Psychiatrist Meng-Chuan Lai has observed the recent rollout of laws restricting gender-affirming medical care in the United States with concern, he says. Some legislators have justified these bills, at least in part, by pointing to his work: In 2020, Lai co-authored a study that found transgender and other gender-diverse people are three to six times as likely to be autistic as cisgender people are.
Lawyer Tom Rawlings, for example, says he read about Lai’s findings in Spectrum. Last spring, Rawlings helped draft Georgia’s Senate Bill 140, which passed in March and cites the overlap between autism and transness as one reason to ban gender-affirming hormone replacement therapy and surgery for minors. An Arkansas law that also passed in March similarly points to an autism diagnosis as grounds to withhold gender-affirming care from minors. And an “emergency rule” issued by Missouri’s attorney general in April — but terminated in May — would have mandated autism screening for anyone seeking gender-affirming care, including adults.
Such policies are driven more by personal ideology than by anything his research suggests, says Lai, associate professor of psychiatry at the University of Toronto in Canada and a clinician at Toronto’s Center for Addiction and Mental Health. Researchers have known about the link for more than a decade. By one 2022 estimate, about 11 percent of trans people also have an autism diagnosis.
“That research is real. We don’t dispute it,” says R. Larkin Taylor-Parker, legal director at the Autistic Self Advocacy Network. “It’s been going on for years, and it’s been replicated in multiple studies.” What’s new, they say, is that politicians are misusing the link to argue that “autistic people are incapable of making decisions about our own care.”
That misuse has some scientists trying to figure out if — and how — they should push back. Anna van der Miesen, a postdoctoral researcher at the VU University Amsterdam in the Netherlands who has researched the link between autism and transness, says that if your research data are used to pass laws, and “the actual study had nothing to do with the laws at all,” then it’s time to speak up.
“We have a responsibility to communicate what the data says, and what it does not say, to the general public — and also to policymakers,” she says.
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ome researchers have already changed how they communicate their findings about the link. The largest study on the topic to date, published in July, came with an accompanying commentary asserting that the results — that autistic youth are three times as likely as non-autistic youth to have medical records suggesting that they are transgender or gender-diverse — “must not be used” to prevent trans youth, including those who are autistic, from accessing gender-affirming care.Other scientists and clinicians have stepped up to offer expert testimony — with mixed results.
In April, Aron Janssen, associate professor of psychiatry and behavioral sciences at Northwestern University in Evanston, Illinois, and Daniel Shumer, clinical associate professor of pediatric endocrinology at the University of Michigan in Ann Arbor, submitted expert testimony in a court case opposing Missouri’s “emergency rule.” On 1 May, a judge issued an order temporarily halting the rule’s implementation, and on 16 May, the attorney general’s office voluntarily terminated it. A few weeks later, though, Missouri passed separate legislation banning gender-affirming care for minors, inmates and prisoners, as well as all Medicaid coverage of such health care.
Shumer, who directs a child and adolescent gender clinic, also recently testified against Georgia’s Senate Bill 140. “When you hear about the rhetoric about how these laws are passed, that the rhetoric is that we’re talking about ‘sterilizing’ and ‘genitally mutilating’ children,” he says, “I think that anyone that’s ever known a transgender child would take offense to that characterization.” Being neurodivergent doesn’t make someone “less deserving of appropriate health care,” he adds.
On 20 August, a judge temporarily blocked Georgia’s ban on hormone replacement therapy for minors, citing Shumer’s testimony. Shumer says he understands not everyone feels comfortable speaking as openly as he has. Because clinical researchers at programs providing gender-affirming care have faced threats, some are “concerned about being public about the work that they do,” he says.
Others choose to communicate less about their work and findings because they “are worried about how aggressive forces may harm precious research initiatives,” John Strang, associate professor of psychiatry and behavioral sciences at George Washington University in Washington, D.C., wrote in an email. Strang also directs a clinic that serves gender-diverse neurodivergent youth, located at a hospital that has received threats related to its work providing gender-affirming care. Some people and their families are too afraid to participate in studies, he says. “This is a challenging time for researchers studying gender diversity.”
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o forge a path forward for research around autism and gender diversity, Strang helped organize a roundtable discussion among nine scientists and clinicians, published in June.“The common intersection of autism and transgender identity has entered the political fray surrounding gender diversity and gender care,” the researchers wrote, “likely due to ongoing stigmatization and distrust of autistic people, their inner experience, and their ability to know who they are.”
“Attempts to restrict autistic transgender people’s access to gender care are unsupported by existing research,” they wrote.
Research and medical communities have spoken publicly against discrimination in the past, says Devon Price, a trans and autistic psychologist and clinical assistant professor at Loyola University Chicago in Illinois. The American Psychological Association, for instance, has filed amicus briefs in past court cases on issues related to abortion, the rights of the mentally ill and the death penalty.
“It is time for the scientific community and the psychiatric community to do the same thing here with trans people,” Price says. “A lot of politicians are outright saying that they want to end our existence. This is not a time for science to be neutral.”
Lai, for his part, says there should be room for scientists to investigate “human nature.” But if that work is “used or taken towards a direction that’s not adequate, from our perspective,” then researchers have a role “to stand up and say, ‘No, this is not what the research should be used for.’”
