Transgender and gender diverse autistic adults' experiences undergoing gender-affirming hormone therapy as prescribed

Recent evidence suggests the prevalence of autistic adults accessing gender-affirming care, including gender-affirming hormone therapy (GAHT), is high. Although best practice guidelines recognise the impact of autistic traits, guidance to support GAHT adherence as prescribed in these patients is lacking.

Hence, two studies were configured within a state-wide Gender Endocrinology clinic at an Australian tertiary hospital: Study A, an online survey of autistic transgender and gender diverse (TGD) and non-autistic adults undergoing GAHT; and Study B, a convergent mixed-methods study, explored autistic TGD adults' experiences of GAHT adherence. Study A (n = 112), consisted of participants with a formal ASD diagnosis (n = 35), self-identifying autistic (n = 46), and non-autistic (n = 31). Study B included semi-structured interviews (n = 6) and the Adult/Adolescent Sensory Profile. Data were analysed thematically and results triangulated with AASP results.

Results indicated that autistic TGD participants experienced more difficulty adhering to GAHT due to sensory processing differences and executive function challenges. Participants' sensory, executive function, healthcare and social experiences whilst undergoing GAHT were explored.

Findings highlight that autistic adults accessing gender endocrinology settings may experience greater challenges adhering to GAHT as prescribed. Identified strategies to promote GAHT adherence included reflecting upon previous sensory experiences, establishing a consistent routine, incorporating administration into personal care routines, involving others in appointments, and peer support.

A high prevalence of autistic adults are accessing gender endocrinology services for gender-affirming hormone therapy (GAHT). In clinical practice, the intersection of autism and gender incongruence can pose unique GAHT adherence challenges as a result of autistic traits. However, there is a paucity of detailed, nuanced exploration of these challenges, meaning current clinical guidance typically remains generic in nature. Our research provides preliminary evidence of the specific nature of increased challenges with GAHT adherence and tolerability amongst autistic transgender and gender diverse (TGD) adults. Qualitative findings provide insight into the strategies used by autistic TGD adults to promote GAHT adherence. These findings can be utilised to support endocrinologists, other clinicians, and autistic adults undergoing GAHT to promote optimal patient outcomes.