Some of you may know that a big part of my professional life right now is tied up in the early diagnosis of, comprehensive treatment planning for, and early intensive behavioral intervention with kids with autism*. I kind of ❤ them, and I kind of ❤ their families. I am involved more peripherally and less intensively with adolescent/adult autism advocacy and services, but really it is preschoolers by whom I am surrounded on a daily basis. 

I get asked a fair amount about connections between autism and being transgender. One of the dominant pathophysiological models of autism is called the extreme male brain theory. (Some people in the autism world are fairly angry about this theory, but no one has put forward a scientific argument against it nor a better scientific model of the autism pathophysiology.) Although we don’t know exactly why it happens, this theory strongly implicates an excess of testosterone during a critical prenatal developmental period that essentially over-masculinizes the brain (and, to a limited extent, other parts of the body – surprisingly, hirsuitism has an elevated base rate in women with ASD). According to this model, whose chief developer is Simon Baron Cohen, there is a general pattern that some cognitive skills follow, which is:

F > M > Autism

… And a pattern that other cognitive skills follow, which is:

Autism > M > F

Where M is neurotypical (without autism) males, F is neurotypical females, and Autism is people of any sex with autism. As with most cognitive skills, individual differences are far larger than group differences in range, and so these are small averaged group effects (not every man or woman, NT or Autism, fits this pattern for every or even necessarily any cognitive skill, but on average, large groups of them do). The general pattern in both cases is that the autism population is at the extreme end of the male side of the curve. In the first case (where women have the advantage) these skills fall into a category Baron Cohen and others call empathizing skills. They tend to be holistic kinds of skills, like fine-grain modulation of production and detection and production of emotions and nuance, non-literal and non-verbal communicative adjuncts that “spice” language. They also include a number of skills that, at least to a neuroscientist, are related. The male advantaged skills fall into an area they call Systemizing, and they include analysis, classification, sequential task analysis, and a number of other skills.

So to start with, there’s already a theory linking autism with sex/gender. The theory explains the way in which the sex differences in autism occur both in terms of base rate and presentation (and why mild autism may go unnoticed in girls). To add to this, there has been some recent research linking people with autism and transgender people, with substantially higher rates of people identifying as transgender among people with autism than in the general population. One of the hardest things for this data to explain, however, is why there are autistic trans girls/women – if autism biases to male, it would seem there would be significantly more trans men among XX-karyotype people with autism, but significantly less trans women among XY-karyotype people with autism, because the pathophysiology of autism biases all people with autism of all sexes in the direction of at least certain kinds of masculinization.

I commented on this on a listserv recently, and a colleague kindly sent me an article I had not seen. This one looked at Baron Cohen’s Empathizing and Systemizing variables (EQ and SQ quotients for these can be derived from standardized, validated questionnaires, and a fair amount is known about the performance of various groups on these instruments). It found something interesting. In this study, adolescents who were transgender had EQ scores comparable to cisgender males. Whether they were MTF or FTM! The SQ’s were in the middle, without statistical differences from either men or women. In other words, the EQ/SQ measures did not classify trans youth in a way that concords with their self-identified gender identity, when in the group accuracy sense, it can do so for cis/NT youth.

And … this is how I experience the world, in terms of the same questions (you can take the questionnaire and obtain your scores here, although ideally it’s helpful to have an external source describe us, since they may see us very differently than we see ourselves):

I may not be perceived exactly this way by others, but this is how I feel, not all the pretending I’ve done all my life, to try and fit in with boys and men … on the other hand, I’m a little skeptical of this idea of the Coach store as “other personality testing” … well, the targeted marketers know me well

It’s pretty much the same way that test that classifies people accurately on sex based on answers to seemingly innocuous questions came out. Both put me overwhelmingly in female territory.

One of my observations about this is that this study is in trans youth. That’s cool and helpful, because many of these kids did not go through decades of forced pretending like I did. On the other hand, generally speaking, younger samples of trans-identified people contain relatively more very binary** and relatively less binary (transsexual) people, although there are also youth who are very binary. I am, by my own admission, and no one is jumping up to disagree, also very binary. I reap lots of benefit from the fact that I made no sense as a “man” but, aside from my height, largely fit right in as a woman. I have two more observations I think might be relevant. One is that, in different contexts, I have actually met probably a fair number of trans people with autism. Of them, only one that I can think of was “very binary” in her appearance. The second is a comment a cis-ally friend made, that in reading Jenny Boylan’s book, she doesn’t hear a woman’s voice, but rather hears a transgender voice. Now, Boylan is pretty binary, and I’m skeptical of my friend’s ability to pick a “transgender” experience out of a blind lineup of male and female voices (or really even for anyone to articulate a proposed nosology for what a transgender voice sounds like). But I have to admit, while I at first pooh-poohed this idea, I wonder now.

Is there a possibility that, rather than FTM and MTF spectrums, what is going on with people who are binary transsexuals (meaning they want to transition, and more specifically to transition into an easily genderable masculine maleness or feminine femaleness) is fundamentally different and separate from what is going on with relatively less-binary people (that is, people who may or may not transition, but do not particularly desire to pass or blend, and who are not particularly seeking an easily genderable presentation)? I’m not saying anyone would be a “true” transgender person and certainly not that anyone would be a false one. I reject this whole line of nonsense that calls me some complicated non-homosexual transsexual male instead of just calling me the intuitively obvious trans woman. If this were the case, is it possible that the former category of very binary trans people would generally classify like cisgender peers who match their gender identity? And this less binary group, whose core experience may be gender role non-conformance (rather than a gender identity that is more directly “opposite” their birth-assigned sex), could in actuality have its own place on the EQ/SQ matrix (and perhaps even on some as-yet-unidentified third orthogonal plane, in which these individuals would be highly differentiated and cis males/females would not, nor would highly binary trans males/females), rather than mirroring male or female values? Like the data on the extreme male brain theory, one would also predict that, alongside gender nonconformance, these brains may be optimized, on average, to do certain things way better than the gender conforming brains many of us have. And put all together, could they, indeed, have transgender voices rather than male or female voices? 

And the final what if: what if among people with autism, this latter proposed grouping were represented at higher base rates, but the former group were not? This might explain the presence of so many trans women with autism and also draw a parallel explanation that could shed light on the experience of less binary NT trans people. It might also explain the fight between the spectrum narrative and the woman-trapped-in-a-man’s-body narrative. I have no recollection of being uncertain, ever, of where I really belonged on the masculinity-femininity continuum. I didn’t know it was possible that I could be a girl, with all the external evidence pointing against it and all the internal evidence pointing towards it. But I’ve always known I don’t have an ounce of masculinity in me. I just didn’t know how to get to womanhood without being killed or benefitting from magic or the technology of an advanced alien civilization. Without being able to experience such a world, I can also say that, for me, being allowed to dress and act like a girl but still grouped with and identified as a boy would not have been enough. The spectrum narrative doesn’t explain why, the first time I put foundation on my face (which is pretty much enough to make me look female), I knew immediately that I was seeing me for the first time. It doesn’t explain why, once I finally accepted the insane idea that I could find my womanhood, I knew exactly what it should look like, whereas I’ve never known how my supposed masculinity could look. To be indelicate, it also doesn’t explain why, when you ask many very binary trans women like me, outside of financial, safety, and outcome considerations, once we start transition, the question “do you want surgical options” this is not much of a question at all. That is, of course I do – given that it is very safe, the outcomes are generally very good, and I can afford it, it’s been a question of when and not if, ever since I decided to transition, and again, once I accepted womanhood, this has always been a foregone conclusion.

Let me stop here and take a really deep breath, because I sound like Professor Bailey from Northwestern, and the next thing you know, I’ll be doing the kind of shoddy research that is performed in gay bars and published in sexology journals. That person and others before him get caught up in trying to prove/disprove transness, as well as a host of other things (most prominently male bisexuality). I don’t care about that at all. And they are connected to traditions that gatekeep access to healthcare services to trans people (particularly access to hormones and surgery). Again, I’m firmly against that – I’m not saying less binary people should not transition, and I’m not saying they should. Actually, all I’m saying is that, while I still kind of hate calls to signal amplify, it may be really important to improving trans peoples’ quality of life to better understand the experiences of less binary trans people. And for that to happen, more of them, both autism and NT, need to tell their stories – neuroscience may also be informative, but it’s a concern that non-binary trans people are doubly marginalized, living trans in a cis world and then damned again by living less binary trans in a binary trans world.

Then, if our experiences are deeply and fundamentally different, us very binary people and less binary people, then maybe we would stop bickering over defining our supposedly common space and instead be allies and co-advocate for our common causes, while respecting each other’s right to have and celebrate their own narratives. I’m not saying I’m sure this is the right answer, but I’m curious. I’ve always thought people with and without autism have a lot to offer each other. I do think very binary and less binary people have a lot to offer each other, too. And what if transgender and autistic people were more involved in the process of trying to identify sub-types or sub-entities? Would we ask different questions based on our desire to help each other and understand ourselves, or would be just as driven to be “right” or to prove/disprove our own experiences’ validity as the sexologists are?

* With respect, I am just going to say “autism”; I mean people diagnosable with autism spectrum disorders, including Asperger’s Disorder, although my hope is that most of them are thriving and living life. I’m also bypassing the question of using the phrase “people with autism” instead of “autistic people” – I use the former because I work with children, and their parents seem to prefer it, but I understand why and respect that autistic self-advocates frequently choose the latter. Finally, I generally use neurotypical, or NT, but I celebrate neurodiversity and I do also like what some people do, which is to say autistic and say allistic for non-autistic people

** I’m making up the wording as I go, sorry, but what I want to delineate is not the difference between genderqueer/genderfluid people and transsexual-identified people, but rather between people who identify deeply with the binary and those who identify weakly with the binary, whether or not they choose hormones, transition, surgeries, and so on.