What happens when you have to combat not only transphobia, but also ableism?
Earlier this year, BBC Two ran a documentary called Transgender Kids: Who Knows Best? The film features Dr. Kenneth Zucker, the former head of the now-closed and discredited Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto and loud media advocate for conversion therapy for transgender children. During the documentary, Zucker makes the claim that transgender children are autistic kids who are fixated on gender. It’s a belief that is increasingly common among those pushing for transphobic corrective medical “solutions” for transgender children and adults, drawn from a gross misinterpretation of current medical studies on the link between autism spectrum disorders (ASD) and gender dysphoria.
There is a link between those with ASD and those with gender dysphoria; though the research done on the subject is thin, a 2010 study out of the Netherlands found that 7.8% of people diagnosed with Gender Identity Disorder (GID) under the older fourth edition of the Diagnostic and Statistical Manual of Mental Disorders—it was revised in 2013 for the DSM-V—also had an ASD diagnosis. It’s estimated that only 0.6% to 1% of the general population have GID. However, popular conservative and gender critical interpretations of this correlation are having damaging effects on the lives of those who have ASD and are also transgender.
Claiming that trans people are really just going through a separate mental disorder that’s unrelated to gender is a convenient and purposeful way to invalidate both transness and those with ASD. It also infantilizes those on the autism spectrum and takes away their free will. V, a non-binary trans woman who asked to remain anonymous, was diagnosed with autism earlier this year. She takes exception to those who seek to erase trans people by using the autism claim. “It makes me feel furious and confused. Like, being autistic and fixated on gender is a totally valid reason to be trans?” she said.
“Again, not my personal experience and honestly I don’t know if that’s a thing that happens but if it is, their genders would still be valid.” She brilliantly disarms the trans as autism claim with a single question: “So what?”
What V is asking for is basic respect and compassion, and her simple question reveals the depths of ableism in both anti-trans and autism discourse. Treating both ASD and transgender identity as a single mental disorder is harmful to both groups of people, but has a disproportionate impact on those who fit under both labels. Medical gatekeeping for transition care is fraught enough without the added hindrance of being on the autism spectrum.
The intersection of trans and autistic came to a head in the case of Kayden Clarke, a trans man with autism. Clarke was killed by police who were responding to a report that he was suicidal. For Clarke, the medical gatekeeping system failed him, leading directly to his death.
All trans people face a form of medical discrimination called gatekeeping, the various roadblocks to accessing transition care that the medical establishment puts in patients’ way. Something like a requirement to see multiple therapists to sign off for a transition-related medical procedure would be an example of gatekeeping. Historically, the role of the gatekeeper is to make trans people “prove” our “real” genders in order to access medical care, and it can be a very difficult process for those with ASD to encounter and work through.
Such was the case for Clarke as well, who faced discrimination not only for being trans but also against his autism. According to a statement from the Autistic Self Advocacy Network, Clarke’s therapist “would not approve his starting on hormones until after his autism spectrum disorder — which she referred to as a ‘disease’ — was ‘cured.’” Trans people who are autistic not only have to combat transphobia in medical situations, but also ableism.
Trans people with autism not only have to combat transphobia in medical situations, but also ableism.
This is a seemingly common conundrum faced by those with both ASD and gender dysphoria, throughout the western world. I spoke with Haley and their brother Eli—who are both trans and on the spectrum—about their experiences in Australia. “In the beginning of trying to access hormone therapy for Eli, we were turned away from an endocrinologist and told to come back when we could give the man a letter from two separate psychologists, not only explaining that Eli did indeed have ‘Gender Identity Disorder’ but also that he was in his right mind and was capable of recognizing the consequences of what he was asking for,” Haley explained. “Despite the fact that Eli was verbally (which was difficult for him) communicating how much he wanted to go on testosterone and how much happier he would be for it.”
Unlike Clarke in Arizona, Eli was eventually able to get the hormone treatment he so desperately needed for his gender dysphoria. “We were eventually able to go to another health-care provider that was much more helpful and did not require anything like that (a letter from our General Practitioner and the psychologist that had been seeing Eli consistently for six months, just for his dysphoria, was all we needed there) before he started HRT [hormone replacement therapy],” said Haley.
“He’s been on T [testosterone] for almost exactly a year now, and it’s the happiest I’ve ever seen him.” The second provider actually followed the Standards of Care set forth by WPATH, a nonprofit, interdisciplinary organization of medical professionals that oversees proper health-care procedures in transgender health, which states that an endocrinologist who is starting a trans patient on HRT would only require at most referral letters from your GP as well as your regular therapist. However, demonstrating this is a seemingly tall order for many trans patients with ASD.
Other trans people with ASD feel they are forced to stay closeted with one or both of their identities due to the stigma. For V, she’s afraid to tell her strict parents anything. “I fear that if I come out with both things to my parents they will believe that me being transgender is an autistic delusion,” she explains. She worries about the fallout that honesty would have on her parental relationship. “It’s difficult to describe the perfect response because I literally cannot imagine an even remotely positive one,” she says. “I figured I’d be lucky to just be disowned from the family and never be able to contact them again, because it’s a good alternative to them just killing me on the spot, or worse and equally likely, kidnapping me and sending me off to conversion therapy.”
The ableist stigma surrounding autism — and autism cure advocacy groups like Autism Speaks that have been criticized as “eliminationist” for their overfocus on finding a cure for autism, which Autism Speaks co-founder Suzanne Wright calls “a disease” (much like Kayden Clark’s therapist) — is embedded within V’s family dynamic. “As for coming forward with my autism, my assumption is that they’ll accuse me of lying and say I can’t possibly be autistic because I was ‘functional’ as a child and no child of theirs could possibly be ‘broken’ or whatever. So yeah, it’s just really really hard to picture anything even remotely positive, much less ‘perfect,’” V explains.
Efforts to provide official support for autistic trans people have been met with stiff resistance from both within the formal anti-trans health-care information industry and transphobic media sources. A joint effort by the Autistic Self Advocacy Network, the National Center for Transgender Equality, and the National LGBTQ Taskforce to promote tolerance and understanding for autistic trans people among the general public has caused outrage within both religious conservative and radical feminist media. Critics on both sides claim that transgender advocates are “targeting” autistic youth in a throwback to the old myth that gay people used to “recruit” straight young people into the “homosexual lifestyle.”
There is a link between ASD and gender dysphoria, as autistic people are statistically more likely to come out as trans than allistic, or non-autistic, people. Research has shown that people with ASD are statistically more likely to show increased gender variance than allistic people.
But there seems to be a simple explanation for this trend. As V explains, “It probably has to do with the fundamental ways the autistic mind works, which are very hard to explain to an allistic. We’re more willing to admit ‘weird,’ socially inexplicable things about ourselves and our experiences/existence to ourselves.” She continues, “Also, as for why we’re more likely to ‘come out’ specifically, we’re already extreme social outcasts, so while my fear of judgement is high it’s like, everyone already hates me anyway, why not be as happy as I can be with myself?”
Trans people who are also autistic face a society that would rather see them not exist entirely. Research from the man at the center of this latest controversy, Kenneth Zucker, concludes that there is insufficient evidence to draw the conclusion that ASD alone causes gender dysphoria. Discussions around supporting those with ASD often involve cures, without any consideration for what those who live with it might think.
On the flip side, discussion around trans people focuses on preventing transition in an effort to assuage cis discomfort with gender nonconformance. It’s a dangerous social intersection to live within, and trans people who are on the autism spectrum deserve self-autonomy and our respect just as much as everyone else does.