Dr Hilary Cass is anti-asexual as well as anti-transgender

It’s impossible to write about “The Cass Report” without falling into a pit of despair. In a just world that woman would be struck off the medical register a la Andrew Wakefield.

We can live in hope.

But as of May 2024, anti-trans journalists are rubbing their palms together with glee. “Yipee! A brand new anti-trans document from a medical practitioner, no less! Finally, some blaze for our entirely manufactured ‘culture war’. More views! More ears! More moneys! ‘Journalism’ lives another dayyy!”

What everyone in the queer community must understand urgently: The Cass Report is anti-asexual as well as anti-trans.

Transphobes and aphobes are the very same people.

In fact, me calling aphobia and transphobia two separate phenomena is an artificial distinction. They roll into one big ball of drain-lard.

WHAT THE TRANS AND ASEXUAL COMMUNITIES HAVE IN COMMON

Aside from the fact that many trans people are asexual and vice versa, everyday experience of these two communities frequently overlaps.

For example, invasive personal questions from randos. Asexuals are regularly asked about masturbation: frequency, fantasies, the entire lot. Some people think it’s okay to talk to aspecs about the most private matters of all — broaching topics they might not even ask their actual sexual partners.

Likewise, visibly trans people face a barrage of prurient interest about their private body parts.

Both asexuality and transgender are considered ‘social contagion’ by bigots.

Both identities are stigmatised.

Transgender and asexual members of the queer community are more likely than gay and lesbians to be subjected to conversion therapies.

Both transgender and asexual people are accused of ‘claiming labels’ because we’re too ugly/socially inept to be the gender/sexuality we were assigned by others. Or else, we’re too pretty as our assigned gender/sexuality, and being who we are is a ‘waste’:

YOU WERE SO PRETTY/HANDSOME BEFORE TRANSITION — it is not, Not, NOT about how YOU think we look or need to be! It’s about US and seeing OURSELVES in the mirror.

— Trans Microagressions

The list goes on.

I don’t want to leave anyone with the impression that it’s just bigotry that unites us. That’s the sort of misguided thinking that excludes certain groups (namely, asexuals) from queer spaces. Trans folk and asexual folk share one big experiential thing in common: The transgender and asexual identities concern relationships to self, whereas gay, lesbian and bi+ identities concern relationships to others.*

*This is an oversimplification but I’d like to end this section on a more positive note. There are more nuanced things to be said about the internal experiences of being queer (and also neurodivergent — see below).

Note that unlike anti-trans animus, which is easy to spot, anti-asexual animus is easy to deny. “How can people be anti-asexual? Asexuals don’t even do anything!”

DENIAL OF EXISTENCE IS A FORM OF BIGOTRY

For an anti-asexual bigot there is no such thing as a genuine asexual, and that is why they rarely mention asexuals at all.

Just because we’re not mentioned directly doesn’t mean they’re not spraying anti-asexual crap all over the show. The reason they don’t mention us directly is because they don’t believe we can exist. Asexual people are: confused, deluded, mentally ill, traumatised. We cannot possibly know ourselves.

Despite dropping the word “trans” obsessively, for any anti-trans bigot there’s no such thing as a transgender person, either.

Trans people cannot exist. Asexuals cannot exist. That’s a big thing in common.

The difference is, people seeking gender affirming care are very visible, whereas asexuality remains somewhat invisible.

(I argue that asexuality is becoming less invisible, but remains illegible.)

DR CASS BELIEVES TRANS PEOPLE MUST HAVE ROMANTIC PARTNERS AND PARTNERED SEX

Rather than link to this week’s infamous NPR Dr Cass interview itself, I instead direct you to the takedown by Erin Reed.

No matter the evidence presented to her on a silver platter, Dr Cass is determined to position medically transitioned trans people as unhappy.

If Dr Cass encounters a delighted trans person living their best life, that’s not good enough for her. “Just wait,” she grumbles. “Thissss so-called happinessss cannot possssibly lassst, because a happy transssed persson is not a thing.”

Here’s what Dr Cass had to say when queried by Meghna Chakrabarti about existing studies:

CHAKRABARTI: Regarding cross sex hormones, the systematic review authors said there is a lack of high-quality research assessing the actual outcomes of cross sex hormones.

CASS: Yes, because we need to follow up for much longer than a year or two to know if you continue to thrive on those hormones in the longer term. And we also need to know, are those young people in relationships? Are they getting out of the house? Are they in employment? Do they have a satisfactory sex life?

This response contains multiple layers of bigotry in itself, and I could talk about the ableism for starters. (Ableism is at the heart of most forms of bigotry.)

We might also talk about the capitalism. A happy trans person is an employed trans person.

1. Many trans people would love to work, but due to widespread anti-trans discrimination perpetuated by the likes of Dr Cass her very self, many trans people cannot find stable employment. (This aspect has been noticed by the wider trans community. See for example: Transition should be measured by “employment,” not satisfaction” published in the LA Blade, Southern California’s LGBTQ News Source.
2. Trans people are disproportionately disabled. To give just one (personal) example, this is because the trans community is more vulnerable to infections such as Covid-19 which results in POTS and ME/CFS. These conditions in and of themselves prevent people from “getting out of the house”. Why is the trans community disproportionately affected by disability? We won’t know until researchers start caring about trans people as people, rather than focusing on eradication. The obvious answer: People whose bodies are already wracked by the general trauma of living are of course more vulnerable when infection hits. So that answer seems part of the story. Poverty from unemployment and social ostracization explains further. But we must also look to the huge crossover between the trans and Autistic community, in which an Autistic phenotype (excuse the medical language) makes an Autistic person more vulnerable to certain health conditions. Those of us in the Autistic community can rattle off exactly what those health conditions are; most doctors cannot. I’d wager Dr Cass herself cannot.
3. People are more than our work. We shouldn’t need to prove our usefulness before we are permitted to live.
4. No matter how happy a trans person becomes, marginalised communities are subject to testimonial injustice. So, even if we say we’re happy, bigots cannot possibly imagine being happy in our position, and so refuse to believe us.
5. Working doesn’t equal happiness anyway. A recent study of Autistic individuals concluded that having a job or a social life doesn’t automatically improve Autistic quality of life. Anxiety and depression tend to go unaddressed, overshadowing everything else. Although this study focused on the Autistic population, we might extrapolate its findings to other marginalised communities with disproportionately high rates of anxiety and depression i.e. the trans community.

Now to the specifically anti-aspec (asexual spectrum) sentiment evinced by Dr Cass.

As well as employment, Dr Cass requires medically transitioned trans people to:

1. Be “in relationships”
2. Have a “satisfactory sex life”

…before accepting any possibility that young trans people are doing just fine.

English speakers will understand that the phrase “in a relationship” is shorthand for “in a romantic/sexual relationship”. Dr Cass does not refer to friendship or kinship. This requirement to be romantic ignores the reality that a significant proportion of trans people are aromantic by orientation. For aromantics, being “in a relationship” was never the goal.

And what does Dr Cass mean by “satisfactory sex life”?

When I pointed out the anti-asexual sentiment evinced in this phrasing to a trans person (who despises the Cass Report as much as I do), they at first gave Dr Cass the benefit of the doubt: “To Dr Cass, a ‘satisfactory sex life’ might mean no sex at all,” they argued.

Okay, but given that Dr Cass does not accept the possibility of aromantic trans people, it is far safer to infer that she does not accept the possibility of asexual trans people either.

When it comes to bigots such as Dr Cass, I am begging allosexual trans people to believe the aspec community when we tell you a bigot is anti-aspec as well as anti-trans. The nature of anti-asexual sentiment may seem different in nature. But at its heart, the bigotry is the exact same: Cass does not believe aspec people can exist, just as she does not believe happy transgender people can exist. She is determined to erase all of us.

Take nothing she says in good faith. Nothing.

DR CASS THINKS PORN IS TRANSING THE KIDDIES

In the same interview at the Bostonian NPR branch of WBUR News, Dr Cass said that “early exposure to pornography” might be to blame for the increasing numbers of adolescent “girls” seeking medical gender transition.

This time, I direct you to the excellent takedown of the NPR Cass interview by Alyssa Steinsiek at Assigned Media rather than to the interview itself. (Preserve your spoons.)

As far as I’m aware, Dr Cass is yet to say anything publicly about asexuals in particular. In fact, she knows so little about the trans community that it’s unlikely she understands the high representation of asexuals within the trans community. Many trans people happen to be asexual.

Once again for those at the back: Many trans people are asexual.

Many asexual folk avoid porn like the plague.

Ergo, many trans people don’t touch porn.

In fact, there are many, many reasons why trans people might avoid porn, and being a porn-averse asexual is only one of those reasons.

How did Hilary Cass arrive at ‘porn’? There’s no throughline to her logic.

For us, though, the throughline is clear: Marginalised queer communities become the scapegoat for whatever cultural anxieties happen to be proliferating at the time.

Worried about porn exposure? That’ll be the transesss fault. Except it’s couched as concern for the transgender kiddies. This makes it just palatable enough for mainstream know-nothings to accept as truth.

WHAT’S IN STORE FOR OUR COMMUNITY

Here’s what happens next, folks. (I’m no sage; we’re already seeing this at the edges.)

Anti-trans blatherers, beloved by mainstream media, believe this:

• “Asexual” trans people would not claim to be asexual if we had a proper relationship with our gender. The only proper relationship with gender is binary cis gender. Being trans is in itself an assault on the possibility of a “healthy” sex life. Only the psychology and psychiatric professions are in a place to deal with this “complex issue”.
• Medical transitioning itself makes children asexual. Something to do with hormones. Because asexuality is not an orientation. It’s hormonal. “Let’s not even talk about genital mutilation! Ew! I can’t even!”

If Dr Cass were asked directly about asexuals, she would come out with something like this. Fortunately, no journalist has asked her yet.

(I wish all journalists would just quit asking her things in general.)

As noted in The LA Blade article, there’s a precedent to the testimonial injustice exacted against the LGBTQIA+ community in particular regards to self-described life satisfaction: Even when we say we’re happy, we are not believed.

Aspec people are very familiar with this. If we say we’re fine without sex/without romantic partners, allosexuals typically have trouble accepting that genuine life satisfaction is ever possible for us.

For trans people seeking gender affirming care, this ‘inability to be happy no matter what’ prejudice has in the past exacted real harm:

[For example, the] error-ridden “WPATH Files,” which stated that transgender people are “suspiciously happy,” seemingly arguing that there is no way transgender people could be so happy given the discrimination they face on a daily basis.

— LA Blade, Erin Reed (who has just won a GLAAD Media award for her writing on LGBTQ+ issues, by the way.)

Erin Reed describes how gender affirming surgeries were abruptly halted in 1979 by a Conservative doctor who, like Cass, ‘based the decision on a study that judged the effectiveness of transition with employment status, legal difficulties, and entering into relationships (notably, points were deducted for transgender people entering into gay relationships).’

(Surgeries were later reinstated, and that doctor is seen as a dark blot in the hospital’s history.)

When anti-trans and anti-asexual doctors determine for themselves what counts as our life satisfaction, to us, this is quite literally dangerous. When Dr Cass bases life satisfaction on anything to do with romance and sexual activity, this is quite literally dangerous.

WHAT’S THE REAL STORY HERE?

If it weren’t for the proliferation of anti-trans and anti-asexual bigots in the world, it would be safe to investigate a very interesting question and trust it be approached in good faith:

Why are so many asexual people also genderqueer?

Once again, I am asking the nonces of this world for one small favour: Flip the question. (They won’t.)

If they weren’t nonces, they would ask this, instead: How does anyone’s gender interact with their sexuality?

Across much of the 20th century, gender and sexual orientation were mistakenly believed to be the same thing. You’re female? You’re attracted to men. You’re male? You’re attracted to women. End of.

In order to understand queer orientations and (trans)gender, we first needed to disentangle those two concepts.

It would be nice to retrace our steps now, and consider how gender and sexuality are, in fact, separate parts of the same phenomenon. As the asexual community can easily show, gender identity absolutely has some impact on how people feel about sex. The large proportion of agender asexuals such as myself would make for a fascinating case study into understanding how human sexuality works, if only The Common Man (TM) were genuinely interested. This stuff is fascinating. Instead, the likes of Dr Cass wish to erase us. If ever we speak, she talks over us. Mainstream media aids and abets this deadly injustice.

And if eugenicist types weren’t hellbent on “curing” Autism, we might safely ask this:

Why are so many genderqueer asexuals also Autistic?

I intuit the answer to this, being a reflective genderqueer, asexual Autistic* myself.

*Note that I make use of the social model of Autism, not the medical model.

Dr Cass and various other anti-trans “experts” believe that Autistic people do not deserve access to trans affirming care because an Autism diagnosis means we are incapable of really knowing ourselves. Autistics are expected to bow to the superior knowledge of experts such as herself. “Rapid onset gender dysphoria” bigots all think the same way about Autism: If you’re Autistic, that rules out any possibility of being transgender. The two cannot co-exist.

Fact: Medical professionals don’t know shit. Not compared to all there is yet to learn.

Until 2013, so-called medical experts believed AD/HD and Autism could not co-exist. Now anyone with two clues to rub together knows AuDHD is super common.

If anyone is listening first and foremost to the medical community for expertise on gender and minority neurotype, back away.

Anti-trans bigots are factually correct about one (1) observation: Autism is a common thread through much of the queer community, especially, perhaps the asexual community.

Or we could put it inversely: Trans people are very well repped in the Autistic community.

For me, asexuality and agender are two flashing lights on the Christmas tree that is Autism. For Autistics, gender does not tend to be as “sticky” as it is for allistics. Overall, we tend to have a different relationship to the self in ways which medical descriptions of Autism fail to describe.

This is a difference, not a deficit. At times, the typically-Autistic relationship to self is of huge benefit to society. For instance, researchers have found that when given the opportunity, non-autistic subjects are far more likely to compromise their own morals for personal gain. Not Autistics, though. With our strong sense of social justice, related to our high affective empathy, and also our permanent positions as social outsiders, Autistics are more easily morally injured than allistics are. It hurts to cause someone pain.

For a non-bigoted view of the connection between Autism and the queer community, a good place to start is, of course, within the Autistic community.

The Neurodiversity podcast has an episode called “The Confluence of Neurodiversity and LGBTQ”.

Some people in the Autistic community use the term ‘autigender’ to describe the way their Autism and gender feel like one and the same thing. Check out the work of Brianne Leeson.

Autistic people are very good at looking at bullshit social norms and saying, “That makes no damn sense. I’m having none of it!”

And what is gender if not a set of nonsensical, repressive social rules? Since learning the gender rules doesn’t come naturally, it’s far easier for us Autistics to conclude, “These rules exist to maintain a gender hierarchy, with cishet men at the top. Hell no!”

That’s not to say that my genderqueerness is a political act. Writing about it online is a somewhat political act, but I’ve known I’m genderqueer for far longer than I’ve known words such as “feminism” and “gender”.

It makes sense to me that, for people seeking frequent partnered sex — allosexuals, that is — one’s gender identity is very important to that mission. It’s far more productive for a cis man who finds women attractive to present as masculine, for example. He’ll achieve more sex with straight women that way.

None of this is a wholly conscious process, but when men grow out their stubble so it’s the perfect length for a date, or when women buy push-up bras, the allosexuals are not just exaggerating their gender; each time they do this, they are affirming their gender to themselves. After a lifetime of doing this, and being treated as one gender, not the other (binary) gender, gender performance* does come unthinkingly for the allistic allosexual cishets (the not Autistic, not asexual, not trans, not gays).

*For the but-but-but crowd, Judith Butler is entirely sick of your questions.

Of course, it’s not safe to talk about the Autism-sexuality-gender connection to a broad audience, precisely because of bigots like Hilary Cass spouting their hatred at every damn opportunity, to as many impressionable know-littles as possible. It is decidedly unsafe to tell the likes of Hilary Cass you’re Autistic if you’re seeking gender affirming care. I know this because I have met one. (The only paediatric psychiatrist in my area of Australia believes this with her whole, bigoted heart. She charged $800 for the privilege of hearing her go on about it.)

This is a call to action: The queer community is somewhat splintered right now. This is how the bigots want it.

I see too many allosexual trans people try to counter the likes of Dr Cass by expressing their wonderful, rainbow allosexuality without also pushing back on the terribly dangerous and repressive belief that, in order to deserve medical transition, trans people must perform partnered romance and sexuality.

Be big, be sexual, be proud. Be as annoying as possible, in fact.

But also? Your allosexuality will never serve as proof for the Cassian idea of successful transition. Sexuality, when it is compulsory, cannot safeguard your humanity.

There’s a good historical reason why trans activism has become highly (allo)sexualised. For much of last century, continuing into this one, trans people seeking medical care were not allowed to be sexual beings at all. The fear was of trans people becoming parents. Surgical sterilisation was often required. Before marriage equality, divorce for married trans people was also required. All of this history is alarmingly recent, and in far too many places around the world, it is ongoing.

So it’s very tempting to ignore the aphobia of people like Dr Cass. It’s easy to miss it’s even there. Who cares about the asexuals, right? Asexuals are best kept off to the side, clearly unable to help in the fight to be both transgender and fully in charge of one’s own sexual body.

This misses the point. Where trans people are required to demonstrate sexual behaviour and enter romantic relationships to prove human worth, this is simply an inverse of the 20th century bigotry. Inversion does not equal subversion. Asexuals are in an excellent position to subvert the expectation of what it means to be human. Include us in your fight. We are a part of this fight.

Compulsory sexuality is dangerous to everyone’s bodily freedom, but especially dangerous for the trans community, whose basic rights remain scarily contingent.

Wherever there exists pressure to be publicly sexual and romantic before your gender is acceptable to society, there can be no freedom.

REFERENCES AND NOTES

If you’re in the mood for a further punch in the skull meat, The Cass Review is here. It’s really long.

An expert very well positioned to critique the transphobia of The Cass Review is Julia Serano, who in turn links to other experts. For now at least she’s removed the paywall to her Substack article about it. If you’re going to read the actual Cass Trash, be sure to read the critique, because it’s not just what’s in the report that’s problematic, it’s what she chose to leave out.

And as I keep saying, it’s harder to spot what’s not there.

Another science brain (a cisgender epidemiologist) looking deep into the Cass Review itself is Gideon M-K, who is writing a series on it.

Doctor Cora Sargeant is a transgender academic whose very job is reviewing papers such as the Cass Review. Dr Sargeant has a podcast called Classroom Psychology and she is very well-positioned to get into it. Dr Sargeant makes the point that when you first start reading the paper, it doesn’t seem too bad, because Dr Cass makes the point that, “When you talk to these young people and their parents/carers, they want the same things as everyone else: the chance to be heard, respected and believed; to have their questions answered; and to access help and advice”. But the deeper you get into the report, the less reassuring it becomes.

(I don’t personally find that a reassuring paragraph to read. If you’ve ever been ‘handled’ by someone very clearly trained in people management — training I’ve had myself, by the way — you’ll perhaps read that as, “People need to feel heard… and sometimes being heard is the main thing they need before realising there’s nothing genuinely wrong with them at all.”)

On 14 March 2024 Cal Horton published an academic paper called The Cass Review: Cis-supremacy in the UK’s approach to healthcare for trans children:

The Cass Review itself can be understood as an example of cis-supremacy, within a cis-dominant healthcare system lacking accountability to trans communities. These findings draw attention to systemic barriers to effective healthcare policy, with relevance for trans healthcare across and beyond the UK.

— Discussion

Evan Urquhart at Assigned Media has this to say about a study (which was lapped up by JRK on Ex-Twitter):

The authors surveyed 68 trans men on testosterone about a range of symptoms, most but not all of which related to pelvic floor health. The most common symptoms reported were also the most minor: Over forty percent of the sample said they had trouble reaching orgasm with a partner, 47 percent said at times they strained when they took a poop, 46 percent reported experiencing constipation, and 42 and 47 percent said they had a sensation of incomplete emptying of their bladders and “post void dribbling” respectively.

— Evan Urquhart

I’d like to add to Urquhart’s takedown of that article by saying that basing success of hormone therapy in trans men on ability to reach orgasm with a partner sounds as backward and narrow-minded as the Freudian notion that a vaginal orgasm is more ‘mature’ than a clitoral one. People who have partnered sex — especially trans people, and especially trans, queer, Autistic people — find many inventive ways to enjoy sex outside the established cishetero-norm.

ABLEISM IN MEDICINE AND RESEARCH HOLDS EVERYONE BACK

A mystery illness stole their kids’ personalities. These moms fought for answers.

This article from the Washington Post is about a young Downs Syndrome woman whose mother happens to be a paediatrician. The mother was distraught when her previously thriving daughter suddenly and massively regressed, sometimes becoming unable to speak. Apparently this happens to a significant proportion of people with Downs.

Why was no one interested in finding out the cause? This paediatrician knew exactly why, being both a mother of a disabled child and also part of the medical establishment:

“I think people just might have a bias that, well, this person already has a disability, so it’s not as important.”

— Eileen Quinn, Sara Smythe’s mother

The article also describes how Downs Syndrome people age differently. First, they are far more likely to get dementia very young. But also, they seem ‘immune’ to other ageing diseases such as high blood pressure. Also, they almost never develop solid tumour cancers. Aside from improving the lives of people with Downs, for researchers, “that could be super-rich to understand aging in general,” one scientist points out.

I’m saying the same thing about Autistics and asexuals. If it weren’t for widespread, systemic ableism, if more research went into finding out why we are the way we are, the knowledge gained would ultimately help everyone, not just us, as a cohort.

DIAGNOSTIC OVERSHADOWING

I briefly mentioned a visit to our local paediatric psychiatrist. Note that my transgender teen was not sent there for trans reasons. His regular paediatrician had come to the end of her knowledge about how to balance his AD/HD and anxiety medications and she wanted a second opinion. Autistic people regularly respond differently from the allistic population when it comes to drugs — yet another hurdle, little understood by the medical community.

But once we got to the psychiatrist, due to a phenomenon known as diagnostic overshadowing, she refused to listen to what was really going on. (Later I worked it out myself with help from our local Autistic community: POTS and ME/CFS. I also learned that the trans community is well aware of this woman — now I check with them if we’re required to see someone new. I’m still looking for a new paediatrician.)

And I’m pleased to report that I did tell the anti-trans psychiatrist exactly what I thought of her. I had nothing to lose by that stage. Nothing has changed, except it was quite cathartic, to read the riot act to someone with that many letters after their name.

When Autistic people visit the doctor, doctors routinely see only the Autism. When transgender people visit the doctor, doctors routinely see only transgender. When someone is both Autistic and transgender, getting any biological issue properly seen to becomes almost impossible. The infuriating tragedy is this: When you’ve got the Autistic genes, you are more likely than the general population to suffer from these other invisible issues.

If anyone wonders what those are, below is an incomplete list. Others have compiled more comprehensive resources for health professionals.

• AD/HD
• OCD
• Depression and/or generalised anxiety, social anxiety
• Perfectionism
• Sensory processing differences
• MCAS
• C-PTSD
• Disordered eating
• Epilepsy (or non-epileptic seizures)
• POTS (postural orthostatic tachycardia — feeling really dizzy and ill when standing up)
• dysautonomia (POTS is one example — another example is trouble with heat regulation e.g. you feel hot when everyone else is cold and vice versa, trouble adjusting to new environmental temperatures)
• sleep disorders (researchers have noticed the high prevalence of sleep disorders in the trans population but as far as I know are yet to make the Autism link)
• CFS (chronic fatigue)
• migraines
• tics and Tourette syndrome
• differences in motor skills (fine motor, gross motor, hypotonia)
• differences in processing speed
• prosopagnosia
• giftedness
• Food sensitivities leading to sore stomach
• “IBS” (when they don’t know what else to call those gut issues) — the gut brain connection is interesting, and may be inextricably linked to anxiety (chicken or egg?)
• Celiac disease or gluten sensitivity
• Gynaecological issues, especially endometriosis, which may have something to do with hypermobility. But because it’s a ‘female issue’, there’s barely any funding gone into the research. They’ll work it out eventually, as certain wonderful scientists who themselves have endometriosis are leading the charge.
• Difficulty with the transition to menopause (See: AutisticMenopause.com)
• Increased incidence of dementia in later life
• Parkinson’s and Parkinson’s-like symptoms (new research)
• Learning differences (dyslexia, dyscalculia, dyspraxia, alexithymia, prosopagnosia)
• Speech and language differences
• Auditory processing differences
• Hoarding behaviours
• Rejection sensitivity dysphoria
• Injustice sensitivity
• Vasculitis conditions e.g. Reynaud’s syndrome (your fingers suddenly become cold and white), livedo reticularis (which shows as mottled skin, mostly on the legs), lymphocytic thrombophilic arteritis
• Scoliosis
• Sight differences

Each of these things has a lot more to it, but I want to talk more about sight differences, because it was learning about the sight differences in Autistic people that finally made me go, “You know what? I really am Autistic. It’s not just imposter syndrome.”

It shouldn’t have required a very obvious biological reality (astigmatism, large pupils and extreme light sensitivity in my case) to ‘confirm’ my own Autism, but there we have it.

75% of people with astigmatism are autistic, 90% of autistic people can be accurately identified by a distinctive pupil response, and we’re still diagnosing autism by observing behavior and deciding how weird it looks to neurotypical people.

— Erika Heidewald

I find playing tennis really unpleasant during the day because even with dark, wraparound sunglasses, the Australian sunlight is too much. I can’t see the ball if I’m facing towards the sun. I much prefer playing at night, but since our local club upgraded to competition level lights, now I see rainbows on the court. I’m not the only Autistic person with this issue — in fact, I didn’t have any idea that other people weren’t seeing rainbows until I listened to an interview with Katherine May, who sees rainbows coming out of those overhead projectors which have since been replaced with interactive whiteboards.

What explains the sight issues? Well, here are two more related conditions which have a huge representation in the Autistic community:

• hypermobility spectrum disorders (HSD)
• Ehlers Danlos syndrome (EDS)

The following sight differences overlap with HSD and EDS, even where hypermobility in the joints is not present:

• Astigmatism
• ‘lazy eye’ (e.g. convergence insufficiency, stabismus)
• far-sightedness
• near-sightedness
• dyslexia
• visual snow
• photophobia (light-sensitivity)
• painful to drive at night, or better than average vision at night
• poor peripheral vision, nystagmus (a visual condition in which the eyes make repetitive, uncontrolled movements)
• a sublexed lens
• cataracts and glaucoma with advanced age
• unusually large eyes or pupils
• retinal issues (e.g. easily detached retina)
• Golden Har syndrome
• pigmentary dispersion syndrome
• Krukenbergs Spindals
• hypermetropia
• epiretinal membrane (wrinkly retina)
• “20/20 vision but with dyslexia or ruthlessly near-sighted”. May be worse when tired, connected to migraine.

(See: Opthalmologic Manifestations in Autism Spectrum Disorder by Carlota Gutierrez, Jorge Luis Marquez — unfortunately they used ‘disorder’ in a paper published so recently — perhaps that’s how to come under the radar of the medical community?)

See also an excellent TikTok on the eye issues that come with Autism by Again With The Yelling

Note that to be deemed “ASD” according to a diagnosing psychologist, you must have ‘social deficits’. Medical people use the DSM-5. The DSM always has been, always will be, a political document.

Thank you to the person on Shitter for that list of sight issues — I’m afraid I copy and pasted the list without attribution, meaning to keep it only for my own reference. And now Shitter’s down the gurgler anyway so I can’t find you in a search. See also: Episode 107 of the Square Peg podcast featuring Autistic women and nonbinary people sharing their stories.

Larre Bildeston is the author of a contemporary (aromantic) asexual romance The Space Ace of Mangleby Flat (2023), set in Australia and New Zealand.