A Danish autism organisation, Autisme- og Aspergerforeningen, released an informative leaflet about autism and gender on their website back in November 2024, which resulted in an angry backlash from the trans activist lobby who claimed they should have centered transgender experiences, rather than autistic experiences. This is a frequent occurrence where Trans Rights Activists (TRAs) demand to be at the centre, even at the expense of others' needs and evidence-based research. I’ve previously reported on this situation here.

This is the ‘autism and gender leaflet’ that received such backlash, translated into English:

Autisme- og Aspergerforeningen

We delve into the challenges that autistic people can experience in relation to gender identity. We have long lacked material that describes how the formation of gender identity can be affected when you have autistic neurology.

Many autistic people experience that their sensory sensitivity means that their gender identity is expressed differently than in peers of the same sex. It can be difficult to see yourself in others who have a different neurology than yourself. This can be confusing for both children , adolescents and adults.

The leaflet highlights how self-understanding and psychoeducation can give autistic people a stronger position in a complex world where people often experience standing out from the norms and feeling wrong.

Autism and gender identity

Gender identity is awareness of one’s gender and the typical or traditional behavior for that gender (The Danish Dictionary). A distinction is made between gender identity and biological sex, "where the former is based solely on the individual’s inner experience and feelings" (The Danish Health Authority).

Autism is a pervasive developmental disorder, which therefore also has an impact on how we perceive our gender identity.

Confusion about identity and gender
Many autistic people have a different sensory processing than the norm. We can be either over- or under-sensitive to sensory impressions such as light, sounds, smells, and touch. This different sensory processing can affect how an autistic person can experience their body and thus also their gender identity.

Puberty is a difficult time for everyone, but it is especially challenging for autistic children. The intense physical and emotional changes can be difficult for autistic children/youth to understand and process. These physical changes can feel extra intense and uncomfortable due to the different sensory processing.

As a teenager, it is natural to be confused and unsure of your identity. For autistic people, this confusion can be even more pronounced, as it is often difficult to see yourself reflected in people without autism.

Over the years, we have seen an increase in the number of autistic children and young people exploring their gender identity. Our experience is that confusion about gender identity is significantly reduced in the 20s and 30s - regardless of which one feels comfortable with.

Gender roles
Autistic people may be less likely to conform to societal expectations of how people of a certain gender should behave or look. Being autistic makes you different from the majority, which makes it natural to express your identity in a different way. Many autistic people have intense interests that do not necessarily match the interests of the majority of people of the same gender and age.

Autistic communication is often different both verbally and nonverbally. For example, autistic girls/women may often have a direct and concrete way of communicating. This can be interpreted as being masculine, just as many autistic girls/women experience discomfort with dresses and long hair.

Boys are often expected to participate in wild and physical play, but this can be difficult for autistic boys to engage in, as their sensory processing can make them more sensitive to physical activity and noise. These sensory challenges can make wild play extremely uncomfortable. Wild play involves a high degree of unpredictability, which can feel scary and unsafe.

Autistic self-understanding
Lack of psychoeducation and self-understanding can play a crucial role in autistic youth’s exploration and understanding of their gender identity.

Without adequate psychoeducation about autism, autistic youth and their families may lack insight into how autism affects identity formation, sensory processing, and the sense of fitting in. This may mean that youth do not have the words and concepts to understand why their experience of gender and identity may differ from the norm.

Lack of self-understanding can also make it difficult for autistic children/youth to distinguish between having a different gender identity and the sensory bodily experiences that are related to autism, along with interests that do not always follow traditional gender roles.

Without knowledge of how autism can affect the understanding of gender roles, the body, and gender identity, young people may feel confused and experience themselves as deviating from what they see among their peers and are presented with in the social media.

The confusion can lead to a search for answers on social media, where idealized images of different gender identities make it even harder to find a place to stand. This can create even more uncertainty, especially for autistic youth who already feel excluded from the social community.

At Autisme-og Aspergerforinengen, we work to create an understanding of how autism can affect both identity and gender identity. We believe that access to psychoeducation and support for self-understanding is fundamental for autistic people to develop an identity so that they can stand by who they are, regardless of social norms and expectations.

The organisation stood its ground in the face of accusations of transphobia, defending their work as evidence-based and rooted in both scientific research and lived experience from autistic individuals.

Unlike any of their other published work, they were forced to prove all their supporting research, which ironically led them to deepen their expertise on evidence vs ideology when it comes to autism and gender.

As part of a Gender Consultation in Denmark, NGOs, medical professionals, autism organisations and citizens were asked to submit their responses.

Autisme- og Aspergerforeningen was the only autism organisation that was not officially invited to give a consultation response to the Danish Health Authorities's new treatment guidelines for gender "incongruence". Since the consultation was open to the public they delivered one anyway, which I’ve translated here - if you haven’t read it yet, I highly recommend you do. They critically engaged with the intersection of autism and gender - without adopting a trans-ideological framework.

Their response is packed with research, examining how autistic traits influence experiences of gender without filtering it through a biased trans-narrative lens.

Autismeforeningen (a larger autism organisation, formerly called Landsforeningen Autisme) did NOT submit anything.

Kvinderettigheder, a Women's Rights group, has also submitted a response, as has Genspect and numerous other organisations.

The response submissions totaled 400 pages, with 90 pages from a single trans-identified male named Amanda - one individual dominating the discussion who advocates for removal of safeguarding in multiple areas -

Make explicit that any refusal of medical professionals to provide adequate care to trans people with mental or physical disabilities - i.e. disabilities that make them unable to take or apply the medicine themselves (e.g. dementia) - should have their license revoked and be imprisoned for medical malpractice. (page 171 Google Translated)

In another section of his response submission, he also tells an alarming story -

I will give yet another example that occurred in a different Nordic country, again from a source I know. During such evaluations when being forced to discuss these topics, the healthcare provider would often have porn visible on their computer - not even something that could be construed as relevant to the topic at hand, but personal porn, and not discreet enough to be entirely out of view. My own source experienced this firsthand, and in future meetings the doctor had students in the room, so that they were not alone. The doctor - who was at an old age - was able to retire soon after without issue or any consequences to him. (page 188 Google Translated)

Members from a trans activist group, Researchkollektivet Trans Tjek, also flooded the responses, even copy-pasting parts of the same text from Amanda repeatedly.

Unexpected Criticism from Medical Experts

Despite LGBT+ Denmark and the TRA-parent group "Association for Support for Transgender Children" influencing the new guidelines, some highly respected medical bodies pushed back: Dansk Pædiatrisk Selskab (Danish Paediatric Society) and Børne- og ungdomspsykiatrisk selskab (Children & Adolescent Psychiatric Society).

These groups challenged the evidence base behind the guidelines, questioning their medical validity.

CKI Odense & CKI København each submitted their organisations responses separately, but then also submitted a joint "concern inquiry", warning that autistic people are being caught in gender ideology and often lack the cognitive/emotional maturity to consent.

One of the points they jointly raised was “We also have a concern that it is particularly people with ASD who later stop or actually regret their treatment…”, which may indicate misdiagnosis. Misdiagnosis in females with autism is common, as is a late-diagnosis in adulthood due to clinicians not recognising autism soon enough, or symptoms/traits being misdiagnosed as something else. I have written about the harms of misdiagnoses, including gender dysphoria, in autistic people here.

Here is the full translated joint “concern inquiry” response:

CKI Odense & CKI Copenhagen

Concern regarding hearing on Guidance for healthcare assistance gender incongruence

To

National Board of Health

The proportion of people with developmental disorders among new referrals to the country's gender identity centers is increasing. A conservative estimate is that around 1/3 of all new referrals today are diagnosed with autism spectrum disorder (ASD), while an even larger proportion have autistic features. This relationship has been described in the literature for the last 15 years or so, but it is only in recent years that we have really seen an increase in the number of referrals, especially of young people with ASD.

The assessment and treatment of this patient group is made difficult by their psychiatric comorbidity, and we would like to draw attention to a growing problem that is difficult to handle within somatically anchored gender identity centers. We would also like to share our concern about whether the group we see today should be offered gender-modifying treatment and, if so, which one.

When assessing and treating people with the above-mentioned developmental disorders, there may be doubts about the indication for the treatment, whether the patient fully understands the consequences of the treatment, and finally doubts about how we can best help them further with or without the offer of gender modification treatment.

The three centers also have different approaches to people on the autism spectrum, which can be seen as an expression of uncertainty in relation to the task with these patients.

Overall, co-morbid ASD presents a number of challenges in the assessment and treatment of gender identity issues:

Patients with ASD may have difficulty describing internal states and communicating them verbally to us so that we understand them. They often have difficulty reflecting on their gender dysphoria due to their pronounced mentalization difficulties. With patients with ASD, we lack a common platform from which to communicate and may risk overlooking the fact that a patient with ASD is very distressed and actually has gender discomfort, but cannot articulate it - or conversely, that we end up treating patients with irreversible medication and surgery, where there is no question of permanent and disabling gender discomfort at all.

Patients with ASD may have difficulty understanding how others think. Therefore, they form their own private logic and understanding of what it means to have gender dysphoria. As a result, they may interpret a number of other social challenges as related to gender dysphoria. Patients with ASD may have unrealistic expectations of how, and with what understanding, the environment will meet the patient after a possible treatment.

Patients with ASD may have difficulty thinking about the future and imagining what life might be like and what it would mean to make these choices. Typically, we experience short, general answers.

Patients with ASD are immature in some areas in relation to their chronological age and, with further cognitive maturation and psychoeducation about the body, emotions, sexuality, etc., could potentially come to the conclusion that hormone therapy and surgery are not the solution. Their reflection on gender discomfort is made more difficult by the fact that patients with ASD may tend to get stuck in a certain way of thinking and therefore lack flexibility towards other perspectives.

An example of the above challenges:

We meet a patient with ASD who has not previously reflected on his gender identity, and for whom puberty was not particularly problematic. However, the patient comes across a description of transgenderism online and in a very short time becomes absolutely certain that he is in this situation himself. The patient states that he is nonbinary, does not express his gender identity to a small extent socially, gives vague or stereotypical descriptions of his discomfort, does not say much spontaneously – perhaps it is even a contact person or parent who does the talking. The person is convinced that hormones and possibly surgery are absolutely necessary to make life significantly better. The patient may add that getting hormones will mean getting the team's approval that they are transgender, and that this will make it easier to come out. Patients with ASD also often state that they cannot continue with their education or work until they receive treatment - they have thus put their lives on hold. Thus, their descriptions of the development of their gender identity may be of special interest.

In terms of informed consent and understanding the consequences of a treatment, patients with autism may well recite side effects to hormones, and will often say that it will not be a problem, but appear immature and unreflective in these considerations.

People with ASD may have difficulty paying attention to education, can only make general thoughts about what the future will be like, and are strikingly unconcerned about the prospect of lifelong treatment. They often state regarding fertility that they imagine “just wanting to adopt” if the desire for children arises. Young people with ASD often have limited or no experience of living out sexuality, but many expect that it will resolve itself when the body changes. They often also state that they are asexual.

We also have a concern that it is particularly people with ASD who later stop or actually regret their treatment due to disappointed expectations of becoming, and being perceived as, a cisgender person of the opposite sex, or a disappointment that gender modification treatment does not alleviate the social isolation and other issues inherent in ASD. Here, the reduced mentalizing ability plays a particular role. These considerations are prompted by our clinical experience, as evidence in this area is still lacking.

The WPATH Standards of Care version 8, 2023, states the following about transgender identity and ASD:

Autistic traits may need to be differentiated from being TGD. SOC8 specifically mentions the risk of conflating autistic traits with being TGD, in the context of adolescence: “[I]t is critical to differentiate gender incongruence from specific mental health presentations, such as obsessions and compulsions, special interests in autism, rigid thinking, broader identity problems, parent/ child interaction difficulties, severe developmental anxieties (e.g., fear of growing up and pubertal changes unrelated to gender identity), trauma, or psychotic thoughts.” (p. S63)

In light of these issues, as well as the large volume of this patient group, we want central page addresses this fact in the upcoming guidance in this area.

We want the guidance to continue to state that special caution must be exercised in the event of ASD or suspicion of this in relation to starting treatment.

We would like to consider whether people with ASD should initially be assessed/offered conversations about gender, body and identity in another setting so as not to contribute to a wrong course by offering courses within a center for gender identity. Furthermore, there may be a need to consider whether the professional competencies in the somatically anchored centers are sufficiently present to handle the assessment and treatment of people with complex/severe ASD.

Kind regards

Center for Gender Identity Odense

Center for Gender Identity Copenhagen

This "joint concern inquiry" was not included in CKI Odense’s or CKI København’s official consultation responses, leading to public speculation as to why CKI Odense and CKI København have both separately sent in their organisations responses without much information or pushback, but then also submitted a separate “joint response” from those same two organisations raising serious concerns.

Members of the public have been speculating over what this might signify. Are the organisations all onboard, or is there doubt within? Are the members in disagreement over the organisation's response? Are some members dissenting from the organisation's narratives?

What about at the individual level?

Anyone who has spent time in autism-focused spaces - whether online support groups, advocacy forums, or social communities - will recognise the overwhelming presence of transgender narratives. These discussions often take precedence over autistic-centred conversations, sometimes to the extent that autism itself is sidelined. Autistic individuals who attempt to refocus discussions on autism or approach the intersection of autism and gender with a neutral or questioning perspective - rather than through a trans-ideological lens - frequently face severe backlash. They are vilified, harassed, trolled, and, in many cases, outright banned from the very communities meant to support them. The result is an alienation from spaces they once considered safe and vital for connection.

Many who have experienced this exclusion have found unexpected refuge in gender-critical (GC) groups, even when these groups are not specifically autism-focused. Unlike their former communities, these spaces have welcomed open discussion, allowing autistic individuals to ask questions, express concerns, and explore the topic of gender without fear of instant condemnation. Within these groups, there is often a notable relief in finally being able to discuss perspectives that were previously silenced.

It is particularly revealing to observe newcomers enter GC spaces with trepidation, requesting patience as they tentatively ask difficult or uncomfortable questions - questions they were unable to raise in their original communities without facing hostility. A recurring pattern emerges in their testimonies: they recount experiences of being shamed, ostracised, or labelled ‘transphobic’ simply for expressing doubts, seeking clarification, or noticing inconsistencies in the dominant narratives surrounding gender and autism. Many describe a gradual realisation that the way these topics are discussed within autism spaces often contains significant contradictions and logical gaps - moments that repeatedly set off internal alarm bells.

For those navigating both autism and gender discourse, the loss of autistic spaces due to ideological rigidity can be deeply unsettling. Yet, for many, the ability to finally engage in honest, critical discussions - without fear of being ostracised - offers a newfound sense of intellectual and emotional freedom.

This situation underscores the urgent need for autism organisations to take a truly non-ideological stance when addressing issues related to gender. Rather than allowing one perspective to dominate while shutting down alternative viewpoints, these organisations must foster open, balanced discussions and evidence-based research that prioritise the needs of autistic individuals above ideological agendas. They should focus on providing rigorous, autism-centered research and data on the intersection of autism and gender, ensuring that any guidance given is rooted in evidence rather than activism.

If you would like to share you views on this topic, you can take part in an online interview.

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