Autism, transness, & gender identity (Part 1)

Hi! As you may or may not know, I’m trans (and I started my transition at the end of 2021). In this article, I will talk a bit about my experience of being trans, how my gender identity evolved over the years, and I will say a few things about the intersection between gender identities and autism. And of course, even speaking on my experience as a trans person alone, it’s unavoidably going to be influenced by my autistic perspective.

Gender dysphoria

Although the American Psychiatric Association defines gender dysphoria as the distress experienced from the incongruence between our sense of gender and the sex we were assigned at birth,^[1]What Is Gender Dysphoria? | APA they—as well as on the Wikipedia entry of gender dysphoria^[2]Gender dysphoria | Wikipedia—used to define gender dysphoria as:

A concept designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender, which may include desire to change primary and/or secondary sex characteristics.

I find the phrase “a strong desire to be of another gender” quite interesting. I suspect they are equating sex and gender here; because in my experience, gender is a core part of who we are, and it seems to be pretty stable. At least in my case, my gender has always been female, rather than experiencing a strong desire to be of another gender.

Well, this is how I argue about it now. I certainly used to express a desire to be female—as opposed to saying that I am female in terms of my mind, even though my body wasn’t.

My gender as a kid

The notion of gender identity is quite fascinating to me, because as far as we can tell, animals don’t have the capacity for a gendered self; it seems this is a uniquely human feature, necessitating advanced reasoning, a conception of the self, and the ability to identify with social constructs.

But my gender became apparent in certain ways long before I had any conception of my gendered self. I guess herein lies the distinction between gender expression and gender identity; I didn’t explicitly identify as anything, but I behaved in gendered ways more associated with girls, and I expressed preferences that were more typical of girls.

When I was 3 years old, I asked my mom if I could have pink shoes. My mom thought this went too far for a little boy, so she “compromised” by giving me red shoes with flowers. I have to laugh at that, because arguably red shoes with flowers are more girly than pink shoes. In the 1700s, European men wore pink, which was a sign of wealth and power.^[3]In the pink: colour in menswear (2020) | V&A Even in the 1920s, pink was associated with masculinity, and often worn by boys (while red was more associated with men).^[4]Pink Wasn’t Always Girly (Broadway, 2013) | The Atlantic But sure, in the ’90s pink was definitely associated with femininity. Incidentally, while my mom didn’t allow me to wear pink shoes when I was 3, I ended up getting pink shoes when I was 33!

Besides a girly preference for shoes, I loved playing with Barbies and Baby Born dolls. I asked my parents if I could get them for my birthday, but they said I can’t, since those are toys for girls. I guess I more or less accepted that I couldn’t have these toys, but it must have confused me; why are the toys I like not appropriate for me? I remember playing with Barbies and Baby Born dolls every chance I got when visiting people who had daughters.

My behavior was also quite girly as a kid. My mom thought I might be gay. I was afraid of boys, as I considered their play to be too harsh. Instead, at school I would play with the girls and make mud soups and play doctor and nurse. Last year I read the book The Female Brain (2006) by neuropsychiatrist Louann Brizendine, and I learned that my play was typical of girls. I find that quite fascinating, because it tells me that my brain and behaviors were innately female. This was before I endured significant conditioning, and before I had any sense of gender. This was just me; as pure and authentic as I could be!

My gender when I was 8

But I did endure male conditioning. As I got older, I learned more about what my parents and other kids expected of me in terms of my gendered behavior and presentation. I guess I learned to mask who I was early on. But I don’t actually remember wishing I was a girl, or wanting to wear feminine clothes.

Not until I was about 8–10 years old. As I was approaching puberty, I started fantasizing about being a woman. I guess these are my first memories of wishing I was born a girl, and this is where my gender dysphoria developed. I became aware of the incongruence between my mind and my body, and delved into fantasies where my body was congruent with my mind. I started secretly crossdressing by stealing my mom’s pantyhose, which I guess were the only feminine clothes I could get my hands on that fit me.

Mind you, I had no idea what gender was at this point. I didn’t feel explicitly male or female, and my feelings about womanhood just seemed like farfetched fantasies and preferences that I could never act on. I had never heard of transgender people, and I had no idea it was possible to change secondary sex characteristics by taking hormones. When I think about it though, my transgender feelings were probably more along the lines of what the APA describes gender dysphoria to be, as I had a desire to BECOME the other gender/sex. I thought of it as transforming into the ‘other’, rather than augmenting myself so I could be my authentic self. I guess I was completely unaware of what an (authentic) self even was.

I remember experiencing a lot of shame, because according to the world and my body, I was supposed to be a boy—yet my mind said otherwise. I just felt wrong. I mean, my fantasies didn’t feel wrong—they were the only things that made sense to me—but the fact that I longed to be something I clearly wasn’t (not physically, anyway) made me feel wrong and inappropriate. I mean, there was clearly something wrong with me, right? I had no one I could share my feelings with, so I kept them secret for many years.

My gender as a teenager

Being a teenager was a confusing experience for me. At this point, I endured a lot more male conditioning, and I was still keeping my gender dysphoria and trans identity to myself. I think it was too difficult to be fully aware of and acknowledge who I was, so I suppressed and repressed it as much as I could. When I was 13, I got into metal and the metal and goth subculture. I grew my hair out, I let my nails grow long, and I started painting my nails at school—and rubbed it off before coming home, as I didn’t want my parents to see it. At the time, I thought I was just being edgy and exploring metal and goth culture. But in hindsight, it was just the perfect cover for me to explore my femininity, wasn’t it?

But here is the weird thing. I became so conditioned to societal expectations of masculinity and the male physique, that I looked at other guys my age with more toned bodies and wished I could look like that. Imagine really wanting to look female, but as a second choice wanting to look more masculine! Such an odd experience to have. I actually had subtle man boobs, which you might think I would be fine with considering I wanted to look like a woman—but no, they made me highly insecure. And any suggestion that I looked feminine made me even more insecure!

I remember uploading the picture below to my social media profile in 2006 (when I was 17), and a friend commented on how feminine my face looked. I was so offended by that! I guess it threatened to undermine the male persona I tried to portray.

Meanwhile, I remember around this time, my girlfriend and I were being playful and silly, and I put one of her tops on. We laughed. I mean, I made it look like a joke, but secretly I wanted it. I showed it off to my girlfriend’s mom’s boyfriend, and he went, “Pfff”. He didn’t think it was funny, and I guess he might have felt embarrassed for me. Whatever dude! I actually didn’t care; I was fortunate enough to be oblivious or otherwise uncaring about certain things as a teenager.

At the time, I remember thinking I appreciated my girlfriend on a deeper level than any cis man could, as I both longed for her and envied her; in a sense, I wish I WAS her—or craved what she had (being a girl). I wished I could express myself the way she could. And I wanted to look pretty!

I remember one time, she told me I looked handsome, and I was so disappointed by that. I asked her, “Am I not beautiful?” I’m Dutch, so I wasn’t familiar with these gendered terms. She explained to me that ‘handsome’ is the male-gendered way of describing someone as beautiful. I didn’t like it! It just didn’t seem right.

For many years, I thought I looked quite nice for a man, but what good is that when you hate being a man? From my teenage years until my transition, I’ve avoided mirrors as much as I could. I just hated seeing myself. It was always a painful reminder.

During my relationship with my girlfriend (which lasted 3.5 years), I never told her about my desire to be a woman. I still felt embarrassed by it, and I feared losing her or being disapproved of if I did tell her. It felt safer to keep it a secret. Besides, I didn’t think there was anything I could do anyway. I had never heard of trans people or transitioning. I thought I was stuck with who I was and what I looked like.

Acknowledging I’m trans

At some point, I downloaded several British documentaries on young trans women and their journeys—about transitioning, finding jobs and acceptance, and trying to learn to live as their authentic selves in a world that is ignorant about their experiences, and responds with confusion and potentially weird looks. I saw both their struggles and their joys. But for me, it was liberating. I came to understand that I could look more feminine, and could maybe even be treated as such. I looked at them with envy and awe. That’s what I want! And they looked so beautiful, being their true selves. I wished I had the courage to pursue that.

I don’t actually remember whether I watched these documentaries when I was still with my girlfriend or after our relationship. But I do remember not being able to truly acknowledge I’m trans until after she broke up with me. The breakup devastated me, but it also liberated me. I finally felt free to acknowledge who I’ve always been, and free to start exploring my femininity. I started crossdressing in private, and wore bras as I went to bed. It felt appropriate, and it felt amazing falling asleep every night feeling like the woman I am—or desired to be.

And yes, I know womanhood is not about wearing bras, and that most women take their bras off at night—as I do nowadays as well. But I couldn’t wear any gendered clothing publicly, and only sometimes wore them in private, so this was my way of affirming my gender by wearing gendered clothing at night.

A gendered autism myth

At age 19, I finally found the courage to tell my parents that I’m trans. Among other things, I told them that I wear bras because it feels appropriate. My mom was quite accepting; my dad was not. My dad didn’t understand.

He discussed it with a psychotherapist friend, and came back to me with what he had learned from her; that autistic people have a poor sense of identity, and that most people with gender dysphoria grow out of it eventually; that it’s just a phase. So he tried to dismiss my experience with a clinical myth about autistic people; that they have a poor sense of who they are, and lack the autonomy to know what’s best for them. I felt so misunderstood by my dad. And he was so wrong!

Mind you, I’ve basically known I’m trans since I was about 8 (although I didn’t have the vocabulary for it back then). I kept this a secret for 11 years! That’s quite a long phase. And I’m 34 now, and still trans. I started my transition at 32, and it was the best decision of my life. It’s not a phase, dad!

To be exact though, it’s not actually an uncommon occurrence for people to experience gender dysphoria and think they’re trans, but for whom transitioning is not a suitable treatment. These are called ‘desisters’.^[5]A Follow-Up Study of Boys With Gender Identity Disorder (Singh et al., 2021) But no paper to date has shown a significant social contagion that would account for most people with gender dysphoria thinking they’re trans due to social influence while they’re actually not—nor is there a paper establishing such an effect with respect to autistic people specifically. Rather, the reason we see more people considering they’re trans is simply due to greater awareness, which helps people with gender dysphoria seek treatment more readily than they did before.^[6]Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? (Arnoldussen et al., 2019) I would probably have pursued treatment much earlier myself if I had known about transitioning sooner.

I guess this is a longwinded way of saying that having gender dysphoria doesn’t necessarily lead to transitions for everyone who has it; and for some, gender dysphoria could be part of early development which either goes away naturally, or can be addressed in other ways. Either way, as far as I’m aware, there is no research to suggest that:

• Gender dysphoria is necessarily a phase for autistic people; or that
• Autistic people have a poor sense of self, which negates the need for gender-affirming treatment

In fact, I think autistic people are often urged to explore more thoroughly who they are. I think during puberty in particular, we tend to be confronted with the question why other people behave so differently, why we don’t show the same innate behaviors, and what might this say about us?

As one paper states, autism is not a contraindication for gender-affirming treatment.^[7]Transidentities and autism spectrum disorder: A systematic review (Bouzy et al., 2023) And if anything, one might expect autism could lead to less identification with gender norms and less pressure to conform to these norms, rather than identification with gender norms of the opposite sex, and a pressure to conform to them.^[8]Transidentities and autism spectrum disorder: A systematic review (Bouzy et al., 2023)

My gender during my 20s

In my 20s, I still couldn’t accept myself as female, but rather thought of myself as having a wish of being female. And I know biologically I will never be female, but in hindsight, it’s a bit puzzling that I didn’t think of being female in terms of gender. It’s now very obvious to me that I always have been female; it just didn’t seem valid to identify as female considering my male presentation. I could acknowledge being trans, but I couldn’t claim being a trans woman. And I think that’s somewhat fair. I mean, my sense of self and certain proclivities and preferences may have been female-coded, but I functionally didn’t live as a woman, nor could I be perceived as such.

When I was around 22, I went to a gender clinic to try to pursue HRT. I don’t know how true this is, but at the time, it felt like I observed a stark difference between me and most other transgender people at the clinic. Namely, it seemed that most trans people were looking to make a transition from one gender to the other—from one binary position to the other. This was not my goal. I wanted to look female, yet I did not care to assume the female role fully. I didn’t think I explicitly felt male or female, so the notion of switching genders also didn’t make sense to me. But in hindsight, of course it wouldn’t, because my gendered self has always remained pretty stable. I wasn’t going to change my gender; I was going to change my appearance and gender expression to conform to my gendered self. It’s only my self-awareness, acknowledgment, and gender expression that have significantly shifted.

Becoming a woman?

I think that my sense of gender was never what was causing me distress, which is why the term ‘gender dysphoria’ is a bit strange. It’s not my gender that is the problem; what caused me distress was my physical appearance, the constraints my appearance and gendered perception put on my gender expression, and that I was treated as a man while I didn’t feel like a man.

I wished I could find comfort in wearing dresses and nail polish without being judged for it or stared at. It’s not about wanting to do those things because I wanted to become a woman; no, it’s about changing my appearance so that I could express myself the way I am. In a sense, I already was a woman by gender. It’s the world that still had to catch up to that fact.

I have a lot more to say about gender identity and how my gender evolved, but I feel this article is long enough. If you want to know more about me and how my gender evolved, read part 2!

Autism, transness, & gender identity (Part 2)