’t feel comfortable setting
or enforcing boundaries, and several struggled with social
skills. Many continued to attend, however, because they lacked
other options. Reynard described the group as an “anxiety
engine, eating people up and spitting them out.”
Reynard felt that, because their autism led them to learn
social skills manually and granularly, it was easier for them to
advocate for and explain the structure that should be added to
the group. The first change they made was to begin meetings by
having participants discuss their “highs and lows” for the week;
116 TRANS AND AUTISTIC

that is, something nice and something bad that happened.

Reynard quickly discovered that the person with the most
intense low got the most attention, which caused others to
describe increasingly traumatic events, and distressed the whole
group. As a result, they instead started the group by asking
participants a silly question, such as “What did you do (or not
do) this week that you deserve a sticker for?” Reynard found
that this encouraged people to ask for praise in a healthier and
more manageable way and, when sharing positive and negative
experiences, to emphasize effort over accomplishment.
The group also used to have a rule called “Step up, step up!”
to encourage members who frequently talked to listen more
and vice versa. Reynard explained that it tended to target
people on the spectrum unfairly, however, because it required
them to pick up cues that they were speaking too much and
caused the group to resent them when they couldn’t. The rule
also led some group members to over-police themselves and
refrain from speaking at all. Reynard, in recognizing that
autistic group members needed to have specific, measurable
standards to follow, replaced it with a practice where, if a
person talks too much, the moderator simply tells them so. The
individual is then asked to wait for three people to speak before
they do (“three and then me”). Reynard explained that this
incident was indicative of a basic difference between autistic
and neurotypical people, which is that the latter are culturally
primed to avoid direct confrontation, and the former prefer
telling people to “shut up when they talk too much.”
Reynard offered an interesting example of how these
changes helped participants deal with anxiety and bigotry. They
were once asked whether being the only person of colour in the
group made them lonely or uncomfortable. They noted that this
made the neurotypical group members very uncomfortable,
which wasn’t productive and, for Reynard, clarified that the
autistic member had only verbalized what others were already
 Reynard 117

thinking, but were unable to say. They noted that they couldn’t
work together to fix the situation, or identify the things that
made them uncomfortable, if everyone couldn’t talk about
it openly. The group consists now, as a result of having this
conversation, of one-third people of colour.
This incident also caused Reynard to realize that, among
European Americans, respect is expressed by “mincing and
couching [words, and] deliberately and fastidiously” packaging
information in a way that is tiresome for autistics. By contrast,
among other Black people, they are encouraged to speak firmly,
directly, and proudly, while showing deference through making
sure that they enunciate words and are clearly understood.
Reynard explains that, in the Black community, it is considered
“disrespectful to imply [we] need our words cut up for us into
smaller and less heavy pieces, like a toddler’s dinner.”

HEALTHCARE
Reynard has a number of diagnoses, including autism, ADHD,
and anxiety. They are guarded in interactions with healthcare
professionals and typically only see doctors when they have
something they can’t manage on their own. Reynard is careful
to prepare for meetings with healthcare professionals ahead of
time by researching and preparing a list of concerns and answers
to doctor’s questions. With the exception of their physical and
transitional healthcare, which they recently consolidated under
a single trusted provider, they tend to keep their transgender,
autistic, and mental health-related care separate from each other.
Reynard keeps their healthcare compartmentalized like
this because they are aware of several cases where providers
have denied transitional healthcare to people with autism. As
a result, they opted to access testosterone therapy through a
harm-reduction clinic and were careful not to mention their
autism. Reynard also didn’t mention their transgender identity
118 TRANS AND AUTISTIC

when they went to the hospital with a broken arm. Similarly,

they have only disclosed their autism with their most recent
therapist, for fear of being dismissed as “too verbal” to be
autistic. Nevertheless, they describe their experience with
healthcare as “fine,” and are more concerned about being
profiled for seeking unneeded pain medication due to race.
Reynard is very involved in helping his best friend Jose,
who is autistic, transgender, quadriplegic, and non-verbal,
advocate for and obtain better healthcare. Reynard observes
that Jose is especially vulnerable in hospital, because staff
there lack knowledge or training in his method of non-verbal
communication. They also find that a great deal of advocacy
is needed to ensure Jose’s gender identity and transitional
healthcare needs are respected in hospital. For instance, he
is often denied testosterone as an inpatient, though he has an
ongoing prescription for it. On another occasion, Reynard
had to explain to a nurse that Jose, as a transgender man,
could not use a urinal in bed. The nurse then told them, in a
conversational manner, that “if her child told her he was trans,
she would have preferred that he had died at birth.” On other
occasions, healthcare practitioners have asked Reynard, as Jose’s
“service human,” whether his quadriplegia is related to being
transgender and, even when he is in distress due to choking and
in need of immediate assistance, have demonstrated a fixation
on what his genitals look like. As a Black transmasculine
person, they often have to balance attempts to intervene and
advocate for Jose against the need to appear calm and non-
threatening, as Jose would be left unassisted if security were
called on them.
Reynard explained that Jose is firmly against being admitted
to a 24-hour facility due to his sensitivities with sound and light,
and a dislike of strangers touching him. As a man who uses
adult diapers, he is particularly disturbed by the idea of having
strangers “stare at his crotch, while he’s helpless to defend
 Reynard 119

himself.” Reynard concludes that, because Jose has “enough

healthcare problems for both of them and several others,”
their own are minor by comparison. They observe that the two
of them “three-legged race into some measure of functional
adulthood,” because while Jose is profoundly impacted by
autism and thus infantilized, Reynard is high functioning, and
therefore overestimated.

MEDIA REPRESENTATION
Reynard wasn’t able to connect with other transgender and
autistic people until they moved to Chicago. As a result, most
of their initial understanding of the community came from
movies and TV shows, as well as books and internet forums.
In particular, they loved the movie Mozart and the Whale.14

SOCIAL RULES
Reynard points out that, though their brains work differently,
neurotypical perceptions tend to be forced on autistics. For
instance, it is presumed and even insisted on that hugs and
back rubs must feel good, when this is not the case for many
autistic people. To Reynard, this is akin to gaslighting, not least
because neurotypical social rules and conventions are often
arbitrary and change in unexpected and unpredictable ways.
For instance, the Black community favours directness and
clarity, and sees Reynard as reserved; conversely, white people
prefer indirectness and obfuscation, and see them as aggressive
and loud. Code-switching15 like this, particularly for an autistic
person, can be exhausting.
In practical terms, Reynard has a lot of difficulty navigating
social rules and expectations. They are, for instance,
“embarrassingly prone to getting sexually assaulted,” because
people read consent into their inability to pick up social cues
120 TRANS AND AUTISTIC

and relay their intent. Reynard describes one incident in which

they agreed to let a person lie in their lap because they didn’t
objectively see the harm. This escalated to more obviously
intimate behaviour, which they didn’t consent to, but also didn’t
know how to signal not being interested in. Reynard takes
longer to process information because they are autistic, and, by
the time they consider what is happening, their response, and
the potential for negative outcomes, the other person might
escalate their behaviour, causing them to repeat the cycle of
analyzing and processing.
Reynard has responded by developing a list of sexual
situations in which they “whitelist” actions. For example,
consent is not automatically given, and no one is allowed
to get close to them until they have finished processing the
situation. Reynard usually feels more comfortable in overtly
sexual situations, in which subtlety and non-verbal social
cues don’t play a part, like gay cruising. In this example,
sustained eye contact is clearly coded as an easy-to-decline
interest in sex. Bondage/discipline, domination/submission,
sadism/masochism (BDSM) communities, which are “high
protocol” and have a lot of “structure,” are similar. Reynard
admits, however, that listing all their desires ahead of time can
sometimes make them feel fragile and as if there is no room for
improvisation. The inconsistency in their tactile and sensory
needs can also be frustrating as, for instance, hugging might
be okay on some days and not on others.

FINAL THOUGHTS
Reynard is a 26-year-old mixed-race genderqueer and non-
binary person living in Chicago. Diagnosed with autism as an
adult, their experience of transgender and autistic healthcare has
been largely positive, though they have been careful to separate
the healthcare they receive, so that different practitioners are
 Reynard 121

unaware of each other, or their various diagnoses. Reynard

has found that, as an autistic person, this is often a necessity
to receive access to transitional care. They also worry that
healthcare professionals will accuse them of being too verbal
to be autistic, which is, in fact, a common concern among those
we interviewed. As a result, Reynard tends to avoid doctors and
manage their own healthcare and, when this is not possible,
carefully prepare for appointments ahead of time.
Overall, Reynard is happy with the healthcare they receive
as a transgender and autistic person and is far more concerned
about being profiled due to race. They are also very involved
in advocating for their friend Jose, who is autistic, transgender,
quadriplegic, and non-verbal, and see their own challenges as
relatively minor in comparison. In fact, it was Jose who inspired
Reynard to transition.
Reynard is far more frustrated by their experiences with social
rules and conventions. As a mixed-race person of colour, they
often find themselves straddling the equally incomprehensible
social expectations of Black and white communities. Reynard
relates, for instance, that their Black relatives tend to see them as
reserved, while the white community interprets their behaviour
as loud and aggressive, and that the former interprets respect as
explicitness and directness, while the latter defines it as couching
beliefs and feelings in subterfuge. This has, in fact, caused serious
and potentially dangerous conflicts with white authority.
Reynard has also found that they are “embarrassingly
prone to getting sexually assaulted” because people read
consent into their actions, they have difficulty communicating
sexual and romantic intent non-verbally, and experience a
lag between receiving and processing other people’s actions.
Additionally, they find that neurotypical romantic preferences
and expectations tend to be forced on autistics, such as
the assumption that back rubs must feel good, which they
experience as a subtle form of gaslighting. Reynard has, as a
122 TRANS AND AUTISTIC

result, established firm rules around what situations they are

comfortable with, which purposefully exclude uncertainty.
They are, for instance, more comfortable in “high protocol”
spaces, like gay cruising and BDSM communities.
Reynard has a mixed relationship with their family. Their
father and brother, for instance, have been overwhelmingly
supportive, while their mother is “cartoonishly racist.” Reynard
has, like many of those interviewed, found critical solidarity
and support from the autistic and transgender communities,
particularly in Chicago, which they moved to for its greater
diversity and transit options. They volunteer as a patient
advocate for people who are transgender and autistic and
moderate a discussion group for people who are genderqueer
and non-binary, where many of the participants are also autistic.

ENDNOTES
1 SROs are law enforcement officers assigned to elementary and high
schools, primarily in the United States, but also in Canada and other
countries.
2 SRO programs tend to disproportionately target minority and, in
particular, Black students.
3 Mandell et al., 2007
4 Maddox, 2016
5 Lee, 2015
6 Levenson, 2017
7 For a follow-up podcast on this case, and the impact it had on the
autistic man, see Quinn (2018).
8 Asperger/Autism Network, n.d.
9 Autism Society of Alabama, n.d.
10 Gargaro et al., 2011
11 de Marchena, Eigsti, & Yerys, 2015
12 Genderqueer Chicago, n.d.
13 Also known as comic strip conversations (National Autistic Society,
2018).
14 Dimbort et al., 2005
15 Code-switching is, linguistically and culturally, “the act of altering
how you express yourself based on your audience” (McWilliams,
2018).
SHERRY

Sherry is a 28-year-old Caucasian and Jewish transgender woman

who identifies as queer, bisexual, and on the asexual spectrum.
Born in Arkansas, she previously lived in Vermont, where she had
a farm and ran for political office. More recently, she has settled
in Seattle. Self-diagnosed with autism and not interested in a
formal diagnosis, Sherry is very active in the transgender and
autistic communities. She uses she/her pronouns. “Sherry” is a
pseudonym.

COMING OUT AS AUTISTIC

Sherry’s mother, who has an undergraduate degree in
psychology, noted that she was awkward in public and didn’t
have many friends. It was at this time that her mother broached
the idea that she may have Asperger’s syndrome. However,
formal diagnosis wasn’t pursued at the time, and she didn’t
revisit the possibility until she was about 23 years old, when
she was friends with a person who was diagnosed with autism.
Sherry found that she was better able to understand and
communicate with her autistic friends than the neurotypical
world, which prompted her to investigate the autistic diagnostic
criteria and symptomatology, and ultimately to conclude
that they fitted her. She has since communicated this to her
doctors and healthcare professionals, who noted it on her
medical records.

123
124 TRANS AND AUTISTIC

Sherry characterizes her coming out as a very gradual and

positive process that has helped her to find and connect with
a larger community of people with similar communication
styles. The only downside has been that people who don’t know
her sometimes don’t believe that she is autistic, owing to her
relatively articulate and verbal nature and, in most cases, lack
of outward autistic symptoms. She has, in fact, been accused
of making it up in order to seek unnecessary accommodations
at the expense of people who are “really autistic” (that is, more
closely resembling an autistic stereotype or caricature).

COMING OUT AS TRANSGENDER

Sherry has very early childhood memories of wondering what
it would be like to be a girl. While growing up, she primarily
explored her gender identity through crossdressing, first when
she was 11, then more regularly from age 14. At the time,
because she lacked more nuanced language, she referred to
herself as a crossdresser who hoped to “go 24/7” in the future.
She began to identify as transsexual at 18 and, in her freshman
year of college, to dress in feminine clothes while at school.
Unfortunately, her parents were hostile to her gender identity
and gave her an ultimatum to stop or move out. She did live
on her own briefly but found balancing school and work to be
overwhelming; she was ultimately forced to move back in with
her parents and go back in the closet. Sherry didn’t come out
again until she was 22 and living on her own. She has been
out since.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Sherry is skeptical about the suggestion that autism and
gender identity might be intrinsically linked and feels that
their coincidence may have more to do with the tendency of
 Sherry 125

autistic people to bow to tradition or take social conventions as

immutable. For instance, she notes that an autistic child might
be less inclined to take a parent’s assertion they are male solely
because of the gender to which they were assigned at birth,
as opposed to how they might identify their gender identity.
Sherry feels that, generally, autistic children are more likely to
explore and think deeply about their own gender identity.

FAMILY
Sherry’s younger sibling is also transgender and she feels
that her biological children are most likely autistic. As noted,
her mother and stepfather were abusive, and punished her
for her gender identity and for behaviours and symptoms
related to autism. As a result, she hasn’t had any contact with
them in person for almost ten years, and not at all since coming
out as autistic. Sherry characterizes her father, with whom she
sometimes speaks on the phone, as more accepting in that he
has made attempts to understand her life.

COMMUNITY AND ACTIVISM

Sherry is very involved in multiple autistic and transgender
communities that intersect with various facets of her identity,
particularly Judaism, political interests, and hobbies. She also
participates in organizing workshops for transgender and
autistic people. Sherry also recently ran for political office;
though she didn’t win, she did do unexpectedly well and
enjoyed the opportunity to share her message with the public.

WORK
Sherry didn’t disclose many negative work experiences, possibly
because her work history has been limited due to disabilities
126 TRANS AND AUTISTIC

unrelated to autism. She reported working in software

development, specifically in the creation of healthcare software
and, before leaving her graduate program, a smartphone app.
She has also worked on a farm in Vermont with her chosen
family and, as mentioned above, ran for political office.

HEALTHCARE
Sherry’s healthcare experience has been mixed. For instance,
her therapist at the time was very hostile to her coming out
as transsexual. As a person who is multiply disabled, she has
also been frustrated with the amount of time it takes to get a
proper diagnosis and the tendency of some professionals to
assign blame for various unrelated concerns to her transgender
identity (e.g. “trans broken arm syndrome”). As regards
accommodations and supports, Sherry often uses a cane or
wheelchair and, on rare occasions, brings her cat along for
emotional support.
Though she is aware that autistic people tend to face greater
barriers when accessing transitional care, Sherry feels she didn’t
experience this as she came out as autistic after beginning
transition. In addition, she shares that medical practitioners
may now be more knowledgeable about the overlap between
transgender identity and autism, and therefore less likely to
deny them transitional care or treat their transgender identity
as an inherent disorder. By contrast, when she was younger,
those with mental health issues were disqualified from
transgender care.

MEDIA REPRESENTATION
Sherry has seen some media representations of people who
are transgender or autistic, including in video games, and is
aware of actors who are transgender. However, she notes that
 Sherry 127

it is often difficult to tell if a character is explicitly autistic, as

this almost always seems to be portrayed through subtext.
As a result, she relies largely on what she calls “head canon,”1
which is the fandom-inspired process of interpreting a fictional
text through a personal lens, and personally accepting as true
elements which may be at most implicit in the source material—
in Sherry’s case, claiming a character with autistic traits as
autistic. For example, though not explicitly characterized as
such in the game, Sherry considers the character Aurene, from
the MMORPG Guild Wars 2,2 to be autistic, because she is a
baby dragon that expresses autistic traits such as flapping her
legs when happy, and not understanding social conventions.

SOCIAL RULES
Sherry describes how, as a child, she had a great deal of trouble
navigating social rules and conventions and, as a result, became
very comfortable questioning those that don’t make sense. She
characterizes herself as gender non-conforming and shares
that she plays with and subverts gender role expectations,
embracing some while throwing others out. This has led some
people to see her as more confrontational and franker than is
expected of a feminine transgender woman. In general, Sherry
notes that many social norms, particularly those for women,
are exceedingly indirect and exhaust her patience. Finally,
she does feel that people treat her differently due to her being
visibly transgender and expects that this will continue for a
long time. She doesn’t have the same experience with people
noticing her autism, though she feels that this would help to
avoid misunderstandings.
128 TRANS AND AUTISTIC

FINAL THOUGHTS
Sherry’s experience of autism and transgender identity has been
mixed. The barriers she has experienced have been significant,
particularly with regards to her family of origin and healthcare
experiences. Her multiple physical disabilities have added
their own challenges. However, her connections with other
transgender and autistic people, both individually and as an
activist, have enabled her to weather and perhaps grow stronger
from these experiences. In some ways, Sherry’s experience is
singular. She is, for example, the only participant to have run
for political office, or lived and worked on a farm. Sherry was
also one of the few participants to state that her experience
of obtaining transitional healthcare has not been made more
difficult by autism which, by her own assessment, may be a
result of coming out as autistic after beginning transition.
Sherry’s experiences are, however, also echoed in many
of the other interviews. She falls, for instance, roughly in the
middle of the age range of other participants interviewed
(21–36 years old). As regards sexuality, Sherry is one of nine
participants who explicitly expressed a queer identity (e.g. gay,
lesbian, queer, bisexual, pansexual) and four who identified as
asexual or greysexual. She also shares her Jewish identity with
at least one other participant. As with three other participants,
Sherry’s autism is self-diagnosed because she hasn’t had the
opportunity or felt the need to pursue a formal diagnosis, which
can be quite expensive and difficult to obtain. Unfortunately,
her negative experience with her family of origin is also not
unusual. She has been able to achieve a somewhat supportive
relationship with her father, though she continues to have no
contact with her mother and stepfather. However, the support
and meaning Sherry has found in transgender and autistic
community activism appear to act as a counterpoint to issues
with her family of origin.
 Sherry 129

Sherry’s mixed experience with healthcare, and hostile care

providers who tend to blame unrelated health problems on
transgender identity, is also reflected by other participants, as
is her frustration with long and sometimes incomprehensible
waiting periods. Like many others, Sherry has had healthcare
professionals react with hostility to her gender identity
and, on other occasions, refuse to accept that she is autistic.
However, she also ultimately feels that transgender healthcare
access has improved dramatically for both neurotypical and
autistic people.

ENDNOTES
1 Kurchak, 2018
2 ArenaNet, 2012
TRISTAN

Tristan is a 25-year-old white, queer, transgender man, who also

sometimes identifies as genderqueer. He was born in Kansas and
currently lives in North Carolina. Tristan was formally diagnosed
with autism in 2016. He has opted to use his real name and he/
him pronouns.

COMING OUT AS AUTISTIC

It was an article in an online humour magazine that first
helped Tristan to understand his relationship to autism; this
article pointed out the various similarities between the Star
Trek character Spock, and people with autism. This helped
Tristan to understand why he had always related so much to
a character other people criticized for “being too logical and
not emotional enough.” Tristan related strongly to “the idea
of having an unemotional exterior [and] a very deep internal
emotional landscape that [he] struggled to manage.”
Tristan received a formal autism diagnosis in 2016. He
pursued the diagnosis because one was required to access
disability-related academic accommodations at his university.
The university did not agree to cover the cost of the required
neuropsychological assessment which, had Tristan not had
insurance, would have been over $1,000. Fortunately, his
insurance brought it down to a $20 co-pay. Tristan later found
out that his mother had considered, then decided against,

131
132 TRANS AND AUTISTIC

getting him tested for autism as a child, because she feared it

would make him feel “more different than [he] already did.”
Tristan’s diagnostic experience was largely negative,
primarily because the practice he consulted didn’t handle
his comorbidities well. Instead, he reports that they fixated
on autism to the point of completely ignoring other issues,
particularly OCD and ADHD. Tristan didn’t learn that he
tested as having “severe” OCD until he requested his diagnostic
records, though the assessor had opined that there was a lot of
overlap between this condition and autism.
Tristan was also frustrated by the way in which the assessor
approached the diagnosis itself. For instance, she assumed that
he had already been diagnosed with Asperger’s, even though he
was clear he hadn’t, and focused primarily on whether he had
“mechanical interests, like trains, as a child.” Tristan recalls
additionally that she partially based her remark that he “was
obviously very high functioning” on his SAT scores.1
Tristan found it odd that, in his medical records, the assessor
described him as both “trans-gender” and “transgender” and
noted that other patients wouldn’t be described as cisgender. He
also felt that, though he was asked to fill out a number of self-
reported forms and psychiatric inventories, the results were
given inconsistent weight in the final assessment. For instance,
though Tristan tested in the severe range for both ADHD
and autism, he only received a diagnosis of “mild Asperger’s
or autism.” Following this rather disastrous experience, Tristan
asked to be assessed by the same practice again, primarily to
revisit the possibility that he had ADHD.

COMING OUT AS TRANSGENDER

For Tristan, realizing he was transgender was a very slow process
that was catalyzed, in part, by discovering the book Female
Masculinity at a local LGBT centre when he was 18 years old.2
 Tristan 133

After reading it, he came to identify, at least temporarily, as

butch and finally as male/male adjacent when he was around
20 years old. Tristan explains that his autism, and specifically
his tendency to see things literally, was a factor in why it took
him so long to come to this conclusion. He elaborates that,
when he was first exploring gender identity, Tumblr wasn’t yet
a major community hub and most online resources referenced
only male-to-female and female-to-male people. Tristan didn’t
identify with the latter because he imagined that it meant that
one “literally changed from a girl into a guy, [and since he]
never felt like a girl in the first place,” he couldn’t understand
how this was possible for him. As a result, he concluded that he
“wasn’t trans, just bad at being a girl.”
Tristan also had trouble with the assumption that transgender
men had to be stereotypically masculine. By contrast, the men
he admired were people like Gerard Way, from the band My
Chemical Romance, and Dr. Frank-N-Furter, a character in
the Rocky Horror Picture Show.3 Tristan’s tendency to think
literally, and take existing examples as prescriptive, caused him
to feel that it wasn’t possible to be a transgender man who had
a different expression of masculinity. It wasn’t until identities
like demiboy, genderfluid, and feminine boy proliferated on
sites like Tumblr that he found ones that mirrored his own.
Tristan now fluctuates between identifying as a guy, which is
true most of the time, and feeling more comfortable with the
term non-binary.
Tristan’s transitional journey has been similarly slow and
measured. He started by changing his name legally, though
he didn’t initially ask anyone to alter the pronouns they used
for him, beyond specifying that they not call him “it.” Tristan
subsequently came out to his mother when she was drunk and
recalls that she asked him “if [he] wanted a penis.” He responded
that he didn’t, to which she replied “good, penises aren’t that
great.” Tristan then came out to his father, who initially “thought
134 TRANS AND AUTISTIC

that he was just trying to escape the way women are treated in
society [and that] he wouldn’t be having this ‘gender confusion’
if they hadn’t let [him] play with both boys and girls toys [as] a
kid.” He reports, nevertheless, that his parents have largely got
used to it, and that they rarely misgender him anymore. Tristan
has now been on testosterone for over four years.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

When asked to consider the relationship between transgender
identity and autism, Tristan admitted that he hadn’t actually
thought that much about it. He clarified that “being trans and
being autistic are both such integral parts of who I am that I
don’t know what causes the other.” After considering it, however,
Tristan concluded that he didn’t think that “autism made me a
boy, or that being a boy made me autistic.” Regardless, autism
is intertwined with his ability to envision, articulate, and
act on his gender identity via transition. For instance, as an
autistic person, it is difficult for Tristan to decode and navigate
contradictory and inconsistent standards of masculinity,
and he notes that gender is inherently confusing to him, as
it is inseparable from social norms. Nevertheless, he rejects
the notion that an autistic person is incapable of identifying
and expressing a transgender identity, not least because of its
ableist implications.

FAMILY
Tristan has a close relationship with his family, who, while
struggling initially, have come to be fairly supportive of his
autism and gender identity. In fact, when he informed his
mother about the former, her first response was “Well, I’m not
surprised.” Tristan also suspects that his father and sibling are
“on the spectrum.” However, in discussing this with them, he
 Tristan 135

learned that his sibling, who is also non-binary, is okay with

this, while his father indicated that he preferred not to be
“labelled.” Tristan’s family have been slower to accept him as
transgender; while his siblings have been very supportive, his
parents, though much more supportive now than initially, have
had more difficulty.

COMMUNITY AND ACTIVISM

Tristan initially characterized himself as not very involved
in the transgender or autistic communities. However, after
exploring this topic in more depth, Tristan clarified that he is
engaged in providing transgender services for his local LGBT
centre and, more recently, worked to start a discussion group
for autistic LGBT individuals. He also hasn’t participated in any
autism rights organizations. Tristan does, however, assist with a
yearly transgender and autistic discussion group at the annual
Philadelphia Transgender Wellness Conference.4

WORK
Tristan works in what he describes as “a very macho”
professional kitchen environment. As an autistic person, he
finds this challenging, particularly understanding unspoken
directions from his manager and when his co-workers are
joking. In fact, in the past, Tristan was once fired due to his
failure to pick up on social cues. On other occasions, however,
he has been passed over for jobs because of gender non-
conformity. In fact, Tristan has found that he experiences more
workplace discrimination when he is out as transgender and is
treated differently as an autistic person, though he attributes the
latter to co-workers unconsciously responding to his different
or unusual behaviour.
136 TRANS AND AUTISTIC

HEALTHCARE
It is fortuitous for Tristan that he is presently on his father’s
insurance plan, and therefore able to afford good healthcare.
His healthcare experience has, however, been decidedly mixed.
For instance, Tristan has had difficulty finding practitioners
who are both compassionate to and experienced in autistic
and transgender issues. While he has recently started seeing a
therapist who specializes in both, for which he feels fortunate,
he was forced to go without for a few years. Prior to this,
Tristan had seen a therapist who was good with transgender
issues, but reluctant to accept or address his autism, instead
making a point of dismissing it by saying things like “Well, if
you think you have autism.” This, coupled with their insistence
on using person-first language (e.g. person with autism), led
him to avoid talking about the issue at all. The therapist’s use
of, and worse insistence on, person-first language suggests that
they were either unaware of, or unconcerned about, linguistic
developments and preferences on this issue.5
Regarding denial of transgender healthcare, Tristan sees
himself as lucky in that he didn’t obtain a diagnosis of autism until
he had started testosterone and had had “top surgery.” Providers
were not, as a result, able to use autism as a reason to enact
greater barriers to, or outright deny, transitional care. Tristan
finds that his transgender identity is more problematic than his
autism when it comes to accessing healthcare. For instance, when
obtaining non-transgender-related healthcare services, as for a
cold, he is forced to decide what medical history to share for fear
of outing himself and possibly impacting the quality of treatment
he receives. As discussed, this is widely known as “trans broken
arm syndrome.” Similarly, many transgender people report being
asked, particularly in emergency departments, inappropriate and
invasive questions and even coerced to show their genitals to
curious professionals.6,7
 Tristan 137

MEDIA REPRESENTATION
Tristan has never seen his experience as a transgender and
autistic person reflected in popular media. He can, however,
identify characters that represent the experience of one or the
other, such as in Orange Is the New Black,8 and the most recent
Power Rangers movie.9 Broadly speaking, however, Tristan feels
that media representation is awful for both transgender and
autistic people, particularly when he was younger, as evidenced
by his having to identify with Spock from Star Trek,10 who was
literally an alien.

SOCIAL RULES
As noted, Tristan has a lot of difficulty with social rules and
conventions, particularly in understanding and navigating
masculinity among cisgender men. His work in a kitchen,
which is a stereotypically “macho” environment, makes this
more difficult and fraught. Tristan’s experience of employment
has also been affected by his autism and transgender identity.
He relates that not understanding social norms makes it harder
to understand what co-workers are trying to communicate and
can’t, for example, always tell if people are joking, or if he is
missing nuance.

FINAL THOUGHTS
Tristan is a young, Caucasian, queer, transgender, and gender-
queer man living in the southern United States. He was slow
to understand himself and come out as transgender. Tristan
attributes this to autism causing him to see things literally and
failing to understand that gender expression could encompass
something other than stereotypical or binary masculinity.
The proliferation of multiple expressions of gender identity
138 TRANS AND AUTISTIC

via sites like Tumblr helped him to understand this wasn’t the
case and he has since pursued transition in a measured and
intentional manner.
Tristan’s experience of transgender and autistic healthcare
has, however, been mixed. For instance, while he ably navigates
barriers and gatekeeping, he also has had trouble finding
compassionate and experienced practitioners for either concern.
Tristan has also had to hide his autism or gender identity from
practitioners in order to receive unbiased healthcare, though
he has never been denied transitional care for being autistic,
perhaps because he didn’t receive a diagnosis until after starting
transition. He did, however, have a particularly frustrating
experience pursuing an autism diagnosis and often finds that
unrelated healthcare problems are attributed to his gender
identity (e.g. “trans broken arm syndrome”).
Tristan’s employment experiences have been similarly mixed.
For instance, he works in a very macho kitchen environment
with a high expectation of non-verbal communication. This
is difficult for him and he often has trouble understanding
workplace expectations and whether co-workers are joking
or serious. As a result, while Tristan’s experience of workplace
discrimination due to gender identity is overt, that related to
autism is subtler, though still present.
Tristan has a close relationship with his family. His parents,
though not always supportive of his gender identity, have made
great strides in understanding and accepting him. Tristan
also derives support from the larger transgender and autistic
community and has assisted in facilitating an annual workshop
for individuals who are transgender and autistic.
Autism and gender identity are, for Tristan, intertwined. He
regards gender, which is inseparable from social definitions,
roles, and expectations, as a particularly confusing concept
for an autistic person. Nevertheless, Tristan is firm and happy
in his identity as a transgender man and hopeful for future
 Tristan 139

opportunities to contribute to the autism and transgender

communities.

ENDNOTES
1 Smith, 2017
2 Halberstam, 1998
3 Adler, White, & Sharman, 1975
4 Philadelphia Transgender Wellness Conference, n.d.
5 Fletcher-Watson, 2016
6 Chisolm-Straker et al., 2017
7 Brown, 2011
8 Tannenbaum, 2013
9 Saban et al., 2017
10 Roddenberry, 1966
CONCLUSION

NOTHING ABOUT US WITHOUT US

The motto Nothing about us without us, or Nihil de nobis, sine
nobis in the original Latin, originated in 16th-century Central
Europe.1 It asserts that no decisions should be made without
the active participation of the group affected by them and
includes their capacity to give and revoke consent. The motto
has been central to disability,2 HIV,3 and transgender4 activism
and is one of the central tenets of autism activism, particularly
where social policy and research are concerned. It is also the
central idea around which this book is formed, and frames the
exploration of the interviews that takes place in this chapter.

ANSWERS TO QUESTIONS ASKED

Coming out as autistic
Our participants had many different experiences of diagnosis
with regards to autism. In general, these can be summarized
as receiving a diagnosis as a child, receiving a diagnosis as an
adult, and being self-diagnosed. There is, however, some fluidity
between these last two categories. Alex, Isabella, Nami, and
Moose were diagnosed as children. Alex found this to be largely
positive, though they were frustrated that they weren’t told about
their diagnosis until several years afterwards. Nevertheless, this
information and their parents’ support greatly helped them to
find their place in the larger autistic community.

141
142 TRANS AND AUTISTIC

Isabella, Nami, and Moose also found their place in the

autistic community, although their paths there were quite
different, as were their experiences of family support. All three,
however, worried that, as Asians, their autism might “shame”
their families and lead to rejection. Isabella’s immediate and
extended family were able to accept this information after
other family members were diagnosed with autism. Nami
and Moose’s families, however, had more difficulty. This
may, in part, explain why Nami describes herself as “broken”
and Moose justifies his mother’s abusive behaviour as being
rationalized by the aforementioned stigma.
Reynard and Tristan were formally diagnosed with
autism as adults after exploring the subject and receiving
neuroeducational assessments at university. Reynard described
this as a very positive process that helped them understand
that their manner of interacting with the world was valid. In
contrast, Tristan had a very negative experience, finding the
process stigmatizing and the assessors overly fixated on autism
to the neglect of other concerns. Interestingly, Reynard and
Tristan both initially sought a diagnosis for ADHD. Reynard
was subsequently surprised to be diagnosed with autism
instead. Tristan, however, was frustrated that the assessor
focused on autism to the seeming exclusion of ADHD.
Grace, James, and Sherry are self-diagnosed with autism, as
was Nathan initially. Grace and Sherry both relayed that their
parents noticed they were “different” as children but rejected
obtaining a diagnosis. James first considered autism shortly
before discovering his gender identity. Nathan, for his part,
explored the subject after noticing similarities between himself
and autistic characters on television. His initial self-diagnosis
was affirmed by his employer, who is a psychologist, before
being confirmed by his own psychologist. Similarly, Sherry has
informed her healthcare practitioners that she is autistic and
had it noted on her medical records.
 Conclusion 143

Several participants related that either they or their parents

avoided an autism diagnosis out of concern that it would
contribute to the stigmatization they faced on an everyday
basis. Some praised this strategy as helping them to succeed in
the neurotypical world by “feigning normality when necessary.”
It may also, in the long run, have contributed to internalized
ableism, as well as avoidance and even bullying of other autistic
people. Grace, for instance, talked about how recognizing
“similar thought processes and behaviours in others…can
[cause her to] become vicariously anxious.” This might not have
been the case if she was allowed to embrace herself as autistic
at a young age, without fear of social exclusion or harassment.
In fact, many participants expressed relief at finding out
that they weren’t alone and that their problems with, for
instance, making friends and eye contact were attributable
to autism rather than simply being “bad.” This knowledge
allowed them to connect with the larger autistic community
and understand that their way of interacting with the world is
valid. Nevertheless, there was wide agreement that some autism
interventions, such as ABA, are ineffectual and even harmful.5
Participants argued that this is the case because they rely on
forcing autistic children to hide or mask their autism and often
use dehumanizing methods to do so.
In fact, masking or camouflaging autistic traits can limit
the availability of support by making it more difficult to be
recognized as autistic,6 particularly for those who are assigned
female at birth.7 Regardless of assigned sex at birth, many of
our participants expressed frustration with being told that they
couldn’t be autistic because they were “too verbal” or “made eye
contact.” Sherry, for instance, has been accused of faking autism
in order to access accommodations. Alex had to purposefully
discard the masking strategies taught to them in order to accept
themselves and integrate into the autism community.
144 TRANS AND AUTISTIC

COMING OUT AS TRANSGENDER

There was no unified version of the transgender coming-
out narrative. Instead, participants had a wide variety of
different experiences that also shared a number of similarities.
For instance, most recalled having uncertainty around or
questioning their gender identity at a very young age. None,
however, received active support from their parents to explore
this subject and, as a result, suppressed these feelings due to
confusion, shame, and fear of both parents and peers.
Of course, their transgender identities never went away and
usually re-emerged during their late teens or early twenties.
Alex, Grace, and Tristan credit the website Tumblr with
enabling them to explore the diversity of gender expression
and identity both within and outside the binary (e.g. male
and female). Media also played a big role, with Alex, Grace,
James, and Tristan identifying a specific book, video game,
documentary, or television show in helping to catalyze their
understanding of themselves as transgender.
Most participants indicated that their transgender friends
were central to them exploring their own gender identity.
Meeting another transgender person helped Alex, Grace, and
Reynard to realize that their transgender identity did not have
to mirror the stereotypes portrayed on television. Much as with
autism, it also prompted Grace and Isabella to re-examine the
ways in which they had engaged in transphobia, out of fear
of being identified as transgender. Almost all participants
continue to find support and solidarity in the transgender
community.
Most participants came out to the larger world in stages.
Several informed friends and supportive family members
first. Their parents’ reactions ranged from acceptance, to slow
acceptance, and outright rejection and disownment. Most fell
in the middle, with initial concerns, and difficulty adapting to
pronoun and name changes. Isabella, Moose, Nami, and Sherry,
 Conclusion 145

meanwhile, experienced different degrees of total rejection. In

no case, however, did this rejection stop them from pursuing
transition. In fact, all participants have undertaken some form
of transition, whether name and pronoun changes, or hormonal
and surgical interventions. And almost all emphasized a desire
to contemplate transitional goals carefully and take transition
slowly.
Some participants also indicated that their sexuality had
shifted since transitioning. James, Reynard, and Tristan, for
instance, identified as a lesbian because they assumed that
their masculinity coupled with a female gender assignment
mandated it. While identifying as bisexual/pansexual prior to
transition, Grace found herself far more attracted to women
and femininity than previously. James characterized this period
of his life as “almost asexual” and has since come to identify
as gay.

LINKS BETWEEN AUTISM AND GENDER IDENTITY

Participants were divided as to whether autism and gender
identity are inherently linked. That is to say, whether autism
causes an individual to be transgender or vice versa. Alex, for
instance, felt strongly that, at least in their case, both are linked.
Grace, James, and Nami were less certain, and felt that it could
be an unrelated correlation. Isabella and Moose, for their part,
felt strongly that autism and gender identity weren’t related.
Nathan, Reynard, Sherry, and Tristan, however, allowed for
the possibility while remaining skeptical. This last group also
concluded that it ultimately didn’t matter, except where access
to transitional care was jeopardized, or autism made it more
difficult to understand concepts like gender.
Several participants commented on why autism and
transgender identity might appear to be connected. They
hypothesized that autistic people tend to be non-conforming
146 TRANS AND AUTISTIC

generally, have difficulty picking up unspoken norms, and are

inclined to explore and question social rules and expectations.
Alex noted that gender is a flimsy social construct that can
often seem nonsensical to people on the autism spectrum. As a
result, while some transgender autistic individuals are strongly
aware of an internal gender, their desire to conform to gendered
social expectations may be limited. Nami suggested that there
may only appear to be a link between autism and transgender
identity because autistic people are less able to mimic cisgender
behaviours or otherwise hide their transgender identity.
Most nevertheless felt that their experience of exploring
their gender identity was affected by autism. Alex indicated
that, as a child, they accepted the gender bestowed on them as
inevitable, if distasteful, until they became aware of language
to describe their experiences and others like them. James
explained that he tends to gravitate towards rigid notions of
transition because autism makes it difficult for him to accept
uncertainty. Moose indicated that, though he is uncertain if
it’s related to feeling more comfortable in his environment, his
autistic symptoms (e.g. stimming, rocking) did become more
pronounced after starting testosterone. Moose and Tristan both
shared that they have trouble understanding and navigating
often contradictory and inconsistent standards of masculinity.
All participants, however, are happy with their current gender
identity and expression.

FAMILY
The individuals interviewed for this book had a variety of
different experiences with their families of origin, ranging from
acceptance and support, to outright rejection. With regards
to autism, Grace hasn’t really broached the subject with her
parents, while Alex and Tristan’s have been very supportive.
Isabella’s family, despite initially having some difficulty, came
 Conclusion 147

to be supportive after several of her cousins received a similar

diagnosis. Nathan’s parents are supportive, though his father
struggles to accommodate his desire for minimal physical
contact. Conversely, James’s family have dismissed the idea of
him having autism, and Moose, Nami, and Sherry’s parents
rejected and/or punished them for it. Reynard, for their part,
found support only from their brother and father’s family.
Interestingly, all but three knew or suspected that other
members of their family were on the autism spectrum.
No participant described their family as being universally
supportive with regards to transgender identity. Alex, for
instance, described their parents as initially struggling to
understand their non-binary gender identity and some
members of their extended family as negative about this
aspect of their identity. Over time, however, they have come to
experience a remarkable level of support from their immediate
and extended family. Alternatively, Isabella has been supported
by her brothers, but not her parents, who characterize her
transgender identity as a deviance. Moose, Nami, and Sherry’s
parents felt similar and reacted by issuing ultimatums or
cutting off contact. For James, contrary to their reaction to his
disclosure of autism, all extended family members except one
have been very supportive. Grace, Nathan, and Tristan found
that their parents needed some time to come to terms with
and process the information, but all consider their parents very
supportive now. Finally, as with autism, Reynard’s brother and
father’s family are immensely supportive.
Nami attributed her family’s lack of support to the social
expectations placed on children in East Asian culture. In fact,
Nami, as well as Isabella and Moose, shared their East Asian
background and experience of parental rejection due to being
transgender and/or autistic. Nathan and Reynard, however,
described their Black/African-American relatives as ultimately
being unconditionally supportive, though they also identified
148 TRANS AND AUTISTIC

the ways in which these relatives consider their autistic traits

to be culturally out of sync. In Reynard’s case, some relatives
blame this on their being partially white.

COMMUNITY AND ACTIVISM

Community was an essential component of every individual’s
life and, for most, activism was as well. In fact, both Moose and
Reynard moved to different cities to be closer to the transgender
and/or autistic communities. Participants credit these groups
with learning to accept themselves, and meeting others like
them, finding friends, and as a source of solidarity and help. In
Isabella and Moose’s case, however, work schedules and income
have made participation in these communities more difficult.
For Moose specifically, racist police checkpoints (e.g. “stop and
frisks”) have been a particular barrier to accessing LGBTQ and
autism supports. Alex also noted that they had to unlearn the
“normalizing” behaviours forced on them by ABA, in order to
fully participate in the autism community.
Regarding individual contributions, Alex co-founded
a group for autistic people in Ontario,8 and Reynard has
been instrumental in reviving and diversifying a group
for transgender individuals. Nathan manages an academic
transgender health lab, 9 helps to organize an annual
conference10 for transgender youth and their parents, and has
presented research originating from the aforementioned lab at
international academic conferences.11,12 Isabella volunteered
with LGBT youth providing peer counselling and services for
homelessness and suicide prevention. Nami mentored autistic
people and worked in the LGBTQ community as a sexual health
educator, advocate, and support person for refugees. Moose
was the subject of media coverage for furthering transgender
inclusivity in his role on the young adult leadership of his
church. Sherry ran for political office, and Tristan has helped
 Conclusion 149

to facilitate an annual workshop for transgender and autistic

people. In addition, Judaism and the Jewish community have
been central to Alex and Sherry’s lives.

HEALTHCARE
Participants reported a number of physical, neurological, and
mental disabilities in addition to autism. For instance, Grace,
Nathan, and Tristan have OCD, while Alex, Isabella, Reynard,
and Tristan have ADHD. Social or generalized anxiety disorder
has been an issue for Alex, Grace, Nathan, and Reynard.
Finally, Alex and Isabella both have a learning disability.
Some participants also contend with physical disabilities like
fibromyalgia, chronic fatigue syndrome, and migraines.
Participants’ experiences navigating healthcare with regards
to autism were mixed. Alex had largely positive experiences with
early autism diagnosis and treatment. Their experience
with their dentist and as the recipient of physical restraints
during school was, however, decidedly more negative.
Similarly, Isabella was happy with the autism healthcare she
received, but upset that her placement in a special education
classroom provided her with a substandard education. Nami
was traumatized by the haphazard and dangerous way in which
her parents modified her physical therapy. Moose’s experience
of early autism diagnosis was traumatic, primarily because
his parents refused to accept it. Others, like James, Nathan,
and Tristan, encountered difficulties in having healthcare
professionals take them seriously with regards to their autism,
or provide help with this. Similarly, both Alex and Tristan
struggled with being misdiagnosed in neuropsychiatric
assessments.
Transitional healthcare experiences were also mixed. Alex,
for instance, struggles with trying to separate the healthcare
interventions they genuinely want, from what is expected
150 TRANS AND AUTISTIC

of them as a non-binary person. They, as well as Reynard,

Sherry, and Tristan, also worry about or have experienced the
phenomenon of healthcare practitioners blaming unrelated
problems on their transgender status. Finally, Moose and
Reynard were careful to hide their autism after being denied
transitional care due to it, while Sherry and Tristan didn’t
experience this issue as they came out as autistic after starting
transitioning.
Several participants struggled to find a competent provider
of autism and/or transgender healthcare. Grace, for instance,
chose to take the initiative of educating her doctor in the
provision of transgender healthcare rather than wait for a rare
spot at a clinic dedicated to transgender healthcare. Her doctor
has been willing to do so, despite also being frustratingly rigid
in interpreting and applying the relevant medical guidelines.13,14
James, likewise, had difficulty finding a GP who was both
competent to provide transgender healthcare and willing to.
Indeed, his GP initially refused to refer him to a specialist
transgender health service, then to continue the treatment
prescribed by this service. Nathan and Tristan, for their part,
have had difficulty finding therapists who are knowledgeable
about dealing with autism.

MEDIA REPRESENTATION
Participants were able to identify several examples of popular
media with autistic characters. This consisted of characters in
TV shows that are explicitly autistic, like The Good Doctor,15
Atypical,16 Parenthood,17 and Degrassi,18 and those coded
autistic, such as Sheldon in The Big Bang Theory.19 Other
media mentioned included biopics and documentaries, such
as Temple Grandin,20 and movies like Mozart and the Whale,21
Power Rangers,22 and Marathon.23 Regarding popular media
with transgender characters, Degrassi was again mentioned, as
 Conclusion 151

well as Orange Is the New Black,24 Boy Meets Girl,25 and Steven
Universe.26 The documentaries The Boy Who Was Born a Girl27
and Genderquake28 were also noted.
Most participants felt that representation for transgender
and autistic issues alone was poor and for transgender/autistic
ones almost non-existent. Regarding the former, the little that
existed was often characterized as “horrific, simplified, and/or
sensationalist” (Grace) and tended to focus on the experiences
of people who are straight and Caucasian, while ignoring those
who are, for instance, people of colour, intersex, asexual, and/
or non-binary. This is particularly problematic since, as Alex
noted, the general public tends to take these representations as
universal and prescriptive (e.g. Rain Man29).
As a result, the individuals interviewed tended to be
drawn to less mainstream outlets such as indie comic books,
podcasts, and user-created content like fanart and fanfiction
as more realistically depicting their lives and experiences. In
fact, several participated in the creation of the latter and often
made use of head canon to do so. Others sought to explore
their autism and gender identities through other media, like
the MMORPGs Guild Wars 2,30 World of Warcraft,31 Clone
Wars Adventures,32 and Star Wars: The Old Republic;33 the My
Little Pony34 fandom; or books like Dreadnought,35 Female
Masculinity,36 and Asperger’s Huh?37 Tumblr blogs and Facebook
groups were also popular areas for exploration.

SOCIAL RULES
Unsurprisingly, most participants struggled to understand and
navigate social rules and expectations, especially those related
to gender roles. Alex, for instance, noted that non-binary
people are expected to perform their gender in a particular
way that doesn’t align with their own non-binary identity.38
Others, like Grace, had trouble separating inability (or more
152 TRANS AND AUTISTIC

frankly, disinterest) in performing stereotypical masculinity

from an underlying transgender identity. Alternatively, several
noted that their relative imperviousness to social expectations
was a net positive, in that it protected them from (and allowed
them to subvert) expectations related to relatively arbitrary
gender roles.
Participants also experienced new problems after coming
out as transgender and transitioning. James and Tristan,
for instance, have difficulty understanding unspoken rules
regarding masculinity, dating, and male friendships. James
expressed frustration with the fact that he receives affirmation
for demonstrating the same stereotypically masculine
behaviours he used to be punished for. Isabella and Nami, as
transfeminine individuals, were concerned about anticipating
and navigating the potential for transmisogynistic violence,
which Isabella regarded as particularly tied to whiteness.
Moose’s experience, however, was unique, as he is in the
position of decoding and disentangling gendered social
expectations of men in Japan, where he was born and raised,
and the US, where he now lives. Nathan and Reynard also
remarked on tensions between social expectations in the Black
community and their own experience of autism. Nathan noted,
for instance, that the Black community’s emphasis on respect
tends to lead them to view autistic behaviour as defiance.
Reynard, for their part, shared that the Black community prizes
directness and, as a result, tends to see them as reserved, while
the white community does the opposite.
Finally, both James and Reynard identified a connection
between their impaired ability to pick up social cues and
expectations with their tendency to walk into dangerous
situations. In James’s case, this has involved not noticing that
he is receiving homophobic street abuse until his partner tells
him. Reynard, on the other hand, characterizes themselves as
very prone to sexual assault, because people incorrectly infer
 Conclusion 153

consent from their actions (or inaction) and they sometimes

fail to notice when situations are becoming sexual.

ANSWERS TO QUESTIONS NOT ASKED

People of colour
Participants were widely and intentionally diverse. Five are
white (two Jewish), three Asian, and two Black/African
American. Of the latter five, three also identify as bi/multiracial.
Despite this, no specific interview question addressed their
experiences of autism in relation to racial or ethnic identity.
The topic nevertheless arose frequently and spontaneously. We
were, as a result, able to explore how people of colour navigate
autism and transgender identity and the ways in which their
racial and ethnic identities impact their access to resources and
even safety.
Nathan noted that Black people prize the virtue of cleanliness
due to historical and contemporary experiences of racism. He
explained that, in his experience, this has led the community
to interpret some OCD symptoms as inherently positive. Both
Nathan and Reynard spoke about how Black communities
interpret aspects of their autism as defiance or “weirdness.”
In fact, some research shows that Black parents report fewer
concerns about autism or autistic symptoms like repetitive
behaviour. 39 Other reports detail the culturally specific
responses of parents to autism and related behaviours40,41 and
note that they may lead Black children to be diagnosed later
than white children.42
Reynard observed that authorities such as parents, teachers,
and police have tended to view their autistic traits as acts of
defiance because they are Black. This has led to several tense
and even dangerous situations that caused them to fear for
their safety. Reynard recalled, for instance, a case in which
the (Black) behavioural therapist of an autistic man was shot
154 TRANS AND AUTISTIC

because police mistook the (Puerto Rican) autistic man’s toy

truck for a firearm.43,44 They further pointed out that police
interaction tools designed for these situations don’t consider
that Black and masculine people may not be safe to retrieve
them from their pockets when they are around police.45
Moose, for his part, wasn’t able to access autism or LGBTQ
supports in New Orleans due to being continuously “stopped
and frisked” when attempting to enter the neighbourhoods in
which they were located. Interestingly, this occurred in both
Black and white neighbourhoods because, as an Asian man,
he didn’t fit the police’s conception of who should be there.
In fact, a great deal has been written about law enforcement
discrimination, and the impact of stop and frisk policies on
queer and transgender people of colour.46,47
Isabella, Moose, and Reynard all reported on the overall
whiteness of the autism and transgender communities. Reynard
noted that this was a characteristic of the transgender group
they facilitate, and that it had to be discussed openly and
honestly to correct it. This may speak to differences in ethnic
and racial cultural communication styles.48 For Reynard,
the Black community expects direct communication, while
the white community prefers it to be indirect, especially
when the issue is contentious. This is consistent with research on
the subject.49 It may therefore be useful to approach autism as a
unique culture that, generally speaking, prioritizes direct verbal
communication; of course, autistic traits differ across cultures.50
Finally, our Asian participants noted that there were
unique cultural expectations attached to their behaviour in
relation to gender identity and autism. Isabella, Moose, and
Nami had all been disowned or otherwise experienced family
sanction for expressing gender variant behaviour and/or being
autistic. The Substance Abuse and Mental Health Services
Administration describes a similar example in which a Japanese
man in treatment was encouraged to follow their standard
 Conclusion 155

practice of informing his family.51 Unfortunately, the family’s

immediate response was to disown him for shaming them.
Moose also described his experience of the tension between
cultural expectations of men and masculinity in Japan and the
United States.

WORK
Although we didn’t specifically ask about employment, in
all but one case participants volunteered this information
during interviews. All currently or previously worked in
some capacity and currently earn between $0 and $67,498
USD/year (average $18,218.19). Grace, James, Nathan, and
Tristan work professionally as, respectively, an employee of
the Federal Government of Canada, a research assistant on an
international project, the manager of an academic laboratory,
and in a professional kitchen. Alex volunteers with their
college’s student access centre and works seasonally as a camp
counsellor. Nami works periodically in event planning and
management, and Moose works both part time in a gay bar and
full time in an administrative job. Sherry previously worked in
software development, on the creation of a smartphone app,
and on a farm. Isabella didn’t identify the kind of work she does
but indicated that she is working long shifts in order to save up
for an apartment and towards future job goals.
The work history and experience of many participants was
impacted by their autism. Alex, for instance, hopes to work as
a social worker with other autistic people. Grace, for her part,
credits her autism with both leading her to be successful in
her current job and creating difficulties in the past, particularly
around finding a post-degree internship. However, Isabella
worries that she will have trouble finding work if employers
know she is autistic. James, Moose, and Tristan feel that
their workplaces are, at least in part, less accommodating of
156 TRANS AND AUTISTIC

autism than gender identity. For instance, they have received

cautions and/or been passed over for positions, due to their
difficulties with identifying social nuances and instructions in
the workplace. Nami, however, is very limited in her ability to
work consistently, multitask, or manage social interactions and,
as a result, isn’t able to manage a nine-to-five job.

SEX
Though we asked about sexual orientation, we did not ask
about participants’ experiences of sex and sexuality. The topic
was, nevertheless, frequently brought up. Alex and Reynard
note that the autistic community may be uniquely vulnerable
to sexual assault, due to a combination of different sensory
and communication needs and a lack of comprehensive and
developmentally appropriate sexual education. Alex worried
that this might metastasize into misogynistic attacks like the
Toronto van attack.52
Alex and Reynard also shared their experiences of abuse in
the contexts of relationships and dating. For Alex, this led to
becoming entangled in emotionally abusive and manipulative
relationship dynamics. They felt that the ABA-style therapy
they participated in primed them for this by emphasizing
compliance over their own sensory needs. Reynard, for their
part, explained that their lack of awareness of non-verbal
communication leads them to miss or misinterpret other
people’s sexual intents and results in being frequently sexually
assaulted. In a similar way to Alex, they feel that their tendency
to go along with what is suggested may contribute to these
situations. As a result, they prefer “high protocol” situations,
like BDSM, where the rules are made clear ahead of time.
In fact, there is quite a bit of emerging evidence documenting
the experience of sexual assault among, and sometimes by,53
autistic people. Taught compliance,54 the tendency to miss or
 Conclusion 157

misinterpret contextual cues,55 and a lack of population-specific

sexual education56 are cited as risk factors. The National Sexual
Violence Resource Center has created a resource to help sexual
assault advocates address this issue.57 Unfortunately, a great
deal of this research approaches the issue from the perspective
of parents and caregivers who seek to address “challenging” and
sometimes “deviant” behaviours. Few resources exist by and for
autistic people, with some notable exceptions. 58, 59

FINAL THOUGHTS
We have discussed the varied experiences of people who are
both transgender and autistic. While ten interviews cannot
represent everyone, we are clearly a diverse and varied group,
with unique concerns, as well as hopes, dreams, and goals. Still,
there are areas that we wish we would have addressed more
directly and substantially.
For instance, while we did not directly ask about religion,
it was spontaneously addressed by two participants. These
participants found Judaism to be a very meaningful part
of their lives and their experiences of transgender identity
and autism. Alex, for example, is heavily involved in their
local Jewish community and has found a lot of meaning
from traditional Jewish observations on gender. Sherry also
spoke unprompted about her experience as a person who is
transgender, autistic, and an observant Jew. It seems apparent
that this conversation would have been more fulsome, with
more people commenting on their experiences with religion,
had we specifically mentioned this subject.
Nevertheless, we hope that other transgender and autistic
people will see themselves and their experiences reflected in
this book, especially the interviews that form its core. It is they
who motivated and made this work possible. We also hope
that healthcare practitioners will take this information to heart
158 TRANS AND AUTISTIC

and consider the ways in which their decisions may harm us,
both directly and indirectly. We wish nothing more than to be
treated as human beings worthy of the same respect and dignity
as those who are neurotypical.

ENDNOTES
1 Kumitz, 2016
2 Charlton, 2000
3 Pacific AIDS Network, n.d.
4 Asia Pacific Transgender Network, 2017
5 Devita-Raeburn & Spectrum, 2016
6 Russo, 2018
7 Bargiela, Steward, & Mandy, 2016
8 Autistics For Autistics, n.d.
9 Keo-Meier, n.d.
10 Gender Infinity Conference, n.d.
11 Philadelphia Transgender Wellness Conference, n.d.
12 World Professional Association for Transgender Health, n.d.
13 World Professional Association for Transgender Health, n.d.
14 Coleman et al., 2012
15 Shore & DePaul, 2017
16 Gordon, 2017
17 Howard et al., 2010
18 Schuyler, Stohn, & Yorke, 2002
19 Cendrowski, 2007
20 Ferguson et al., 2010
21 Dimbort et al., 2005
22 Saban et al., 2017
23 Myeong-hong, Seung-yeop, & Chang-hwan, 2005
24 Tannenbaum, 2013
25 Kerrigan et al., 2015
26 Sugar, 2013
27 Channel 4, 2009
28 Channel 4, n.d.
29 Johnson & Levinson, 1988
30 ArenaNet, 2012
31 Blizzard Entertainment, 2004
32 Daybreak Game Company, 2010
33 BioWare Austin, 2011
34 Thiessen et al., 2010
 Conclusion 159

35 Daniel, 2017
36 Halberstam, 1998
37 Schnurr, 1999
38 Williams, 2019
39 Donohue et al., 2019
40 Bauer, Winegar, & Waxman, 2016
41 Mann, 2013
42 Gourdine, Baffour, & Teasley, 2011
43 Levenson, 2017
44 For a follow-up podcast on this case, and the impact it had on the
autistic man, see Quinn (2018).
45 Asperger/Autism Network, n.d.
46 The Williams Institute, 2015
47 Morgan, 2013
48 Substance Abuse and Mental Health Services Administration, 2014
49 Asante & Davis, 1985
50 Carruthers et al., 2018
51 Substance Abuse and Mental Health Services Administration, 2014,
p.1
52 Monsebraaten, 2018
53 Moyer, 2019
54 Gammicchia & Johnson, 2014
55 Weiss & Fardella, 2018
56 Sevlever, Roth, & Gillis, 2013
57 National Sexual Violence Resource Center, 2018
58 Newport & Newport, 2002
59 Ashkenazy & Yergeau, 2013
FURTHER READING
AND RESOURCES

The following pages list further reading and resources that

expand on what is discussed in this book. Several are mentioned
throughout by the individuals we interviewed and we felt that,
because they are particularly apt, we should draw attention to
them here. Others are discussed here for the first time. All are
an excellent place to start your further reading on the topic of
transgender people who are also autistic.

GROUPS
Academic Autistic Spectrum Partnership in Research and Education
(AASPIRE)
http://aaspire.org
An academic partnership with autistic individuals to create and co-
author research on autism. The website contains a wealth of materials
and resources, both resulting from this partnership and not. In
particular, check out the toolkit on primary healthcare resources for
autistic adults at https://autismandhealth.org.1

Association for Autistic Community

http://autisticcommunity.org
An organization that supports autistic folks to grow and learn
from each other. It also offers a yearly multi-day conference called
Autspace.

161
162 TRANS AND AUTISTIC

Autism Acceptance Project

https://the-art-of-autism.com
An organization that supports and organizes exhibits of art by autistic
individuals.

Autism National Committee (AUTCOM)

www.autcom.org
Founded in 1990, AUTCOM advocates for autistic civil rights and
puts on an annual conference.

Autism Women & Nonbinary Network

http://autismwomensnetwork.org
An organization by and for autistic women, girls, and non-binary
folks.

Autistic Self Advocacy Network (ASAN)

https://autisticadvocacy.org
ASAN advocates throughout the US for autistic rights and
lobbies against aversives (e.g. shocks), restraints, and seclusion
in autism treatment and education, and, in general, the idea of
curing autism. It has successfully lobbied against campaigns that
portray autism negatively (e.g. Autism Speaks, PETA) and runs the
Autism Campus Inclusion Summer Institute, which is a week-long
training for autistic college students. The latter resulted in a resource
for autistic college students, available at http://navigatingcollege.org.2
It also developed a resource on relationships and sexuality, available
at http://autismnow.org/wp-content/uploads/2013/02/Relationships-
and-Sexuality-Tool.pdf.3

Autscape
www.autscape.org
Annual UK conference by and for autistics.
 Further Reading and Resources 163

MEDIA
Boy Meets Girl4
A UK sitcom about transgender characters, recommended by James.
Stars a transgender woman, as a transgender woman, in one of the
lead roles.

Parenthood5
A US television show that features a character with Asperger’s (Max),
which Nathan found particularly helpful. There is also a fascinating
academic article6 on the value of this character to the autism
community, given the tendency to focus on autism through the lens of
his parents and the larger community, rather than his own experience.

Steven Universe7
An animated US television show, recommended by Alex, which
features several non-binary and queer characters in prominent roles.
The creator, Rebecca Sugar, also recently came out as non-binary.

The Boy Who Was Born a Girl8

UK documentary, recommended by James, about a 16-year-old
transgender boy in the process of transitioning.

NEWS ARTICLES AND EDITORIALS

Autism Advocacy and Research Misses the Mark if Autistic People are Left
Out9
https://theconversation.com/autism-advocacy-and-research-misses-
the-mark-if-autistic-people-are-left-out-94404
Article in The Conversation that discusses the importance of autistic
people being included in campaigns and research on the subject of
autism. It investigates the history of autism-led campaigns and what
is gained by designing research that focuses on autistic people as
co-researchers.
164 TRANS AND AUTISTIC

Autistic and Queer: Coming Out on the Spectrum10

www.afterellen.com/people/424935-autistic-queer-coming-
spectrum
Article in AfterEllen that discusses people who are both queer and
autistic. It explores the issues unique to this population in terms of
dating, sex, socializing, and coming out.

Autistic New Yorkers Share Their Stim-Toy Stories with “Aftereffect”11

www.npr.org/sections/health-shots/2018/07/07/625756385/autistic-
new-yorkers-share-their-stim-toy-stories-with-aftereffect
Article in NPR that interviews several autistic people about the self-
stim toys they use. It is a response to the podcast Aftereffect, which
discussed a case in which an autistic man’s stim toy (a toy truck) was
mistaken for a firearm, resulting in his personal assistant being shot.
The article also presents short profiles of several autistic people.

Behind the Spotlights of Transgender China12

www.whatsonweibo.com/behind-the-spotlights-of-transgender-
china
Article in What’s on Weibo that discusses the increasing visibility of
transgender people in China, particularly on the social media site
Weibo, and via transgender celebrities. It explores their many positive
experiences as well as more challenging issues, like legal recognition
of gender and cost of sex reassignment surgery.

Face Blind13
www.wired.com/2006/11/blind
Article in Wired that discusses the condition face blindness, or
prosopagnosia, which denotes an inability to recognize faces, and is
common among those with autism.

Gender Identity in Halakhic Discourse14

https://jwa.org/encyclopedia/article/gender-identity-in-halakhic-
discourse
Article in Jewish Women’s Archive about multiple gender identities
in Judaism.
 Further Reading and Resources 165

Georgia’s Separate and Unequal Special-Education System15

www.newyorker.com/magazine/2018/10/01/georgias-separate-and-
unequal-special-education-system
Article in The New Yorker about children being warehoused and
receiving substandard education in special education schools
throughout Georgia, US. It follows the story of a young Black family
with an autistic child.

How Our Society Harms Trans People Who Are Also Autistic16
https://medium.com/the-establishment/how-our-society-harms-
trans-people-with-autism-9766edc6553d
Article in The Establishment that discusses the unique barriers
faced by transgender people who are also autistic. It focuses on the
tendency of transitional healthcare professionals to subject autistic
people to longer waiting times and more stringent gatekeeping, and
to attribute transgender identity to autism.

How Trans Players Find Support from the Gaming Community17

www.vice.com/en_ca/article/8gegvx/how-trans-players-find-
support-from-the-gaming-community-58477ff7b003780236751598
Article in Vice that explores communities formed by transgender
people who participate in gaming, including video and board games,
and their use of these mediums to explore their own gender/s.

Imaging a Fuller Spectrum of Autism on TV18

https://psmag.com/social-justice/autistic-license
Article in Pacific Standard that discusses the importance of claiming
autistic-coded characters as autistic (or head canon) to autistic
individuals. It explores how autistic people use and interact with
popular culture to create representations of themselves where they
may not explicitly exist.
166 TRANS AND AUTISTIC

Is the Most Common Therapy for Autism Cruel?19

www.theatlantic.com/health/archive/2016/08/aba-autism-
controversy/495272
Article in The Atlantic that explores the potential cruelty of applied
behavioural therapy, which is the most common treatment for
autism. It discusses its basis in attempts to “make people with autism
‘normal’” and presents the perspectives of autism rights advocates,
who strongly condemn the practice.

“It’s Torture”: Critics Step Up Bid to Stop School Using Electric Shocks on
Children20
www.theguardian.com/us-news/2018/nov/16/judge-rotenberg-
center-massachusetts-electric-shocks
Article in The Guardian that discusses the use of electric shock
“aversives” at the Judge Rotenberg Center, which is a school for
special needs children in Massachusetts. It also explores the campaign
against this practice, led by a coalition of disability groups, including
the National Autism Association.

Low Academic Expectations and Poor Support for Special Education

Students are “Hurting their Future”21
https://hechingerreport.org/low-academic-expectations-poor-
support-special-education-students-hurting-future
Article in The Hechinger Report that discusses the failure to provide
adequate education to students in special education classrooms. It
doesn’t deal with autism specifically, but instead explores the effect of
low academic expectations for all students with disabilities.

Meet the People Being Left Out of Mainstream Conversations About

Autism22
www.complex.com/life/2016/04/autism-women-poc
Article in Complex that interviews and discusses people who are both
transgender and autistic. It explores the ways in which participants
defy expectations of people with autism.
 Further Reading and Resources 167

Take the Autism Test23

www.wired.com/2001/12/aqtest
An online copy of Dr. Baron-Cohen’s Autism Quotient test, which
measures autism in adults, as presented in Wired. It can be filled in
and scored on the website.

The Costs of Camouflaging Autism24

www.spectrumnews.org/features/deep-dive/costs-camouflaging-
autism
Article in Spectrum News that discusses the tendency among some
autistic girls and women to hide or camouflage their autism, and
the ways in which this is achieved. It explores how this can result
in women receiving a diagnosis later in life and that, while this
behaviour can result in greater social and career advancement, it can
also come at the cost of greater anxiety and isolation.

The Dangers of Trans Broken Arm Syndrome25

www.pinknews.co.uk/2015/07/09/feature-the-dangers-of-trans-
broken-arm-syndrome
Article in PinkNews that discusses the phenomenon of “trans broken
arm syndrome,” in which healthcare practitioners blame unrelated
healthcare issues on one’s transgender status, and fail to treat, or
insufficiently treat, the presenting issue.

The Invisibility of Black Autism26

https://undark.org/article/invisibility-black-autism/?fbclid=IwAR
05Vo0aynvaZozZRfriXxD5k19u41dPblGtcCUWskMYBgHbo9L-
BoqRMnU
Article in Undark about the tendency to misdiagnose autistic Black
children due to institutional bias and racism.
168 TRANS AND AUTISTIC

When It Comes to Health Care, Transphobia Persists27

www.theglobeandmail.com/opinion/article-when-it-comes-to-
health-care-transphobia-persists
Article in The Globe and Mail that discusses the extreme
discrimination faced by some transgender people when seeking
emergency healthcare and the tendency for healthcare professionals
to fixate on the individual’s transgender status, over other, more
pressing issues. It follows the experience of a transgender woman in
an Ontario emergency room.

BLOG POSTS
Anarchism: In the Conversations of Neurodiversity28
https://maxxcrow.wordpress.com/2017/12/07/anarchism-in-the-
conversations-of-neurodiversity
Blog post that explores anarchism as a response to the societal
mistreatment of neurodiverse and, more specifically, autistic
individuals.

Being Nonbinary Has Nothing to Do With Looking Nonbinary29

https://medium.com/@transphilosophr/being-nonbinary-has-
nothing-to-do-with-looking-nonbinary-bef864483a43
Blog post about the expectations of non-binary to present in an
androgynous manner regardless of their own personal preferences.

Exploring Non-Binary Identity Theory in the Age of the Internet or Why

Tumblr Might be Right About Something for Once30
www.oxbowschool.org/assets/gallery/os36-final-projects/docs/
sidney-h-os36paper.pdf
Article about the ways that young queer individuals use Tumblr to
explore non-binary gender identities and how this site exists as a
unique place in which to do so.
 Further Reading and Resources 169

Fuck You and Your Fucking Thesis: Why I Will Not Participate in Trans
Studies31
https://tagonist.livejournal.com/199563.html#/199563.html
Blog post about the intrusiveness of research requests focused on
transgender individuals and communities.

How Cultural Differences Affect Autism Diagnoses32

https://blogs.scientificamerican.com/guest-blog/how-cultural-
differences-affect-autism-diagnoses
Blog post for Scientific American that explores the reliance on socially
construed diagnostic criteria for an autism diagnosis. It points out
that these criteria presume symptoms that are considered negative in
a western context but may be normal or desirable in other contexts.
This may similarly be true for groups within the western world.

It Doesn’t Have to be This Hard33

https://tragicgenderstory.com/2017/05/11/it-doesnt-have-to-be-
this-hard
Blog post from Tristan about his experiences navigating the process
of autism diagnosis.

Neurowonderful34
www.youtube.com/channel/UC9Bk0GbW8xgvTgQlheNG5uw
YouTube channel with videos exploring the author’s experience as a
transgender and autistic person.

Social Stories and Comic Strip Conversations35

www.autism.org.uk/about/strategies/social-stories-comic-strips.aspx
Blog post that explains what social stories and comic strip
conversations are and how autistic people can use them to improve
communication, safety, and self-care.
170 TRANS AND AUTISTIC

The Significance of Semantics: Person-First Language: Why It Matters36

www.autistichoya.com/2011/08/significance-of-semantics-person-
first.html
Blog post that discusses the difference between person-first
(individual with autism) vs. autism-first (autistic individual)
language. It explores the history of the linguistic debate and why it’s
important.

WTBS 13 Transgender Patients: How to Foster a Safer Emergency

Department Environment37
https://emergencymedicinecases.com/transgender-patients-
emergency-department
Blog post, from an emergency medicine doctor, that discusses common
issues for transgender people in emergency rooms and explores ways
that these environments can be made more transgender friendly.

JOURNAL ARTICLES
Postsecondary Employment Experiences Among Young Adults with an
Autism Spectrum Disorder RH: Employment in Young Adults with
Autism38
An article that examines employment issues for autistic people.

Race Influences Parent Report of Concerns About Symptoms of Autism

Spectrum Disorder39
Academic article about how race plays a role in the recognition of
autism symptoms. It specifically investigated whether Black parents
reported fewer autism concerns than white parents among a sample
of 174 18–40-month-old children.

Reclaiming Travesti Histories40

A fascinating academic article on the impact of Spanish colonization
on the expression of gender diversity in Latin America, its impact
on modern-day gender diverse people, and the reclamation of the
term travesti.
 Further Reading and Resources 171

The AASPIRE Practice-Based Guidelines for the Inclusion of Autistic

Adults in Research as Co-Researchers and Study Participants41
Academic article from the Academic Autistic Spectrum Partnership
in Research and Education presenting guidelines for the inclusion
of autistic individuals as co-researchers and participants in
academic research.

The Empire Strikes Back: A Posttranssexual Manifesto42

This article is a response to a widely published anti-transgender essay.
The author uses this essay to establish the existence of transgender
people throughout history and privilege transgender people’s
perspectives on the “transgender body” over those of cisgender
individuals and professionals.

“What’s the Point of Having Friends?”: Reformulating Notions of the

Meaning of Friends and Friendship Among Autistic People43
Academic article about autistic people’s interpretation and experiences
of friendship and how they sometimes differ fundamentally from
neurotypical individuals.

Whose Expertise Is It? Evidence for Autistic Adults as Critical Autism

Experts44
An article based on a study of autistic adults that presents an ar­
gument for the inclusion and leadership of autistic adults in research
on the subject.

Why Sheldon Cooper Can’t be Black: The Visual Rhetoric of Autism and
Ethnicity45
An article that explains how the concept of autism is constructed in
such a way as to preclude people of colour.

BOOKS
All the Weight of Our Dreams: On Living Racialized Autism46
Book about the experience of racialized people who are autistic.
172 TRANS AND AUTISTIC

Authoring Autism: On Rhetoric and Neurological Queerness47

Academic book that defines autism as an identity instead of an
impairment. It challenges how autism has been pathologized and
criticizes behavioural interventions such as ABA, likening them to
gay conversion therapy. She also argues that autistic people are the
best equipped to talk about their own experiences of autism.

Call Me Crazy: Stories from the Mad Movement48

Book about the history and current status of the Mad Movement.
Also tells the author’s story of going from a patient to an activist.

Uncomfortable Labels49
Insightful and candid memoir from a transgender woman who is
gay and autistic.

WEBSITES AND PODCASTS

Aftereffect50
Podcast about the long-term impacts on an autistic man whose
caregiver was shot by police after they mistook the man’s toy truck
for a firearm.

Gender Dysphoria & Autism with Aron Janssen MD51

Podcast featuring autism and transgender specialist Dr. Aron Janssen.
It explores the overlap between these two issues from the viewpoint
of a clinician.

JOURNALS, MAGAZINES, AND MEDIA COLLECTIVES

Altogether Autism
http://altogetherautism.org.nz
A New Zealand-based journal on autism.

NOS Magazine
http://nosmag.org
Web magazine with articles by and for autistic folks.
 Further Reading and Resources 173

The Aspergian
https://theaspergian.com
Collective of neurodivergent individuals who are cataloging the
experience, insights, knowledge, talents, and creative pursuits of
autistics.

The Thinking Person’s Guide to Autism

www.thinkingautismguide.com
Guide and blog on information for autistic people, professionals, and
parents.

ENDNOTES
1 Academic Autistic Spectrum Partnership in Research and Education,
n.d.
2 Ashkenazy & Latimer, 2013
3 Ashkenazy & Yergeau, 2013
4 Kerrigan et al., 2015
5 Howard et al., 2010
6 Holton, 2013
7 Sugar, 2013
8 Channel 4, 2009
9 Pellicano, 2018
10 Parker, 2015
11 Quinn & Sullivan, 2018
12 Koetse, 2015
13 Davis, 2006
14 Fonrobert, n.d.
15 Aviv, 2018
16 Burns, 2017
17 Baume, 2016
18 Kurchak, 2018
19 Devita-Raeburn & Spectrum, 2016
20 Pilkington, 2018
21 Butrymowicz, 2017
22 Weiss, 2016
23 Wired Staff, 2001
24 Russo, 2018
25 Payton, 2015
174 TRANS AND AUTISTIC

26 Silberman, 2016
27 Benaway, 2018
28 Crow, 2017
29 Williams, 2019
30 Sidney, n.d.
31 Tagonist, 2009
32 Bauer, Winegar, & Waxman, 2016
33 Smith, 2017
34 Schaber, n.d.
35 National Autistic Society, 2018
36 Brown, 2011
37 Ovens, 2017
38 Roux et al., 2014
39 Donohue et al., 2019
40 Campuzano, 2006
41 Nicolaidis et al., 2019
42 Stone, 1992
43 Bertilsdotter Rosqvist, Brownlow, & O’Dell, 2015
44 Gillespie-Lynch et al., 2017
45 Matthews, 2019
46 Brown, Ashkenazy, & Onaiwu, 2017
47 Yergeau, 2018
48 Shimrat, 1997
49 Dale, 2019
50 Quinn, 2018
51 Burke, 2016
Appendix 1: Informed
Consent Form

Our names are Noah Adams, Bridget Liang, and Reubs Walsh.
We are independent researchers looking at the experience of
folks who are both transgender and autistic for a forthcoming
book on the topic with Jessica Kingsley Publishers. As we are
people who are also transgender and autistic, this topic has a
lot of personal meaning to us and we are committed to treating
your responses and stories with respect and dignity.
We are asking that you answer a short questionnaire about
your experiences of being transgender and autistic. This will
help us to get a basic sense of what this community looks like.
This questionnaire will take up to 20 minutes to complete, after
which we will interview you for approximately one to three
hours. Following the interview, you will be eligible for a $100
CAD honorarium. We will also ask you to recruit two other
transgender/autistic people, who will be eligible for the same
honorarium after completing this interview. This is a recruitment
technique known as snowball sampling, and will help us to
introduce a random element to our inclusion of participants.
As this is a small community, you may know or have worked
with us. Whether or not this is the case, you should not feel
pressured to take part in this study, nor will there be any negative
effects should you choose not to, or later drop out. Regardless,
all responses will be anonymous, unless you request otherwise.

175
176 TRANS AND AUTISTIC

If you have any questions about the study, please contact

Noah Adams.

INFORMED CONSENT
We invite you to take part in a study on the experiences of
individuals who are transgender and autistic. Your participation
is voluntary, does not pay any money, and you may drop out
at any time. The information below tells you about any risks
or drawbacks that may result, and while your participation
probably won’t help you, we might learn things that will help
improve future research.

WHO WILL BE CONDUCTING THIS RESEARCH?

Noah Adams, MSW
Toronto, Ontario
[email protected]

Bridget Liang
Toronto, Ontario
[email protected]

Reubs Walsh
Amsterdam, Netherlands
Vrije Universiteit
[email protected]

STUDY PURPOSE
The purpose of this study is to explore the experiences of adults
who identify as transgender and autistic.
 Appendix 1: Informed Consent Form 177

WHO CAN PARTICIPATE IN THIS STUDY?

Anyone who self-identifies or is diagnosed as both autistic and
transgender, and is 18 years or older.

WHAT WILL YOU BE ASKED TO DO?

You will be asked to take part in an audio-recorded conversation
about your experiences as transgender and autistic using your
choice of telephone, Skype, or, if possible, in person, at a time
and place of your choosing. You will be asked to confirm that
you identify and/or are diagnosed as transgender and autistic
and provide some basic demographic data (e.g. income,
ethnicity, disability). After this you will be asked to discuss your
experiences as a person who is both transgender and autistic for
between one and three hours. This information will be edited
and used to form a chapter of the book and you will receive
a draft copy of this chapter and a chance to respond, before
publication, with any comments or corrections. You will not
receive co-authorship on the resulting publication.

POSSIBLE DISCOMFORTS AND RISKS

There is no physical risk associated with this study and the risk
of emotional discomfort is remote. You should also be aware
that we will go to great lengths to protect your anonymity
unless, of course, you prefer to be identified.

POSSIBLE BENEFITS
On completion of the interview, you will receive an email with
the final results of this research, a free copy of the resulting
book, and an honorarium of $100 CAD. Your participation will
also assist in better understanding this topic and you may also
appreciate thinking and speaking about your experiences.
178 TRANS AND AUTISTIC

COMPENSATION AND REIMBURSEMENT

Those who complete the interview will receive a $100 CAD
honorarium for their participation, as well as a free copy of the
resulting book.

CONFIDENTIALITY AND ANONYMITY

All interviews will be audio recorded and saved under password
on the researcher’s computer. The researcher will type out the
audio file, word for word, and save it to their laptop under
a password, at which time the audio file will be deleted. On
completion of this research, these files will be stored for five
years, after which they will be securely deleted.
Your interview will be used to write a single chapter of the
book and reported in such a way as to preserve your anonymity.
You will be given a chance to select a pseudonym for use in the
book, and if you choose not to select one, one will be chosen
for you. You will also receive a draft copy of your chapter for
review and comment and will be advised about including or
excluding information that may identify you. You will be given
the option to be identifiable and de-anonymized in the book,
if you so choose. Ultimately, confidentiality will be protected
to the degree permitted by law and, in most cases, no one but
the researchers will see the text or audio files. However, the
researchers have a legal duty to report suspected child abuse or
neglect, the abuse or neglect of an adult in need of protection,
and/or risk or threat of harm to self or others.

PARTICIPATION IS VOLUNTARY
Participation in this study is voluntary. You are free to turn
it down or withdraw at any time, subject to the following
guidelines. You are also free to skip any questions, pause the
interview, or stop completely, at any time, without explanation.
 Appendix 1: Informed Consent Form 179

QUESTIONS AND DROPPING OUT

Contact Noah Adams at [email protected] if you wish
to drop out or have questions. You are free to withdraw your
consent until June 30th, after which we will begin the writing
process. Dropping out of this study will have no impact on
any existing professional or personal relationship with the
researchers. During this study, you will be informed of any new
information that might affect your decision to remain in it.

CONFLICT OF INTEREST
This research has no sponsor, and while the publication of the
resulting book may result in modest royalties, these will be used
to pay for the honoraria provided to interviewees.

I have read the details about this study. I have been given a
chance to talk about it and my questions have been answered. I
hereby consent to take part in this study; however, I know that my
participation is voluntary and that I may withdraw at any time.

Participant Researcher
Name: . . . . . . . . . . . . . . . . . . . Name: . . . . . . . . . . . . . . . . . . . .
Signature: . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . .
180 TRANS AND AUTISTIC

I understand that this interview will be audio recorded and I give

consent to do so.

Participant Researcher
Name: . . . . . . . . . . . . . . . . . . . Name: . . . . . . . . . . . . . . . . . . . .
Signature: . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . .

I agree to let you directly quote any comments or statements

made in any written or audio reports, without seeing the quotes
prior to their use, and I understand that my anonymity will be
preserved by not attributing them to me.

Participant Researcher
Name: . . . . . . . . . . . . . . . . . . . Name: . . . . . . . . . . . . . . . . . . . .
Signature: . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . .

I wish to be identifiable in the resulting publication by Jessica

Kingsley Publishers.

Participant Researcher
Name: . . . . . . . . . . . . . . . . . . . Name: . . . . . . . . . . . . . . . . . . . .
Signature: . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . .
Date: . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . .

You will get a copy of this form for your records.

Appendix 2: Interview
Questions

1. When did you first know you were autistic?

a. (Prompt) What was it like “coming out”?

2. When did you first know you were trans/non-cis?

a. (Prompt) What was it like “coming out”?

b. (Prompt) How would you describe your gender identity

now? How did you reach the terminology/language you
use?

3. Do you think autism and gender identity are related?

a. (If non-binary) Do you feel like your being non-binary

is related to being autistic?

4. Do you have a self-identified or diagnosed disability other

than autism spectrum?

a. (Prompt) How does that interact with your autism

spectrum?

181
182 TRANS AND AUTISTIC

5. Tell me about your family.

a. (Prompt) Are they supportive of your gender identity/

autism?

b. (Prompt) Is anyone else in your family autistic/trans?

6. Are you involved in the autism/trans community?

7. Tell me about your experience with healthcare (mental/

physical/autism/transgender).

a. (Prompt) Do you need/receive any accommodations

and/or supports?

b. (Prompt) Does being trans/autistic make your

relationship with healthcare more difficult?

8. Do you see your experiences reflected in the media/popular

culture?

9. What is your experience with everyday social rules/

conventions and those specific to gender?

a. (Prompt) Do people treat you differently because you’re

transgender and/or autistic?

10. Do you have anything you want to add?

Appendix 3: Demographic
Questions

1. What is your age?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. What country and city were you born in?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. What country and city do you presently live in?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. What pronouns do you use?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

183
184 TRANS AND AUTISTIC

5. What sex were you assigned at birth (on your original birth
certificate)?1

† Female

† Male

† Prefer not to say

† Other; please specify:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. Which of the following describes your present gender

identity? (Please check all that apply.)2

† Bi-gender

† Boy or Man

† Crossdresser

† Feel like a boy sometimes

† Feel like a girl sometimes

† FTM

† Genderqueer

† Girl or Woman

† MTF

† T Girl
 Appendix 3: Demographic Questions 185

† Trans Boy or Trans Man

† Trans Girl or Trans Woman

† Two-spirit

† Other; please specify:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Which of the following describes your present sexual

orientation? (Please check all that apply.)

† Ace spectrum

† Bisexual

† Gay

† Lesbian

† Pansexual

† Queer

† Straight or Heterosexual

† Two-spirit

† Not sure or Questioning

† Other; please specify:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
186 TRANS AND AUTISTIC

8. Are you on the autism spectrum?

† No

† Yes

† I don’t know

† I’d rather not say

a. What is your specific diagnosis?

† Asperger’s

† Autism

† Non-verbal learning disability

† I don’t know

† I’d rather not say

† Other; please specify:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Are you formally or self-diagnosed?

† Formally

† Self-diagnosed

† I don’t know
 Appendix 3: Demographic Questions 187

† I’d rather not say

† Other; please specify:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Please identify and describe your racial/ethnic identity.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. What is your best estimate of your total income, before taxes
and deductions, from all sources in the past 12 months?
Please specify denomination and to the nearest amount you
know and/or feel comfortable.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11. At this point, what is the highest level of education you have
completed?

† Did not graduate from high/secondary school

† High/secondary school graduate

† Some college or trade school

† College or trade school graduate

† Some university
188 TRANS AND AUTISTIC

† University – Bachelor’s degree

† University – Graduate or professional degree

† I don’t know

† I’d rather not say

ENDNOTES
1 Questions 5 and 7 were adapted from the National Transgender
Discrimination Survey (Grant et al., 2011).
2 Questions 6 and 11 were adapted from Trans PULSE (Bauer &
Scheim, 2015).
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Subject Index

ableism, internalized 24–5, 42, 143 responses to 56, 77, 111

accommodations 103 Reynard 109
activism Sherry 123–4
Autistics For Autistics 30 Tristan 131–2
Autistiqueers 30 coming out as transgender
discussion group 115–7 Alex 25–6
overview 148–9 Grace 42–5
patient advocate 115, 118–9 hostility to 124
ADHD 55, 111, 132, 142 Isabella 56–8
advocate (patient’s) 115, 118–9 James 66–70
allistic 10 Moose 78
applied behavioural therapy Nami 90–1
(ABA) 9, 24–5, 30, 143 Nathan 100
asexual 10 overview 144–5
Asperger’s syndrome diagnosis 55 Reynard 112
autism Sherry 124
as part of identity 24 in stages 144
see also diagnosis of autism Tristan 132–4
Autistics For Autistics 30 communication (sign language) 29
Autistiqueers 30 community
moving location for 80–1
overview 148–9
Baron-Cohen, Simon 73
socializing within own 30–1
confrontational, being
chosen family 10 perceived as 104, 127
cisgender 10 consent 19, 175–80
Clarke, Kayden 14 cultural factors 79–80, 84, 92, 104,
code-switching 119 142, 147–8, 152, 153–5
coming out as autistic
Alex 23–5
data collection 17–9
Grace 41–2
dating 59, 72, 81
gradual process 124
demographic data 19–21
Isabella 55–6
diagnosis of autism
James 65–6
age at 141
Moose 77–8
child’s unawareness of own 23–4
Nami 89–90
comorbidities and 132
Nathan 99–100
difficulty obtaining 14, 66, 71, 100
overview 141–3

201
202 TRANS AND AUTISTIC

diagnosis of autism cont. GP’s attitude 48, 70–1, 150

family rejection of 77 Grace 47–9
increase in 16 hormone replacement therapy 60
multiple labels 89 increase in knowledge within 126
negative experience 132 insurance 60, 83
self-diagnosis 41, 65, 123 interference from parents 94
discussion group 115–7 Isabella 60–1
dissociation 95 James 70–1
diversity of population 13, 17 lack of knowledge within 70
Moose 82–3
Nami 94–5
education
overview 149–50
accommodations 103
Reynard 117–9
level of 20–1
waiting periods 82, 136
special education class 60
see also therapy
teachers’ understanding 109–10
hormone replacement therapy 60
emotional dissociation 95
employment see work/employment
ethnic identity 153–5 identity categories 19
executive function 99–100 identity-first language 10–1
insurance, health 60, 83
interview instruments 17, 175–88
family
interviews 18–9
chosen 10
cultural differences and 92
disapproval from 92–3 Judaism 31–2, 157
dismissiveness towards autism 68
interference in healthcare by 94
Kinsey, Charles 110
mixed relationship with 45, 113–4, 125
overview of experiences 146–8
rejection by 15, 79–80, 125 language, identity-first vs.
responses of 58, 133–4 person-first 10–1, 136
support from 28–9, 45, 101, 134–5 links (autism/gender identity)
Alex 26–8
as “false parallel” 58
games, role-playing (MMORPGs)
Grace 45
26, 50–1, 127, 151
Isabella 58
gatekeeping by healthcare
James 67–8
profession 14, 33, 70, 82
Moose 78–9
gender dysphoria 112
Nami 92
Gender Infinity Conference 102
Nathan 100–1
genderfluid 25, 133
overview 145–6
GP’s attitude 48, 70–1, 150
Reynard 113
Grandin, Temple 35
Sherry 124–5
greysexual 10
Tristan 134
group (discussion) 115–7

Mad Movement 90
head canon 10, 127
masking 143
healthcare
media representation
Alex 33–5
head canon 10, 127
compartmentalizing different
increase in 103–4
areas of 117–8
lack of 35, 61, 72, 83
educating your provider 48–9
negative 137
gatekeeping around 14, 33, 70, 82
 Subject Index 203

non-mainstream media 49–50 social rules

overview 150–1 adapting to different 61
race and 83 after transitioning 72–3
methodology analysis of 95–6
consent 19, 175–80 at work 135, 137
data collection 17–9 and being perceived as
demographic data 19–21 confrontational 104, 127
interview instruments 17, 175–88 code-switching 119
participant selection 17 cultural differences in 84
text-based interviewing 18 difficulties with 36
Minassian, Alek 31 overview 151–3
multiplayer online role-playing games in sexual situations 120
(MMORPGs) 26, 50–1, 127, 151 strategies to help with 50
My Little Pony 42 social scripts 93
social stories 115
socialization, within own
neurotypical 11
community 30–1
nothing about us without us motto 141
stealth transgender 69
suicidality 34
pansexual 11
participant selection 17
Tajiri, Satoshi 83
patient’s advocate 115, 118–9
testosterone research 102
person-first language 10–1, 136
text communication 29
physical restraint 34
text-based interviewing 18
play therapy 34
therapy
police 110
applied behaviour analysis
political office (running for) 125
(ABA) 9, 24–5, 30, 143
pronouns 19
psychoanalysis 47
psychoanalysis 47
variations in quality of 48, 136
trans broken arm syndrome 11, 126, 136
questionnaire 17–8, 181–8 transgender, definition 11
transitioning
decision-making around 113
racial identity 153–5
disclosing intention 43–4
racism 80–1, 104, 110, 114, 148, 153–4
factors influencing 34–5
religion 31–2, 157
social rules after 72–3
research
transmisogyny 11
exploitation by 13–4
transsexual 11–2
viewpoint of 13
Tumblr website 144
role-playing games (MMORPGs)
26, 50–1, 127, 151
waiting periods 82, 136
whiteness 116–7, 154
self-awareness
work/employment
as autistic 41, 65–6, 111, 123
autistic traits and 69–70
as transgender 26, 42–3,
coming out at 44–5
56–7, 91, 132–3
income 20, 155
sexual abuse 91
in macho environment 135
sexual assault 156–7
mixed support at 69–70
sexual attraction (post transition) 67
overview of experiences 155–6
sexual harassment 57
social rules at 135, 137
sexual misunderstanding 120
social scripts at 93
sign language 29
support from 46, 81–2
Author Index

The number following “n” refers Brill, S.A. 44n7

to the endnote number. Brown, E. 60n10
Brown, L.X.Z. 11n4, 136n7,
170n36, 171n46
519 Community Centre 59n8, 93n10
Brownlow, C. 90n1, 171n43
Academic Autistic Spectrum Partnership
Brubaker, J. 37n31
in Research and Education 161n1
Burke, C. 172n51
Adams, N. 13n2, 17n14, 34n22
Burkin, C. 20n26
Adler, L. 133n3
Burns, K. 82n8, 165n16
Alcock, J. 20n26
Butrymowicz, S. 63n17, 166n21
ArenaNet 127n2, 151n30
Asante, M. 154n49
Ashkenazy, C. 171n46 Camp Kennebec 30n4
Ashkenazy, E. 157n59, 162n2,3 Campuzano, G. 9n2, 170n40
Asia Pacific Transgender Network 141n4 Carruthers, S. 154n50
Asperger/Autism Network 110n8, 154n45 Cassidy, S. 34n20
Auer, M.K. 67n10 Cendrowski, M. 35n25, 72n18, 151n28
Autism Canada 37n33 Centre for Addiction and Mental
Autism Society of Alabama 110n9 Health 30n7, 60n11
Autistics For Autistics 30n6, 148n8 Chang-hwan, S. 84n12, 150n23
Aviv, R. 63n16, 165n15 Channel 4 66n6, 72n16, 151n27,28, 163n8
Charlton, J.I. 141n2
Chen, R. 81n7
Baffour, T.D. 153n42
Chisolm-Straker, M. 136n6
Bai, D. 92n8
Coleman, E. 49n11, 150n14
Bakan, M.B. 79n3
Craig, F. 99n4
Barahona-Correa, J.B. 55n2
Crow, M. 90n3, 168n28
Bargiela, S. 143n7
Cuil Press 32n17
Baron-Cohen, S. 65n1, n2, n4
Bauer, G.R. 20n23
Bauer, S.C. 153n40, 169n32 Dale, K.D. 172n49
Baume, M. 37n32, 165n17 Daniel, A. 43n5, 151n35
Benaway, G. 168n27 Davis, A. 154n49
Benford, P. 18n18 Davis, J. 93n12, 164n13
Bertilsdotter Rosqvist, H. 90n1, 171n43 Davis, N. 70n14
BioWare Austin 26n3, 151n33 Daybreak Game Company 26n2, 151n32
Blizzard Entertainment 43n6, 151n31 de Marchena, A.B. 112n11
Bonvillian, J.D. 37n34 Demetriou, E.A. 100n5
Bouman, W.P. 9n1 Dempsey, A. 31n11
Bourns, A. 48n10 DePaul, S. 35n26, 150n15

205
206 TRANS AND AUTISTIC

Devita-Raeburn, E. 30n9, 143n5, 166n19 Johnson, C. 156n43

Dimbort, D. 119n14, 150n21 Johnson, M. 35n30, 84n13, 151n29
Donohue, M.R. 153n39, 170n39 Jones, R.M. 102n9
Draeper, J. 71n15
Duncan, C. 16n12
Katz-Wise, S.L. 67n12
Dyck, D.R. 96n13
Keen, D. 21n29
Dym, B. 37n31
Keo-Meier, C. 102n7, 148n9
Kerrigan, E. 72n17, 151n25, 163n4
Egale Canadian Human Rights Trust 59n9 Knutson, D. 11n5
Ehrensaft, D. 102n13 Koetse, M. 56n3, 164n12
Eigsti, I-M. 112n11 Kukla, R.E. 32n15
Eldred-Cohen, C. 83n11 Kumitz, D. 141n1
Ellis, R. 14n8 Kupferstein, H. 39n19
Kurchak, S. 127n1, 165n18
Faraday, C. 42n3
Fardella, M.A. 34n23, 157n55 Latimer, M. 162n2
Ferguson, S. 35n27, 150n20 Lee, J. 110n5
Fiesler, C. 37n31 Levenson, E. 110n6, 154n43
Filipe, C.N. 55n2 Levinson, B. 35n30, 84n13, 151n29
Fletcher-Watson, S. 10n3, 136n5 Lime Connect 13n4
Fonrobert, C.E. 32n14, 164n14 Lorenz, T. 18n16
Freeman, Z. 60n10
FTM London 67n7
McWilliams, A.T. 119n15
Maddox, L.A. 110n4
Gammicchia, C. 156n54 Mandell, D.S. 110n3
Gargaro, B.A. 111n10 Mandy, W. 143n7
Genderqueer Chicago 115n12 Mann, A.R. 153n41
George, R. 20n20 Matthews, M. 171n45
Gillespie-Lynch, K. 171n44 Maxis 50n12
Gillis, J.M. 157n56 Meier, S.C. 67n11, 102n12
Gordon, S. 35n24, 150n16 Monsebraaten, L. 31n12, 156n52
Gourdine, R.M. 153n42 Moody, C. 34n22
Graffeo, D. 60n10 Morgan, G. 80n4, 154n47
Grant, J.M. 20n24 Moyer, M.W. 156n53
Myeong-hong, S. 84n12, 150n23
Habermann, A.M. 32n16
Halberstam, J. 133n2, 151n36 National Autistic Society 93n11,
Hendricks, D. 20n25 115n13, 169n35
Hitomi, M. 34n22, 60n12 National Sexual Violence
Holton, A.E. 163n6 Resource Center 157n57
Howard, R. 99n1, 150n17, 163n5 Nelson, K.E. 37n34
Howlin, P. 20n26 Newport, J. 157n58
Huang, H. 16n12 Newport, M. 157n58
Human Rights Campaign 96n14 Nicolaidis, C. 18n19, 171n41
Nobili, A. 16n10
Jackson, K. 90n2
Jackson, M. 35n27 O’Dell, L. 90n1, 171n43
Jacobs, L.A. 16n13 Onaiwu, M.G. 171n46
James, S.E. 21n28
Janssen, A. 16n12
 Author Index 207

Ontario Ministry of Children, Smith, L.T. 14n6

Community and Social Smith, T. 132n1, 169n33
Services 30n8 Spectrum 30n9, 143n5, 166n19
Ovens, H. 170n37 Standen, P.J. 18n18
Standifer, S. 18n17
Steward, R. 143n7
Pacific AIDS Network 141n3
Stohn, S. 99n2, 150n18
Paramo, M. 55n1
Stokes, M.A. 20n20
Parker, S. 164n10
Stone, S. 171n42
Payton, N. 11n6, 167n25
Strang, J. 14n7, 16n9, 20n21, 78n2
Pellicano, L. 13n3, 163n9
Substance Abuse and Mental Health
Perry, B. 96n13
Services Administration 155n51
Philadelphia Transgender
Sugar, R. 35n28, 151n26, 163n7
Wellness Conference 46n8,
Sullivan, K. 1646n11
102n10, 135n4, 148n11
Supporting Our Youth 59n7
Pilkington, E. 92n9, 166n20

Tagonist, A. 14n5, 169n31

Qalonymous ben Qalonymous
Tannenbaum, N.K. 137n8, 151n24
ben Me’ir 32n16
Teasley, M. 153n42
Quinn, A. 110n7, 154n44, 164n11, 172n50
Thiessen, J. 42n1, 151n34
Thom, K.C. 58n6
Ramirez, R. 81n6 TransBareAll 67n8
Re:searching for LGBTQ2S+ Health 56n4
Rhyne, J.M. 37n34
Voss, P. 90n4
Richa, S. 34n21
Vrangalova, Z. 67n9
Ridley, G. 21n29
Ringo, A. 31n10
Robinson, J.E. 99n3 Waxman, S. 153n40, 169n32
Roddenberry, G. 137n10 Webster, A. 21n29
Rodgers, J. 34n20 Weiss, J.A. 34n23, 157n55
Roth, M.E. 157n56 Weiss, S. 166n22
Roux, A.M. 170n38 White, B. 16n11
Rowe, W. 60n14 White, M. 133n3
Russo, F. 66n5, 143n6, 167n24 Williams Institute 20n22,
21n27, 80n5, 154n46
Williams, R.A. 151n38, 168n29
Saban, H. 137n9, 150n22
Winegar, J. 153n40, 169n32
Saines, E.G. 35n27
Winter, S. 90n5
Sandin, S. 92n8
Wired Staff 65n3, 167n23
Sarrett, J. 18n15
Withers, A.J. 60n15
Schaber, A. 169n34
World Professional Association
Scheim, A.I. 20n23
for Transgender Health
Schnurr, R. 24n1, 151n37
102n11, 148n12, 150n13
Schuyler, L. 99n2, 150n18
Seung-yeop, L. 84n12, 150n23
Sevlever, M. 157n56 Xtra 30n5
Sharman, J. 133n3
Sherbourne Health Centre 48n9
Yergeau, M. 157n59, 162n3, 172n48
Shimrat, I. 172n47
Yerys, B.E. 112n11
Shore, D. 35n26, 150n15
Yorke, B. 99n2, 150n18
Sidney, H. 42n2, 168n30
Silberman, S. 167n26