on being trans
written by Finchley (them/him
I’m Finchley (they/him) and to jump to it, I’m transgender and autistic. I like getting that out of the way a little earlier on because it changes people’s social expectations of me, and gives me agency to make clarifications.
Being trans and also having a disability is an interesting place to navigate. Both intersections are already at a higher risk than cis, abled, straight counterparts of experiencing medical prejudice due to the pre-existing conditions. It can be very irritating to navigate between sensory issues and issues caused either by gender dysphoria, or the ‘ongoing’ puberty that trans people go through during transition.
Autism is a neuro-developmental disorder. It is a form of neurodivergence, a word that also includes ADHD, dyslexia, dyspraxia, SPD/APD (Sensory Processing Disorder, or Auditory Processing Disorder) and other conditions. It can impact social, behavioural, linguistic, sensory and executive functionality. This means I can struggle starting and completing tasks, get overwhelmed from lights and sounds in my surroundings, can’t regulate my body temperature and sometimes struggle to respond to needs like going to the toilet and remembering to eat and drink at various intervals.
I can, however, hyper focus on certain special interests for hours on end. I am the monarch of ‘Forgetting to do Important Things’ and reign supreme over my lands of ‘Falling down rabbit holes at inconvenient moments and emerging three days later a new found expert in said topic’. But that’s just me and as they say; “if you know one autistic person, you know one autistic person”.
Autism in women is suspected to be shockingly underdiagnosed, with 75% of diagnosis being in boys, but no indication that there is a genetic or medical link between autism and boys. That coupled with the fact that girls and those Assigned Female At Birth (AFAB) are often encouraged to engage in social play as youngsters, mean that the neural-development between girls and boys (assigned at birth/in youth) is vastly different, and so autism presents differently between them.
I was diagnosed at 17 and that was after a nearly three-year battle between my GP, my school and the local education psychologist. My internal GD (Gender Dysphoria) that was at a constant boiling point throughout the latter stages of puberty was a distraction, and what’s more, I didn’t want it to detract from the diagnosis I really needed. I was worried, as many people are, that one condition would lead to be seen as an invalidation of the other. This causes a particular issue for AFAB people at large.
There is evidence that medical bias, particularly by male doctors, to AFAB patients, is still very prevalent, meaning certain conditions are not always taken seriously, especially concerning reproduction. This also applies to trans, disabled and non-white patients who may all experience medical neglect, and this makes the intersection of having a disability and trying to navigate the medical scene pretty tricky. Anglia-Ruskin University completed a study that found a 14% diagnosed correlation between trans people and autistic people, though a further 28% of people involved in the study were ‘above the cutoff point for a (autism) diagnosis’ (2019).
I am not entirely sure what ‘above the cutoff point’ means, as you can be diagnosed at any age with autism, but the researchers believe the percentage to be much higher. You could include the vast number of undiagnosed but self-identifying autistic people, those who haven’t currently started transitioning, or can’t transition at all (medically) who may never be involved in a study like this, for example.
Though some people theorize as to why the crossover is much higher, it shouldn’t impact the care provided, be it medical or social. I personally have been denied contraception by a doctor, had to have my primary care physician confirm to my gender clinician that I am on sound mind to consent to GD treatment (due to the autism diagnosis) and have had to self-navigate my own responses to the effects of testosterone, and the bodily changes that come with it. While these things are frustrating, I am somewhat glad for the recognised link. The gender clinic health providers are more alert to these things, and it’s even opened up a couple of conversations with my doctor, which I fully believe she’ll take into consideration next time she has a patient with a neurodivergence (or any other disability, providing it’s safe).
Mostly though, I spend a fair portion of my time talking on the internet about inclusivity. Both the communities offer up challenges - being in the autistic community can sometimes (though to be fair, not often) lead to challenges surrounding conversations of queer/trans identities. Being in the LGBTQ+ community can often lead to many issues surrounding visibility and accessibility - I can’t really go to a club or even a pub and expect to be able to hear or process meaningful sound long enough to hold a conversation - yet these places are the only permanent spaces made for the queer community. The best social option is the relatively dedicated queer autistic community online, a digital presence that shifts between social sites, and connects us through mutual identifiers no matter where we are in the world.
If you feel you may be autistic (or in any way neurodivergent) and are queer, feel free to join any spaces you can find. Medical and social barriers shouldn’t be a limitation and not everyone will have access to diagnoses. Not only are the shared experiences some comfort in a world programmed very differently to us, I have found many answers to niche problems or explanations for things I didn’t even think I needed to know. As I myself grow as a person, I hope every queer, neurodiverse person has more access and better support than the generations after.
We are flourishing.