Autistic Transgender Youth Require Specialized Support Interview with:

Dr. John Strang, PsyD Division of Pediatric Neuropsychology Children's National Health System.

Dr. John Strang

Dr. John Strang, PsyD
Division of Pediatric Neuropsychology
Children’s National Health System. What is the background for this study? What are the main findings

Response: Gender dysphoria or transgenderism (GD) and autism spectrum disorders (ASD) often co-occur. Between 9 and 25% of youth referred for gender dysphoria concerns have co-occurring ASD. Autistic transgender youth often require significant supports; their autism symptoms alone present challenges, but when combined with gender dysphoria, the clinical needs and complexities increase significantly. For example, an autism spectrum disorder, with its resulting social and communication challenges, can make it more difficult for a transgender teen to advocate for their needs around gender. Specialists from youth gender clinics from around the world have years of experience working with autistic transgender youth. This study used an international search process to identify experts in co-occurring ASD and GD. Twenty-two experts were identified and participated in this multi-stage consensus building study. A set of initial clinical guidelines for the evaluation and care of youth with co-occurring ASD and GD were produced.

The guidelines emphasize the importance of assessing for ASD among youth gender referrals, as well as for assessing for gender concerns among youth with ASD. The guidelines indicate that many youth with ASD and GD are ultimately found appropriate for gender affirmation (previously described as gender “transition”), including medical gender supports (e.g., puberty suppression medications, cross-sex hormones, etc.)

However, the guidelines emphasize that there may need to be a more extended period of assessment in many of these cases. Autism-related cognitive-behavioral and social interventions supporting flexible thinking, planning, future thinking, self-awareness and social awareness are often a necessary component of this extended assessment process; decisions around gender may emerge slowly as the young person increases in their ability to think realistically into the future, including the long-term implications of gender-related treatments. What should readers take away from your report?

Response: The co-occurrence of ASD and GD is not uncommon, and youth with this co-occurrence often need highly specialized supports. If a child presents with this co-occurrence, it is important to develop a collaborative care team including an autism specialist and a gender specialist who work closely together, if there is not a provider with both ASD and GD experience. Families often must play an increased role in the supports for these youth. For example, trans youth with ASD may need greater supports for achieving their gender-related needs, such as knowing how to present as their desired gender. What recommendations do you have for future research as a result of this study?

Response: Our expert team was not able to achieve consensus over specific guidelines for when to commence gender-related medical treatments for youth with ASD and GD. This is an important area for future research, including longitudinal outcome studies. Thank you for your contribution to the community.


J Clin Child Adolesc Psychol. 2016 Oct 24:1-11. [Epub ahead of print]
Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents.
Strang JF1, Meagher H1, Kenworthy L1, de Vries AL2, Menvielle E3, Leibowitz S4, Janssen A5, Cohen-Kettenis P6, Shumer DE7, Edwards-Leeper L8, Pleak RR9, Spack N10, Karasic DH11, Schreier H12, Balleur A6, Tishelman A13, Ehrensaft D14, Rodnan L15, Kuschner ES16, Mandel F17, Caretto A18, Lewis HC19, Anthony LG20.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 8, 2016 by Marie Benz MD FAAD