Gender identity development in autistic individuals: An interview study

Autistic individuals report more gender-related questions and gender incongruence compared to non-autistic peers. However, research on gender identity in autistic individuals lacks longitudinal perspectives and underrepresents cisgender males. This study explored how both cisgender autistic individuals and trans and gender-diverse (TGD) autistic individuals experienced their gender identity development in a broad sense. Fifteen autistic adults (aged 27-52) participated in semi-structured interviews. Data were analyzed using a qualitative longitudinal approach combining phenomenological and process analyses, guided by the Qualitative Analysis Guide of Leuven (QUAGOL). The autistic community was involved in developing research questions, study design, interpreting and discussing results. Phenomenological analysis revealed three themes: (1) exploring a comfortable identity; (2) negotiating oneself with others; and (3) interacting with societal perspectives on gender. Process analysis identified three themes: (1) learning by experience; (2) gender identity development takes time and is demanding; and (3) changing perspectives on gender. Gender-related questions shaped by individual, environmental, and societal factors were present in both cisgender and TGD autistic individuals, though convergence and divergence existed. Gender identity development was experienced as intertwined with autism and demanding, emphasizing the need for supportive environments, peer connections, and appropriate timing and conceptualization of autism diagnoses to foster positive gender identity development.Lay AbstractHow both cisgender autistic people and trans and gender-diverse autistic people talk about their gender identity development.Why was this study done?Not everyone feels they have a gender identity, but everyone goes through a development in which gender identity plays a part. Some people experience a difference between their sex assigned at birth and how they experience their current gender. Here, we refer to this small group as trans and gender-diverse and to those whose gender aligns with their assigned sex as cisgender. An increasing number of studies show that autistic people identify more often as trans and gender-diverse compared to the general population but also autistic cis persons can have questions about gender. However, little research on gender identity in autistic individuals had looked at how their sense of gender developed. So, we wondered how autistic adults experienced their gender and how this changed while growing up.How was the study conducted?We interviewed 15 autistic adults between 27 and 52 years old about their gender identity development. In the interviews, we focused on (1) how autistic people described their sense of gender and (2) how their sense of gender changed over time.What did the study find?For both cisgender autistic individuals and trans and gender-diverse autistic individuals, gender identity development was a personal journey. We found three key themes: (1) exploring an identity that feels right as an individual; (2) in social situations, finding a balance between personal identity and others' expectations; and (3) in society, interacting with social views on gender. We also found three themes related to changes over time: (1) people learning by experience; (2) gender identity development takes time and is demanding; and (3) perspectives on gender change over time. However, variety existed in how these themes were expressed and experienced.Why is this important?Interviewees shared how autism and identity, including gender identity, intertwined. For some, this was challenging. This shows how adequate information and support on gender and autism, and connections with other autistic people can contribute to a positive gender identity development. Also, a well-timed autism diagnosis and positive views on autism can further support this development.