Gender identity development in autistic individuals: An interview study

Contextual differences influencing the salience of gender identity

Gender identity held little significance during childhood, regardless of current gender. As one cis woman reflected, “as a child, I don’t think I questioned it” (P5). During puberty, participants of all different genders experienced a suppression of gender exploration in high school, although in different ways. Some, especially those with negative social experiences in primary school, described a strong desire to fit in by “not adopting a more gender-critical stance”—referring here to not feeling free to question gender norms—because that “wouldn’t have fit with my attempt to appear as average as possible” (P15, cis man). Others, particularly participants overwhelmed by challenges such as autistic burnout, explained that gender simply “did not pop up” as they felt “completely stressed out” (P8, trans man) with one trans woman escaping from such challenges by being busy with “using video games, music, and drugs to survive” (P13). As a result, gender exploration emerged later, “when the rest of my life became calm” (P8, trans man). In a more accommodating environment later in life, trans participants described a sudden need to act on the awareness of their gender identity. A trans woman expressed frustration at long waiting lists, saying, “I just want to move forward” (P13), while a trans man described his realization as an “epiphany” (P8). Others, however, ranged from continuing to question the meaning of gender to finding it unimportant. One agender participant noted, “nobody can explain what it means to be, to adopt, or to feel a gender” (P4), while others described gender as “not being meaningful” (P15, cis man). For cisgender individuals, this lack of meaning was experienced as “not being an obstacle” (P15, cis man), whereas non-binary and agender participants disconnected from the gender binary, focusing instead on personhood, as one non-binary participant explained, “I didn’t really know there was a difference between boys and girls [. . .] I just saw everyone as not being me” (P9).

Being okay with who you are

The importance of feeling comfortable with one’s body emerged across gender identities, though participants followed different paths. One group felt at ease accepting their assigned gender, calling it a “default choice” or “simply convenient” (P1, cis man), and stated, “I have no problem with how I look” (P7, cis woman). Others, both cis and TGD individuals, described feeling “not at home in my own body” (P14, non-binary person). Body positivity in sex education, not focusing on “how the body should look” (P12, agender person), was seen as potentially helpful, while TGD individuals also noted that surgical procedures and tools such as binders helped them achieve “that straight body . . . the one I had always wanted” (P14, non-binary person).

Also comfort in others’ gender labeling was important for both cis and TGD individuals, yet experiences varied. For those who felt satisfied with how they were perceived, it was important that their appearance reflected their gender expression and matched how they wanted others to relate to them: “I feel comfortable living this way [. . .] being seen and treated this way” (P3, trans man). However, a non-binary participant rather found comfort in “indifference” to others’ labeling, noting they “don’t feel the strong need to correct them” (P2).

Feeling different in various aspects of life, including gender, was described by both cis and TGD participants as both challenging and liberating at the same time. On the one hand, feeling different could lead to intense tension: “I can’t fake anymore . . . No one is going to tell me who I am or who I’m not” (P14, non-binary person). Despite being distressing, such moments of tension were also seen as turning points by TGD individuals, helping them to set boundaries and resist gendered expectations. For one agender participant, an experience of boundary violation led to rejecting gendered norms altogether: “I won’t be able to do that anymore. I don’t want to do it anymore either” (P12). On the other hand, feeling different was described as “a kind of relief” (P12, agender person), as this participant explained that identifying as agender allowed them to distance themself from binary gender expectations and feel more authentic and comfortable with who they was, especially when navigating difficult social situations. Gaining confidence and autonomy played a key role, as one participant shared, “I could stand on my own two feet and say: You know what, not today” (P2, non-binary person). In addition, being okay with who you are was central, explained as “to radically choose to be myself, at all times” (P4, agender person). Acts like changing one’s name symbolized this liberation for TGD individuals as one agender participant shared, “[name change] gave me control over what shape I could be . . . and broke me free from my parents’ influence” (P4).

Thinking in contradictions and categories

Participants of all different genders experienced an inclination toward black-and-white thinking about gender, influenced by internalized gender ideas, which led to doubts and confusion about their gender identity, though the nature of these experiences and ways of handling them varied. Gender stereotypes influenced beliefs among both cis and TGD individuals, sometimes leading to the rejection of certain activities based on personal principles. As one cis woman explained, “This is what girls do, this is what boys do, I fit more with the boys, so I’m not like other girls” (P11). Another shared how this thinking shaped the rejection of certain behavior: “[Boys] were often the athletic types, so for a long time I was anti-sports on principle” (P15, cis man). Binary thinking about gender left both cis and TGD participants “struggling” to “find that balance” (P13, trans woman) between extremes, especially when they did not align with stereotypical gender traits, leading to doubt about their identity and sense of authenticity. As one non-binary participant explained, “Your authenticity is somewhat affected by this as well, because it doesn’t align each time” (P2). However, specific to TGD individuals, binary thinking could feel unsettling by experiencing disappointment after exploring a transgender identity, as one non-binary person stated, “Then I really lived as a man for a while. But that wasn’t right either” (P14). In addition, participants who identified with the opposite sex based on linking weakness to femininity and strength to masculinity experienced increased doubt when those stereotypes were no longer present. For example, one participant who previously identified as a trans man and now as agender shared, “I could not feel masculine anymore because of how weak I felt” (P6).

How participants handled this confusion also varied. For example, one cis man looked for clear answers by linking gender to biological sex. This participant explained, “It’s already confusing [. . .] I really need that structure [. . .] due to my autism,” adding, “gender and sex are inherently linked [. . .] gender is fixed” (P1). In contrast, a non-binary participant embraced the confusion, viewing it as important to their identity and as “associated with their own non-binary identity” (P2). In addition, both cis and TGD found it easier to achieve a balance by acknowledging categorization is limiting: “The more you develop, the more you realize that labels can’t describe everything” (P11, cis woman), and experiencing gender identity as changing: “It’s not always the same [. . .] Some days, it is a bit fluctuating” (P6, agender person). Their experiences were affected by things like spiritual “internal energy” (P4, agender person), appearance, which felt “affirming of my gender and thus connected with my identity” (P4, agender person), and social surroundings: “Being constantly surrounded by men made me act more masculine [. . .] It did influence my identity” (P7, cis woman).

Intertwinement of autism and gender

For all but one recently diagnosed participant, gender identity development was closely connected to autism. In addition, an autism diagnosis was experienced as helpful for self-understanding by participants of all different genders, offering “a step toward better understanding myself and how I function” (P13, trans woman). Connecting with other autistic individuals further supported this process, allowing participants to refine their sense of identity by “making clearer what makes me different [within the autistic community]” (P2, non-binary person). However, not all autistic traits (e.g. need for structure) were seen as influencing gender.

For assigned males at birth who described themselves as “sensitive” (P13, trans woman) and for a trans man who recalled “getting control over my aggression” (P3) in childhood, autism influenced the experience of gender identity through different ways of showing emotions and how others see them. As one agender participant explained, “[Boys] tended more toward aggression than emotional reactions. I think I had a bit of both at the same time [. . .] and I think that had something to do with autism.” They added, “I think teachers felt like, you’re tall, you’re a man, so why are you struggling so much physically? And why are you so emotional?” (P12).

For TGD individuals who felt stress related to autism, gender caused accumulated stress with the “above standard stress from autism” intensified by “an extra layer of stress” (P8, trans man). This was especially noticeable for trans individuals experiencing difficulties in organizing their transition process and for those experiencing “that everywhere, some parts of me are welcome, but others are not. Never all of me” (P4, agender person).

Navigating the outside world

Navigating the outside world required balancing between being themselves and fitting in, shaped by both autism and gender identity, regardless of gender. One agender participant reflected, “I didn’t know that I was permitted to be someone else with my own story, my own identity. I think that’s also partly due to my autism” (P12). While feeling forced to follow societal expectations to function in daily life, both cis and TGD participants resisted societal norms that conflicted too much with their identity. As a cis man described, “Going along with it. But if I felt too much resistance to the macho behavior, then I wouldn’t” (P15). Still, anxiety about negative outcomes held both cis and TGD participants back from being themselves, including fears of “street violence” (P4, agender person) or bullying. Interestingly, anxiety about bullying was expressed by those who witnessed it rather than experienced it firsthand. One participant felt “cautious” after seeing boys harass girls at school, noting: “It could happen to you here” (P10, cis man). To navigate social interactions, both cis and TGD individuals adopted specific roles, as one explained, “It’s easier to interact if you show who you are today. Like saying, look, I’m a gay man, or I’m the one checking tickets” (P2, non-binary person). However, for participants who presented a different gender online than in daily life, switching between these different worlds was exhausting, like “to come home and suddenly have to, like, log into your video game and make people think you’re a girl” (P2, non-binary person). In addition, specific TGD participants shared their gender identity only with trusted persons. As one trans man noted, “It’s more for those close to me [. . .] I don’t always feel like explaining it to cisgender, heterosexual people” (P8).

Finding courage to be different

For participants of all genders, feeling different from others in relation to gendered expectations raised questions: “I experienced the mismatch, but I didn’t know what to replace it with” (P13, trans man). Realizing that gender identity is unique and gender labels are not fixed was helpful for these participants. As one cis woman noted, “I’m allowed to decide what femininity means to me [. . .] despite it not fitting the traditional picture” (P11). Being autistic also made it easier for both cis and TGD individuals to embrace differences regarding gendered expectations. One cis man reflected, “Autism has been somewhat liberating, even in terms of gender,” adding, “I’m not going to conform perfectly anyway” (P15). At the same time, autism was linked to difficulty understanding others’ resistance to difference: “I think my autism doesn’t always make it easy for me to understand why someone feels resistance to something that seems perfectly logical to me” (P12, agender person). Further, both cis and TGD individuals saw embracing their identity as a political act “helping to make it politically discussable” (P12, agender person), possibly drawing support from the presence of gender diversity throughout history. Still, conforming to gender norms did not necessarily alter cis and TGD individuals’ sense of identity. As one non-binary participant put it: “The fact that I went through that didn’t affect who I was” (P2). A specific challenge in finding courage to differ for TGD individuals was the importance of names across generations. As a non-binary participant shared, “Being named after my grandfather . . . made it hard for my family to accept my new name” (P2). More broadly, society’s lack of openness to gender diversity affected both cis and TGD individuals. For instance, a cis man reflected on how, in some progressive activist contexts, masculinity was rejected altogether, leaving him little room to identify in a positive way as male: “I don’t feel supported by those wanting to get rid of masculinity . . . some people simply feel like a man” (P15). Intrusive questions worsened this lack of openness for both cis and TGD participants, as one trans man recalled, “all the staff [in psychiatric care] kept asking me questions. It just wasn’t pleasant” (P8). In addition, participants who presented in a feminine way experienced the sexualization of their gender identity, with one trans woman noting, “You’re seen as a fetish” (P13).

Exploring together

Relationships played an important role in shaping participants’ gender identity development, providing both benefits and challenges. Romantic and sexual encounters revealed the connection between gender and sexual orientation and sexual experiences for all genders. A cisgender participant thought about his identity after dating women who later identified as lesbians: “What does that say about me? What am I, then?” (P15). Gender diversity-accepting relationships, particularly with partners also exploring their gender identity, provided a feeling of understanding for cis and TGD participants, as “you don’t have to explain all of that. The other person immediately understands it” (P14, non-binary person). On the other hand, heterosexual gender roles in romantic relationships hindered exploration for all genders, creating fixed expectations that left participants feeling “trapped [. . .] where I couldn’t meet those expectations” (P10, cis man). Moreover, individuals who felt positioned within power dynamics shaped by heterosexual norms emphasized the importance of equality in interactions as essential for self-exploration and expression. One non-binary participant noted, “equality in my daily life [. . .] helps my non-binary identity to thrive” (P9). In addition, conversations with TGD individuals were considered helpful in creating new perspectives across all genders but held additional value for TGD individuals due to common experiences of feeling misunderstood. A cis woman explained, “The fact that you can share ideas about this with others broadens your own perspective” (P5), while a trans woman described still searching for someone who “understands me and what I’m going through” (P13). Similarly, a trans man found conversations with others who shared his identified gender particularly meaningful and a trans woman described how thought-provoking questions helped broaden her perspective, noting, “When people ask targeted questions, it gives you the space to think about it” (P13).

Participants found gender dynamics within groups and bonding with peers challenging. While navigating social scripts was challenging for participants of all genders, those who grew up primarily among female friends felt little connection to others based on gender. One cis woman elaborated on this experience, stating: “The typical dynamics that emerge when many women are together . . . It doesn’t do much for me, and I always feel quite uncomfortable in that situation,” adding that they felt like an “alien” in “that kind of behavior that seems automatic” (P7). In the broader context, participants of all genders valued supportive environments, often referred to as “a secure environment” or “a safe space,” for offering space to “bring these things out in me . . . and stretching my comfort zone just a little” (P4, agender person). For TGD individuals who explored different identities online, these spaces also served as safe environments for identity experimentation. As one non-binary participant described, “Having your character drawn in different clothes, like outfits you’d not yet dare to buy for yourself” (P2).

Engaging with professional care

Few participants mentioned receiving help from professionals, with TGD persons particularly emphasizing its importance. Such experiences were discussed not as part of experiencing the developmental process itself, but as factors that could either support or hinder a positive sense of gender identity. One trans man appreciated an expert who approached gender “from the perspective of my autism,” alleviating concerns that it “might just be a temporary obsession” (P3). General counseling was beneficial for one non-binary participant for addressing “the constant cycle of gender dysphoria, anger, stress, burnout” (P9), though a trans person felt it focused too much on “peripheral aspects . . . never the core” (P13).

Visibility in society

The visibility of diverse gender roles in society influenced how participants perceived the possibilities for exploring their gender identity. These possibilities depended on societal awareness of gender diversity by both cis and TGD individuals, with participants valuing “small victories,” like “shops removing the male/female divide in their forms” (P9, non-binary person). While TGD persons were particularly hindered by the lack of awareness in healthcare, with a trans man participant noting, “It would have helped me if those caregivers had shown a bit more . . . sensitivity” (P8), particularly cis men felt that gender had become “a bit of a hot topic” (P1), making it a sensitive topic to discuss in broader society.

For participants of all genders inclusivity and representation in media were also important for self-exploration, with words used to describe gender helping participants “begin to think about themselves” (P6, agender person) and providing “the words I did not have before” (P8, trans man). Inclusive literature and music offered valuable role models, with characters becoming “the role models I couldn’t find” (P5, cis woman). This was valuable as the absence of role models was a challenge for cis and TGD individuals. A cis man noted his father’s absence had “greatly, hugely undermined” his “image of the man” (P10). In addition, disinformation hindered self-recognition for cis and TGD individuals. For example, one agender participant did not agree with the idea of “being born in the wrong body,” explaining, “my body just feels . . . normal to me” (P12).

Gender-related ideas in society

Society’s binary view of gender, both in-person and online, did not match how some understood their own identity, causing confusion and discomfort for both cis and TGD individuals. Growing up without strict expectations generally provided “a bit more comfort” (P1, cis man), in contrast to strict parenting that strengthened “default thinking” (P5, cis woman). Strict gender divisions further hindered overall identity development for both cis and TGD individuals. A cis woman noted, “I didn’t receive the same encouragement [as boys] from my teacher” (P7). Both groups also described how these norms affected them early on. One non-binary participant shared, “as a child, I already knew that this didn’t feel comfortable” (P14). Linking bad behavior to gender added to confusion. An agender participant recalled being told, “You’re not allowed to hit girls,” and reflected, “we don’t hit each other, and that could have been the end of it” (P12).

For one group of participants who grew up as a boy but experienced female interests during childhood, gender and behavior felt unrelated, stating, “It doesn’t mean that it will define my identity” (P4, agender person). In contrast, a group of TGD individuals felt that behavior and appearance shaped others’ perceptions, restricting self-expression. For example, one non-binary participant avoided skirts because “it makes me be seen more as a woman and sexualized” (P14). However, participants of all genders emphasized physical traits. One non-binary explained, “It wasn’t really about behavior . . . [but my] high-pitched voice, and the expectation of being a girl was projected onto me” (P2).