Autism Spectrum Disorder Among Gender-Diverse Children and Adolescents: A National Cohort Study.
Autistic AFAB teens are far less likely to start gender-affirming meds—so screen and refer early.
01Research in Context
What this study did
Erez and colleagues looked at every gender-diverse teen in a national medical record set. They asked who started puberty blockers or hormones and who did not.
Kids with an autism diagnosis were flagged so the team could compare access rates.
What they found
Autistic teens who were assigned female at birth were far less likely to begin gender-affirming meds.
These youth also carried more mental-health diagnoses than their non-autistic trans peers.
How this fits with other research
The new numbers echo what Marsack-Topolewski et al. (2025) heard in interviews: autistic gender-diverse teens feel pressure to hide who they are. Camouflaging may keep them from asking for medical care.
Dental studies show the same pattern. Heald et al. (2020) and Shawler et al. (2021) found autistic kids with lower IQ or higher support needs get fewer routine dentist visits. Erez extends this idea to gender clinics: having autism predicts another missed service.
Zhang et al. (2022) showed private insurance still leaves gaps for autism therapies. Erez adds gender care to the list of services that slip through the cracks.
Why it matters
If you work with autistic teens, add one quick screen: ask about gender identity and any plans for puberty blockers or hormones. Flag AFAB clients for extra support and help families navigate referral paperwork. A five-minute checklist can shorten the wait for life-saving care.
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02At a glance
03Original abstract
Autism spectrum disorder (ASD) is more prevalent in transgender and gender-diverse (TGD) individuals than in the general population, yet the specific developmental pathways within and clinical outcomes of this intersection are insufficiently understood. This study examined how ASD and sex assigned at birth (SAAB) are associated with gender-related milestones, access to gender-affirming consultation and care (GACC), and psychiatric outcomes. We reviewed electronic medical records for 786 TGD children and adolescents (aged 4-19 years) presenting to a national referral clinic between 2013 and 2025. Demographic, developmental, and psychiatric variables were analyzed across four ASD-by-SAAB groups using generalized linear models and logistic regressions, with Bonferroni-adjusted post hoc comparisons (α = 0.0083). ASD was documented in 9.7% of the cohort, with referrals of autistic TGD patients increasing significantly over time. Autistic patients presented with a distinct profile, characterized by higher socioeconomic position (SEP), intellectual giftedness, non-binary gender identity, and an earlier stage of pubertal development at presentation. Crucially, while ages at gender-related milestones were largely comparable between neurotypes, autistic assigned female at birth (AFAB) adolescents were significantly less likely to initiate puberty suppression or gender-affirming hormones than their non-autistic peers. Furthermore, higher SEP was associated with earlier clinical presentation only for non-autistic youth. Autistic TGD patients exhibited a higher psychiatric burden, with an ASD diagnosis uniquely associated with elevated rates of anxiety, ADHD, and psychotropic medication use. These findings reveal a disparity between developmental synchrony and clinical access, underscoring the need for autism-informed protocols to support equitable gender-affirming care.
Autism research : official journal of the International Society for Autism Research, 2026 · doi:10.1002/aur.70235