Gender Variance in Men and Women with Autism

Background: Autism reflects one form of human variation of neurotypical norms. Binary gender is prevalent in neurotypical individuals, but one study (Bejerot & Eriksson, 2014) has shown increased gender variance in women with autism and decreased stereotypical masculine (but not feminine) gender role characteristics in both men and women with autism, using self-report measures. Increased rates of autism diagnosis or level of autistic traits in children, teenagers and adults with gender dysphoria have also been reported. The phenotypic and underlying developmental relationships between autism and gender variance have yet to be clarified. 

Objectives: To investigate variations in gender identity and gender role characteristics in men and women with autism using both self-report and implicit measures. 

Methods: A total of 167 adults participated, including 34 biological males and 48 females with autism, and 46 neurotypical (control) males and 39 females. Self-reported gender variance was measured using the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and Lippa’s gender-stereotyped occupational (10-item) and hobby (18-item) preference questionnaires. Implicit association between self and gender (tested using self-related versus gendered terms) were measured using an Implicit Association Test (IAT). Group differences were tested using nonparametric (when involving GIDYQ-AA) and parametric methods. 

Results: Men with autism self-reported more variant gender identity (against natal sex) than control men (Mann-Whitney U=261.5, p<0.001), as did women with autism compared with control women (U=493, p<0.001); no sex differences were noted within either the control or autism group. Across diagnosis, men consistently showed stronger preferences for gender-stereotyped masculine hobbies/occupations than women (hobbies: F(1,158)=60.2, p<0.001; occupations: F(1,158)=32.4, p<0.001). After sex-stratification, women with autism reported significantly stronger preferences for gender-stereotyped masculine hobbies/occupations than control women (hobbies: T(82)=5.0, p<0.001; occupations: T(82)=4.3, p<0.001). These effects were in the same direction but less strong (occupations: T(72)=2.6, p=0.01) or non-significant (hobbies: T(72)=0.4, p=0.72) in men with autism compared with control men. IAT showed a strong implicit association between self and gendered terms of one’s natal sex in both sexes, irrespective of diagnosis. After sex-stratification, there was no difference in gender-identity IAT effects (the association strength between self and male-gender) between men with and without autism (T(76)=0.2, p=0.82), whereas women with autism, on average, showed weaker gender-identity IAT effects (between self and female-gender) than did control women (T(83)=2.5, p=0.01). Correlations between IAT effect and self-report variant gender identity (GIDYQ-AA) were significant in women with autism (Spearman’s rho=0.28, p=0.03) but minimal in other groups. 

Conclusions: We found increased rates of men and women with autism self-reporting variant gender identity that did not fit the neurotypical gender-binary norm, compared with control men and women. Women with autism compared with control women, particularly, further reported stronger preference for gender-stereotyped masculine hobbies/occupations, weaker implicit association between self and female-gender, and stronger implicit-explicit correlation in gender identity. These effects were not evident in men with autism compared with control men. Gender variance is more prominent in adults, especially women, with autism. This may reflect phenotypic overlap between the autistic and gender spectra, and common biological underpinnings and/or gender socialization experiences during development.