The Co-occurrence of Gender Dysphoria and Autism Spectrum Disorder in Adults: An Analysis of Cross-Sectional and Clinical Chart Data.

Heylens et al. (2018) looked at medical charts of adults who asked for gender care.

They counted how many of these adults also had an autism diagnosis.

The team compared that count to autism rates in the general public.

Six times more adults with gender dysphoria had autism than you would expect.

Many others showed autistic traits even without a full diagnosis.

George et al. (2018) asked autistic adults the same question from the other side. They found high gender-dysphoric traits in people already diagnosed with autism.

Cohen et al. (2018) extended the link downward, showing kids with gender dysphoria also score in the middle between typical and ASD groups.

Chang et al. (2022) followed up longitudinally, finding that autistic teens with low family support and lots of repetitive behaviors are most likely to express gender-related wishes later.

Burrows et al. (2018) pulled every paper on this topic into one map, confirming the 2018 cross-sectional chart review sits inside a fast-growing pattern.

If you assess an adult seeking gender-affirming care, screen for autism. Use a quick tool like the AQ-10. If the score is high, offer longer interview time, clear visuals, and sensory breaks. Catching both identities early means better mental-health support and smoother service access.

This study examined 532 clinical chart records plus 63 adults assessed with the SRS-Adult and Autism Quotient (AQ). Adults with gender dysphoria scored significantly higher on the SRS-A than the norm population, and nearly 5 percent exceeded the AQ cut-off for clinically significant autistic traits.

A confirmed ASD diagnosis appeared in 6 percent of the gender dysphoria charts, roughly six times the general-population rate. Birth-assigned males were affected significantly more often than birth-assigned females.

Elevated autistic traits do not equal an ASD diagnosis, and screening tools like the AQ and SRS-A overselect. Use them to triage, then confirm with structured diagnostic assessment before drawing conclusions.

For clinicians in gender-affirming and autism services alike, the practical takeaway is to routinely screen for the co-occurring condition, because the overlap is large enough to change assessment and support planning.