Researchers from the Autism Research Centre at Cambridge University have revealed that autistic individuals who identify as transgender or gender-diverse (TGD) experience significantly lower-quality healthcare compared to both their cisgender peers and the general population. The findings, published today in Molecular Autism, mark the first large-scale study investigating the healthcare experiences of autistic TGD individuals, highlighting critical gaps in the support they receive.
The study builds on previous research, which found that both autistic and TGD individuals separately face worse healthcare experiences and are more likely to be diagnosed with various mental and physical health conditions. A 2020 study by the Autism Research Centre indicated that TGD individuals are more likely to be autistic and display higher levels of autistic traits compared to their cisgender peers. Despite these findings, the specific intersection of autism and TGD identity had not been studied in depth—until now.
In this groundbreaking study, the team surveyed 174 autistic TGD individuals, 1,094 autistic cisgender individuals, and 1,295 non-autistic cisgender individuals. Participants completed an anonymous self-report survey that assessed both their healthcare experiences and rates of mental and physical health conditions. The survey covered 51 aspects of healthcare quality, ranging from communication and anxiety to access, advocacy, and sensory issues. Key questions asked participants to rate their experiences on fundamental healthcare tasks, such as understanding health professionals, describing pain levels, and managing appointments.
The results were striking: autistic TGD and autistic cisgender individuals reported significantly poorer healthcare experiences across nearly all 51 areas compared to their non-autistic cisgender counterparts. This stark contrast underscores the widespread disparities in healthcare access and quality for those on the autism spectrum, regardless of their gender identity.
Autistic TGD individuals reported anxiety, shutdowns, and meltdowns during healthcare encounters at rates three to 11 times higher than non-autistic cisgender individuals. Additionally, when it came to understanding their healthcare providers and articulating their health concerns, autistic TGD individuals fared far worse. For example, only one in five autistic TGD individuals felt they could clearly communicate pain levels or understand healthcare instructions, compared to 10 out of 10 non-autistic cisgender individuals.
The study also found that autistic TGD individuals are more likely to suffer from long-term physical and mental health conditions. For every 10 non-autistic cisgender people with at least one diagnosed physical health issue, 15 autistic cisgender and 23 autistic TGD individuals reported similar conditions. Mental health diagnoses followed a similar pattern, with 50% of autistic cisgender individuals and 109% of autistic TGD individuals reporting mental health concerns, compared to just 10% of non-autistic cisgender participants.
The findings are particularly alarming given the well-established higher risk of suicide and self-harm among both autistic and TGD populations. A 2023 report from the Department of Health and Social Care identified autistic individuals as a priority group for suicide prevention in England. The study found that autistic TGD individuals were 5.8 times more likely to report self-harm than non-autistic cisgender individuals.
These results underscore the importance of an intersectional approach in healthcare, taking into account the compounded challenges faced by individuals with multiple marginalized identities. Researchers urge clinicians to be aware of the unique barriers autistic TGD individuals face in accessing quality care.
Professor Sir Simon Baron-Cohen, Director of the Autism Research Centre, emphasized the need for systemic changes in healthcare. “We need to consider how to adapt healthcare systems to meet the needs of autistic transgender and gender-diverse people. Policymakers, clinicians, and researchers must collaborate with autistic individuals to reduce barriers and improve healthcare outcomes,” he said.
The study’s findings are a call to action for healthcare professionals and policymakers to better understand and address the specific needs of autistic TGD individuals, who face heightened health risks and significant challenges in accessing appropriate care.
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