Constructing the Autistic–Transgender Intersection: A Critical Discourse Analysis

ABSTRACT

Researchers increasingly report a statistical intersection between autism and transgender (trans) identities. Claims about this estimated relationship have recently proliferated within and beyond scientific research, particularly amidst escalating political struggles over the rights and recognition of trans people. Our study critically analyses discursive patterns among these claims to investigate how and to what effects diverse actors construct the intersection of autism and trans identities. We qualitatively analysed a purposive sample of 30 texts, including psychological research, clinical literature, news and opinion articles, state legislation, activist materials and autistic trans individuals' published narratives. We propose that claims about the autistic‐trans intersection can be understood through four discursive types: psychiatrisation, repressive protection, medical management and affirmation and reclamation. These types represent differently patterned ways of (1) explaining medical vs. social ‘causes’ of the intersection and (2) legitimising versus delegitimising autistic trans identities, with each type promoting distinctive medical, cultural and political practices as responses. In this case study, we present the autistic‐trans intersection as a site at which social actors with varied political aims and differential access to power reproduce and resist normative systems of gender and ability, pursue varied processes of de/medicalisation and negotiate expert knowledge and uncertainty.

1. Introduction

The intersection of autism and transgender (trans) identities (i.e., binary or non‐binary gender identities that differ from one's sex assigned at birth) has become an object of widespread scientific and public attention. Since de Vries et al. (2010) first reported an ‘overrepresentation’ of autism among youth diagnosed with gender dysphoria, dozens of psychological studies have aimed to quantify and explain this co‐occurrence (Kallitsounaki and Williams 2023). Leading clinical standards now direct providers to consider autism as a factor in determining access to medical treatment for trans people seeking gender‐affirming care (GAC; Coleman et al. 2022). Within news and opinion media, coverage of this intersection ranges from human interest stories about autistic trans people's experiences (e.g., Luterman and Rummler 2024) to headlines accusing ‘trans activists’ of manipulating autistic children into transitioning (e.g., Bradley 2017). State bills (e.g., Georgia S.B. 140 2023; Ohio H.B. 68 2023) and conservative activist groups (e.g., American Family Association 2020) cite the ‘co‐morbidity’ of autism and gender dysphoria as grounds for restricting GAC access for minors. Meanwhile, growing memoirs (e.g., Dale 2019), personal essays (e.g., Adams and Liang 2020) and blogs (e.g., Amanzi 2020) highlight autistic trans people's own narratives.

This paper investigates the production and consequences of claims about the intersection of autism and trans identities as they extend across multiple areas, implicating the healthcare, legal rights and societal recognition of autistic and trans people. Below, we trace historically shifting constructions of autism and trans identities and review theoretical perspectives on the politics of scientific/medical knowledge before describing our critical discourse analysis (CDA) methodology. We then present a typology of four ways in which professional and lay actors discursively construct the autistic‐trans intersection, arguing that different stakeholders use medicalising and demedicalising patterns of discourse to either legitimate or discredit autistic trans identities. We also connect our findings to the role that claims of expert (un)certainty play within political struggles, including over trans rights. Finally, we discuss implications for intersectional analyses of gender and disability within medical sociology.

2. Background

2.1. Social Constructions of Autism

Sociologists often study autism and trans identities separately as socially constructed categories, with particular attention to processes of medicalisation (Conrad 1992; Zola 1976). One strand of literature traces the historical development of autism as a medical category; although psychiatrists first conceptualised autism in the 1940s as a rare childhood disorder, the current diagnostic paradigm defines autism as a common neurodevelopmental condition encompassing broad differences in social interaction, communication and behaviour (Eyal 2013). Sociological accounts attribute the categorical expansion of autism to several interactive forces, including new ways of regulating child development with the growth of child psychology in the 1960s–1970s (Evans 2017); organised efforts between families and professionals to increase service access by broadening diagnostic criteria (Eyal 2013); and the late twentieth‐century formation of an ‘autism industry’ with financial stakes in a market for interventions (Broderick and Roscigno 2021).

The case of autism also demonstrates how medicalisation can be contested by a wide range of actors. Barker and Galardi (2015) find that lay commentary on autism often features concerns about medicalising normal human behaviours, whereas autism professionals and family members defend the status of autism as a ‘real’ disorder and assert the need for wider diagnostic criteria to maintain access to services. Meanwhile, since the early 1990s, an autistic‐led social movement has redefined autism as a form of neurological diversity (i.e., neurodiversity) and a marginalised collective identity rather than a pathology (Kapp 2020). For neurodiversity activists, rejecting the medical model still confirms the social and political reality of autism, with the goal of addressing barriers to autistic people's full participation in society (Chapman 2020). Our study considers how various professionals and lay publics continue to negotiate these historically shifting, often competing medical and social meanings of autism as they construct the autistic‐trans intersection.

2.2. Social Constructions of Trans Identities

Sociological literature similarly recognises trans identities as dynamic constructions (Gill‐Peterson 2018; Schilt and Lagos 2017). Trans identities have historically been medicalised as psychiatric disorders, as evidenced through diagnoses such as ‘gender identity disorder’ and ‘transsexualism’ in previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth DSM edition replaces these diagnoses with ‘gender dysphoria’, distress emanating from an ‘incongruence’ between gender identity and sex assigned at birth (American Psychiatric Association 2013). The update was intended to move the locus of pathology away from trans identity itself; however, some scholars argue that the classification of gender dysphoria as a mental disorder maintains psychiatry's regulatory control over trans lives (Riggs et al. 2019).

The medicalisation of trans experiences extends beyond psychiatry. Some trans people have sought surgical and hormonal treatments at least since the mid‐twentieth century, with access contingent upon their fulfilment of strict diagnostic criteria (shuster 2021). The past few decades have also yielded an expansion of interventions that align trans people's bodies with idealised standards of masculinity and femininity (Gonsalves 2020). Under this paradigm, medical providers typically define ‘healthy’ transition outcomes in terms of binary sexed characteristics that correspond to a binary, stable gender identity and expression (Davis et al. 2016). Many trans health activists, in contrast, advocate for a model of GAC that facilitates trans individuals' self‐determined goals outside of any normative template (Hanssmann 2023). Trans studies scholars have similarly advanced an expansive understanding of ‘trans’, focusing on socially situated experiences of moving beyond hegemonic gender boundaries (Gill‐Peterson 2018; Stryker 2008). These critical perspectives challenge medical authorities' control over trans people's experiences and bodies while supporting individuals' access to desired medical services.

In opposition to efforts for trans rights and depathologisation, reactionary anti‐trans movements have increasingly mobilised across the United States, the United Kingdom and other contexts. These movements construct trans existence as simultaneously a pervasive threat to women and children and an unreality, asserting an immutable sex binary as biological ‘truth’ (Amery and Mondon 2024). Anti‐trans activists advance their own challenges to medical authority by promoting bans on GAC for youth, rejecting leading health associations' support for GAC access (Wuest and Last 2024). As with autism, struggles over medical understandings of trans experiences are intertwined with struggles over identity, political recognition and material resources.

2.3. Politics of Scientific Knowledge and Uncertainty

These conceptual histories of autism and trans identities demonstrate how scientific/medical knowledge and the social world mutually shape and reinforce one another. Scientific classifications of humans (e.g., diagnoses) articulate previously unrecognised ways of being as specific ‘kinds of people’; in turn, classified people may collectively identify with, contest, and modify expert knowledge about their classification (Hacking 1986). Claims to scientific knowledge are also powerful tools for organising and legitimating institutional practices. The dominant evidence‐based medicine paradigm bases clinical practice on an evidentiary hierarchy privileging the ‘gold standard’ of randomised control trials (Sackett et al. 1996). Likewise, policymakers embrace evidence‐based logic as a means of minimising uncertainty and discretion in decision‐making, despite depending on socially situated judgements about what constitutes ‘evidence’ (Parkhurst and Abeysinghe 2016).

Gender and sexual politics have long been a site of competing lay and professional attempts to produce, use, challenge and alter scientific knowledge (Epstein 1996). Gay and lesbian activists beginning in the mid‐twentieth century worked with allied researchers to discredit the psychiatric pathologisation of homosexuality as unscientific, leveraging the field's gradual redefinition of homosexuality as normal and even immutable as a basis for gay civil rights (Wuest 2023). In response, conservative anti‐gay movements advanced their own studies claiming that homosexuality could be changed by treating underlying psychosocial causes (Waidzunas 2015). Similarly, anti‐trans rights movements today frequently invoke the psychological theory that trans identities are a curable ‘social contagion’ among youth, appealing to scientific authority despite many researchers' rejection of the theory as based on dubious evidence (Ashley 2020). Setting aside their truth value, these claims to scientific evidence demonstrate how opposing movements construct ontologies of sexuality and gender that align with their political needs.

In summary, autism and trans identities have been continually (re)constructed over time through interactions among publics and professionals with varying interests, often revealing tensions between forces of medicalisation and demedicalisation. These struggles over meaning are intertwined with consequential processes of identity‐making and collective action. As a recently defined object of both scientific and public attention, the autistic‐trans intersection presents a unique site to analyse the politics of knowledge about neuro‐ and gender divergence. Our study therefore asks: How do actors across varied social arenas construct and leverage the intersection of autism and trans identities?

3. Methods

We investigated this question using critical discourse analysis (CDA), a theoretical and analytic approach that examines how patterned ways of representing the world, or discourses, reflect and produce social and ideological conditions (Fairclough 2003; Wodak and Meyer 2001). Discourses communicate knowledge that informs social action (Wodak and Meyer 2001). CDA elucidates this process by tracing how individual speech and textual representations at the micro‐level (e.g., verbal statements, journal publications, blog posts) function to legitimate and advance macro‐level practices that sustain dominance of some groups over others (e.g., diagnostic systems, legislation; Van Dijk 2003). CDA is therefore well‐suited for studying relationships between language, power and inequality.

3.1. Data Collection and Sources

Scientific knowledge claims are produced, circulated and deployed through interactions among diverse actors within and beyond scientific institutions (Epstein 1996; Hilgartner and Bosk 1988). To examine these dynamic processes in relation to the autistic‐trans intersection, we analysed texts across six arenas of communication: psychological research, gender‐affirming medicine, news and opinion media, US state legislation, social activism and autistic trans individuals' lived experiences. These texts respectively included peer‐reviewed journal articles, clinical guidelines, reports and editorials from popular media outlets, bill texts, materials published by activist organisations and published autobiographical narratives (e.g., blogs, essays). We identified relevant materials using the Scopus citation database, Google News aggregator, LegiScan legislation database and Google Search, systematically entering search phrases that retrieved texts including key terms related to both ‘transgender’ and ‘autistic’ (see Supporting Information S1: Table S1 for details).

These searches returned a high volume of results; for example, searching Scopus yielded 246 original research articles from the earliest retrieved record (Williams et al. 1996; a single‐case study that first speculated a relationship between autism and ‘gender identity issues’ in children) to the date of the search in December 2023. Considering the in‐depth qualitative analysis demanded by the research question, we used a purposive sampling strategy to compile a sample of 30 texts (Palinkas et al. 2015; Supporting Information S1: Table S2). We intentionally sampled five texts from each arena of communication, aiming to capture variation in text sources and authors, target audiences and arguments rather than produce a statistically ‘representative’ sample (Small 2009).

To refine this process, we sorted the results of each search by relevance and reviewed the top 50 records against theoretically informed criteria. Specifically, we included texts that advanced or engaged with claims about the scientifically reported relationship between autism and trans identities, and we prioritised those that were frequently cited or referenced by other texts that we encountered. We did not impose restrictions by date but sought to include texts published across a range of years, allowing us to trace the circulation of specific claims over time. As an important limitation, we restricted our sample to texts published in English, and our analysis primarily focuses on the US sociopolitical context. Despite this limited scope, we intend for this study to motivate further international and transnational analyses.

3.2. Analytic Strategy

We utilised a three‐stage analytic process following queries outlined by K. Jørgensen and Praestegaard (2018) and grounded in Fairclough's (2003) conceptualisation of CDA as addressing three interrelated dimensions: (1) the text and its linguistic features; (2) discourse practice, the relationship between text and broader discourses; and (3) social practice, the macro‐level contexts in which discourses are embedded. The first author began the text analysis stage by reading and inductively coding each text line‐by‐line (Saldaña 2016) using NVivo qualitative coding software. This stage involved annotating elements of vocabulary and grammar, such as specific words used to characterise autism, trans identities and their proposed intersection. The first author then produced memos identifying patterns and potential interpretations that they discussed with the second author. We repeated this process for the discourse practice stage, coding for instances of intertextuality (i.e., authors' references to other texts, particularly in making claims about autism and/or trans identities) and interdiscursivity (i.e., references to larger systems of meaning, including existing cultural assumptions and narratives). To analyse social practice, we compared our existing codes to identify patterns in how texts reinforced, promoted and/or challenged specific ways of understanding and regulating neuro‐ and gender divergence.

Researchers engage in CDA from inherently partial subject positions and are themselves embedded within ideological systems (Wodak and Meyer 2001). Consequently, we considered our different standpoints as sources of strength and potential limitations for this project (Smith 1987). The first author is a non‐binary, White, autistic student at a large private university. Their observations of growing public attention to autistic trans experiences shaped the development of the research question. The second author is a cisgender, queer, neurotypical, White woman who serves as non‐tenure‐eligible faculty at the same institution. Together, our divergent and shared experiences of institutions of medicine and higher education informed our analysis of emergent discourses around gender, age and ability. Throughout our analysis, we discussed how our individual understandings of discursive elements converged and contrasted with one another, leading to a richer understanding of the examined texts and their social consequences (Van Dijk 2003). Further analyses from scholars across a range of disciplines and with diverse connections to trans and autistic communities could yield valuable interpretations beyond our own.

4. Results

Based on our analysis, we developed a typology of four patterned ways that claimsmakers construct the intersection of autism and trans identities. These discursive types vary along two dimensions. First, each type advances primarily medical or social explanations for reported associations between autism and trans identities. Second, each promotes legitimising or delegitimising evaluations of autistic trans identities. Figure 1 displays and summarises these types as quadrants, labelled: psychiatrisation (medical/delegitimising), repressive protection (social/delegitimising), medical management (medical/legitimising) and affirmation and reclamation (social/legitimising). Importantly, individual texts sometimes employ more than one of these types; we discuss these dynamic interactions after characterising each type separately.

FIGURE 1.

Summary of discursive typology.

4.1. Psychiatrisation

The discursive type of psychiatrisation (medical/delegitimising) positions trans identity as a symptom of autism, rather than a valid relationship to gender. We observed this type in psychological studies that approach both ‘autism spectrum disorder (ASD)’ and ‘gender dysphoria (GD)’ as medical conditions characterised by impairment and distress (i.e., de Vries et al. 2010; Kaltiala‐Heino et al. 2015; Strang et al. 2014; VanderLaan et al. 2015). The authors of these texts construct the ‘comorbidity’ of autism and gender dysphoria as an anomalous epidemiological problem. For example, in their small descriptive study that first claimed to quantify this intersection, de Vries et al. (2010) state that the reported ‘incidence of 7.8% ASD in gender identity clinic referred children and adolescents…confirms the clinical impression that ASD occurs more frequently in gender dysphoric individuals than expected by chance’ (933). Noting this deviance from ‘chance’ then establishes the estimated relationship between autism and gender dysphoria as a problem requiring explanation.

Researchers raise and respond to questions of aetiology by naming ‘autistic traits’ or ‘symptoms’ such as ‘obsessions’, ‘rigidity’ and ‘black‐and‐white thinking’ as potential causes of gender dysphoria, particularly among youth. VanderLaan et al. (2015) illustrate this pattern in the discussion of their study, after reporting that children receiving gender‐related services showed more parent‐reported ‘obsessions’ (used as a proxy for ASD) than controls:

Future research is needed to discern the developmental pathway(s) by which elevated, gender‐related obsessionality contributes toward GD‐ASD comorbidity. One possibility is that ASD sometimes leads to intense interests in cross‐sex objects or activities, giving rise to a clinical presentation of GD.

(217)

Such speculations about ‘possible’ causes are then presented as empirically based scientific explanations in public‐facing texts from right‐wing media outlets (e.g., Duggan 2023; Kirkey 2017). For example, Duggan's (2023) report in The Daily Caller claims, ‘Children with autism make up an outsized proportion of the transgender‐identified population, and autism spectrum traits make them particularly vulnerable to thought patterns that can lead youth to pursue gender transitions, according to research and medical professionals’. Duggan cites de Vries et al. (2010) as evidence for a documented ‘connection between transgenderism and autism’ before relaying the opinions of researchers and clinicians known for vocally rejecting the validity of trans identities, such as Kenneth Zucker (see Schoenike 2023). These figures repeat the hypothesis that rigid thinking or obsessions drive autistic youth to mistakenly ‘believe’ they are trans, presented by Duggan as an uncontentious causal mechanism. Through such intertextual processes, psychiatrisation circulates between academic and public contexts.

Psychiatrisation synthesises existing discourses of autism and trans identities as psychopathological, thus epistemically discrediting, categories. By attributing trans identities among autistic youth to mental deficits, psychiatrisation denies the reliability of autistic youths' self‐knowledge. Calls to investigate a ‘broader autism phenotype’ in relation to gender dysphoria (e.g., de Vries et al. 2010, 935), along with claims that posit undiagnosed autism as an overlooked cause of trans identities (e.g., Soh 2023, opinion in the Washington Examiner), then dismiss all trans people as potentially ‘just’ autistic. Consequently, certain researchers and commentators who cite them advocate for psychiatric interventions into autism as a means of ‘treating’ non‐normative gender identities. For example, after reporting their retrospective study's findings that autism and other psychiatric diagnoses were ‘overrepresented’ at one gender identity clinic, Kaltiala‐Heino et al. (2015) call for more restrictive GAC guidelines to ‘account the needs of those with severe psychopathology and identity confusion’ (8). In this way, psychiatrisation asserts psychiatric jurisdiction over trans experiences through the category of autism.

4.2. Repressive Protection

The discursive type of repressive protection (social/delegitimising) constructs the autistic‐trans intersection as the product of converging social problems. This type, frequently deployed by organisations that advocate against trans rights, represents autistic youth as particularly ‘vulnerable’ to peer‐ and media‐related pressures to transition. One publication from Transgender Trend (2022), an organisation that claims to oppose ‘gender ideology’, characterises trans identity as a ‘social contagion’ and argues: ‘For autistic girls who are desperate to be accepted by their peers, a trans identity presents a socially sanctioned way of being different’. This publication and similar materials also frame medical transition as inherently dangerous, repeatedly describing GAC as an ‘experimental’ practice likely to cause harm.

Repressive protection attributes correlations between autism and trans identities to collusion between a corrupt medical establishment and a threatening ‘trans movement’. For example, commentary from the conservative Christian legal advocacy group Liberty Counsel claims, ‘Autistic kids are being pushed into chemical and surgical sterilisations at a rate of five times the rest of the population, according to a new and comprehensive study’ (Staver 2023). Although the cited study (Warrier et al. 2020) reports the prevalence of autism in a non‐clinical survey of trans adults, Staver uses this statistic as evidence that a ‘highly profitable gender care industry’ driven by ‘trans propaganda’ is hastily subjecting autistic youth to harmful transition procedures. In addition to assuming that all instances of GAC (‘sterilisations’) are coercive, this claim conflates trans identity with medical intervention, obscuring the fact that many trans youth and adults do not or cannot access GAC.

A subtler version of this narrative appears in state legislation targeting GAC. For example, Georgia Senate Bill 140 (2023) cites ‘a massive unexplained rise in diagnoses of gender dysphoria among children’ and the ‘comorbid’ relationship between gender dysphoria and autism as evidence supporting its ban on GAC for minors. The bill ends by asserting the state's ‘obligation to protect children…from undergoing unnecessary and irreversible medical treatment’. Other attempts to restrict GAC specifically proposed heightened liability for providers who treated clients without documenting that they did not have autism (Arkansas S.B. 199 2023; Missouri 15 CSR 60‐17.010 2023; North Carolina S.B. 560 2023; Ohio H.B. 68 2023). Overall, the logic underlying these measures suggests that coercive forces are driving vulnerable youth, typified by autistic youth, into unsafe medical interventions.

Repressive protection echoes a wider reactionary ‘anti‐gender’ discourse that labels any challenge to the biological determinist sex/gender order, including trans people, as a corrosive ‘ideology’ requiring elimination (Amery and Mondon 2024). Similarly, repressive protection employs previous anti‐LGBTQ movements' tactic of framing children as targets of a predatory queer ‘agenda’ (Stone 2019). Given cultural associations between autism and childhood, autistic youth become paradigmatic victims within anti‐trans narratives. By accusing the ‘gender care industry’ of exploiting vulnerable populations, claimsmakers also use this discursive type to mobilise a wider sense of disempowerment under profit‐driven medical systems. These cultural anxieties are then woven into narratives of perpetration and victimisation that justify GAC bans as a ‘protective’ response. Repressive protection thus operates as a concrete exercise of power, asserting state control over the medical institution and trans individuals.

4.3. Medical Management

The discursive type of medical management (medical/legitimising) conceptualises autism and trans identities as valid and non‐mutually exclusive categories, specifically through a medical framework of ‘autism spectrum disorder’ and ‘gender dysphoria’ and related diagnostic terms. Medical management constructs the autistic‐trans intersection as a complex ‘co‐occurrence’ requiring careful clinical evaluation and treatment, but unlike psychiatrisation, this treatment potentially includes GAC. For example, Strang et al. (2018) introduce the first clinical guidelines to focus on this intersection with the rationale:

The co‐occurrence of ASD and GNC [gender nonconformity]/GD in adolescents presents significant diagnostic and treatment challenges given the social, adaptive, self‐awareness, communication, and executive function complexities of youth with ASD. However, many adolescents with this co‐occurrence are found clinically appropriate for GD‐related treatment.

(107)

As this statement indicates, medical management presents autism as a ‘challenge’ to, but not a disqualification from, the process of identifying and treating gender dysphoria.

The framing of this ‘co‐occurrence’ as a medical scientific puzzle circulates across scientific, clinical and public contexts. Clinical guidelines from leading groups of health professionals cite prevalence‐focused research to establish autism as a special consideration within GAC (e.g., American Psychological Association 2015; Coleman et al. 2022; National LGBTQIA+ Health Education Center 2020; Rafferty et al. 2018; Strang et al. 2018). Meanwhile, some researchers emphasise ‘clinical implications’ as rationale for increasingly large quantitative investigations into autism among trans populations (e.g., Warrier et al. 2020).

The discourse of medical management reaches public audiences via news media. For example, a story for the general interest publication Slate suggests that the ‘correlation between gender dysphoria and autism’ reflects the need for medical care that addresses both diagnoses (Erquhart 2018). The story cites Strang et al.'s (2018) clinical guidelines and quotes the lead author:

‘Certainly, you can find cases of kids for whom some aspect of autism seems to be driving gender dysphoria. But over time, we’re seeing that a good number of neurodiverse teens coming into gender clinics truly are transgender or gender diverse,’ Strang said.

(Erquhart 2018)

This quote affirms that many autistic youth ‘truly are transgender’ and deserve GAC but also implies a need to discern this group from illegitimate ‘cases’. The World Professional Association for Transgender Health (WPATH) reiterates this logic in its Standards of Care, stressing that providers must ‘differentiate gender incongruence from specific mental health presentations’, including ‘special interests in autism’ (Coleman et al. 2022, 63). The WPATH Standards repeat Strang et al.'s (2018) recommendations that GAC providers develop expertise in autism, collaborate with autism specialists, and extend assessment and treatment timelines for autistic youth seeking GAC. However, the Standards do not specify how to ‘differentiate’ between autism and gender dysphoria, marking their intersection as an object of uncertainty.

The professionals that promote medical management invoke the discourse of evidence‐based medicine in their calls for standardised clinical practice guided by systematic, quantitative research. Simultaneously, prominent guidelines charge providers with subjectively determining whether autistic patients fulfil diagnostic criteria for gender dysphoria independently of their autism. This mandate to identify which autistic patients are ‘truly trans’ reflects wider discourses of transnormativity (Johnson 2016), which holds trans experiences accountable to narrow medical standards of legitimacy. In practice, this makes autistic trans people's access to GAC contingent upon providers' interpretations of their internal experiences.

4.4. Affirmation and Reclamation

Finally, affirmation and reclamation (social/legitimising) validates autistic trans experiences through a lens of social identity. This discursive type manifests clearly within texts presenting personal and/or community‐based perspectives on the autistic‐trans intersection. These texts represent quantitative estimates of trans identities among autistic people as an expression of autistic people's ‘nuanced’, ‘unique’, ‘fluid’ and ‘diverse’ understandings of gender. For example, in their advice book for autistic trans people, autistic trans advocates Purkis and Lawson (2021) embrace ‘recent research’ quantifying this intersection by claiming: ‘When you consider our honesty, our preponderance for truth and fairness, then gender is likely to be more fluid and less binary’ (16). Non‐binary autistic blogger Rivera (2021) further explains that ‘being Autistic has fundamentally shaped how I relate to gender’ because ‘being Autistic means that I am willing to examine all of these social constructs under a magnifying glass’. Other writers similarly connect their autism to ‘non‐conformist’ gender identities (Alyia 2019, 111) and ‘defiance’ of fixed gender categories (endever 2020, 113), contrasting with the psychiatrisation narrative that ‘rigid’ thinking about ‘cross‐sex interests’ leads autistic people to adopt (implicitly binary) trans identities. From these perspectives, autistic people have an enhanced ability to reject the normative sex/gender binary compared to their non‐autistic peers.

Affirmation and reclamation also directly challenges other discourses by conceptualising ‘autistic’ and ‘trans’ as marginalised intersecting social identities. In a blog for the National LGBTQ Task Force, non‐binary autistic activist Brown (2016) critiques the assumption that trans identities are a symptom of autism as an ‘erasure of autistic and other neurodivergent and trans people’. Autistic trans activist Anafi (2023) similarly rebukes references to autism in recent anti‐GAC bills as ‘attacks’ by ‘anti‐trans extremists’, rejecting the claim that ‘autistic people are being misled and manipulated into thinking that they're trans’. Such messages of collective resistance are also relayed to wider audiences through sympathetic news articles. One story for The Hill, a popular political news outlet, reports: ‘Autistic LGBTQ people are pushing back against those invoking autism as a way to limit LGBTQ rights, calling it a misunderstanding of both communities that denies their autonomy’ (Budryk 2023). Overall, affirmation and reclamation constructs the autistic‐trans intersection in both quantitative and sociopolitical terms as representative of a distinct minority group.

This minoritising framework facilitates claims to specific forms of societal recognition for the autistic trans community. For example, a joint statement by autistic and LGBTQ activist organisations asserts that autistic trans people have ‘rights’ to ‘have respect and dignity for the gender they know themselves to be’, ‘determine their day‐to‐day expression of their gender’ and ‘make medical decisions and access affirming health care’ (Autistic Self Advocacy Network, National Center for Transgender Equality, and LGBTQ Task Force 2016). The statement challenges ‘healthcare providers or family members’ who ‘deny the validity’ of autistic trans people's identities, claiming social and medical gender affirmation as fundamental rights connected to ideals of dignity, self‐expression and autonomy. Such statements also mobilise the discourse of neurodiversity by defining autism as a valuable expression of human variation. By embracing the autistic‐trans intersection as evidence of autistic resistance to restrictive social norms, advocates challenge pathologising narratives but reinforce a fundamental connection between neuro‐ and gender divergence.

4.5. Interactive Constructions

Although our four discursive types offer a tool for conceptualising multiple constructions of the autistic‐trans intersection, they are not static and discrete. Actors across varied arenas deploy these types in response to and in combination with one another as they engage in struggles over defining and ‘treating’ autistic trans experiences. For example, the transnational ‘gender critical’ organisation Genspect combines elements of discursive types to discredit autistic trans experiences while claiming a politically neutral position. In one statement lobbying the World Health Organisation (WHO) to halt its development of guidelines for trans healthcare, Genspect (2024) criticises the guideline development group for including members who are ‘trans or gender diverse and are advocates for gender affirming care’ but no ‘detransitioner who feels they were harmed by gender affirming care’. This point echoes the accusations of repressive protection, implying that medical authorities are colluding with trans activists to knowingly promote ‘harmful’ GAC practices. Genspect also alleges that WHO's perceived support for GAC and trans people's rights to legal gender recognition fail to consider ‘preceding events’ to gender dysphoria, citing ‘higher rates of autism and other neurodevelopmental and psychiatric diagnoses’ among trans people. As in psychiatrisation, naming autism as a ‘preceding event’ encourages the inference that autism causes, and thus invalidates, gender dysphoria.

In the same text, Genspect invokes medical management's emphasis on specialised professional knowledge by discrediting the guideline development group for lacking ‘members with expertise in autism or neurodiversity’, leveraging this critique to cast doubt over the entire guidelines proposal. The statement's references to ‘neurodiversity’ and ‘trans and gender diverse individuals’ also borrow the progressive language of affirmation and reclamation, despite Genspect's designation as an anti‐LGBTQ hate group by the Southern Poverty Law Center (2024). As this example illustrates, organisations such as Genspect may use ambiguous discursive combinations to frame their opposition to trans rights and GAC in terms of apolitical concern.

5. Discussion

This study uses a critical discourse analysis (CDA) approach to examine how social actors construct the intersection of autism and trans identities across arenas of psychological research, gender‐affirming medicine, news and opinion media, state legislation, social activism and lived experience. We identified four discursive types—psychiatrisation, repressive protection, medical management and affirmation and reclamation—representing different ways of explaining and evaluating the autistic‐trans intersection. This typology captures how different professionals and publics use scientific claims as a flexible tool to negotiate social categories, define acceptable ways of being, and shape distributions of societal power.

5.1. Autism and Transness as Intersectional Constructions

Discourses surrounding the autistic‐trans intersection illustrate how constructs of gender‐ and neurodivergence are constantly reproduced and transformed in relation to one another. The discursive type of psychiatrisation posits that social and cognitive impairments cause alarming proportions of people who are ‘just’ autistic to misidentify as trans, implying that all trans individuals must be suspected as potentially autistic and thus unreliable subjects. Meanwhile, the medical management type selectively grants legitimacy to autistic trans people who can prove that their autism does not ‘influence’ their gender dysphoria. This logic reduces gender identity to a discrete, static diagnostic category rather than an intersectional, dynamic social experience. Psychiatrisation and medical management construct autism as a form of divergence that threatens normative frameworks of both cisness and transness, corroborating other arguments that gender‐ and neuro‐normativity are intertwined (Jackson‐Perry 2020; Shapira and Granek 2019).

Alternately, our analysis of repressive protection highlights how political actors strategically decompose intersecting categories of difference into a binary of dangerous others and innocent victims. Narratives of repressive protection describe ‘trans activists’ as conspiring with medical authorities to advance an ideological agenda that disproportionately harms autistic people, particularly youth. Similar to other reactionary movements targeting minoritised groups (e.g., racialised anti‐immigration movements), commentators and activists who deploy these narratives construct trans people as homogenised and exaggerated threats to justify restrictive state interventions (Amery and Mondon 2024). However, rather than directly positioning the trans ‘other’ against a generic ‘us’ (i.e., an imagined ‘normal’ citizenry), repressive protection foregrounds autistic youth as an exceptionally vulnerable population. This strategy divides autistic and trans people into two mutually exclusive categories of essentialised ‘others’, with the protection of the former obligating ‘us’ to constrain the latter.

Finally, our study demonstrates how intersections can be reconstructed as sites of affirmation and reclamation. Consistent with other works that analyse autistic trans individuals' writings (Adams 2022), autobiographical writers in our sample represent autism as a non‐pathological difference that shapes their broadly non‐conforming interactions with the social world, including gender. Some authors and activists also use claims about the commonness of trans identities among autistic people to affirm the autistic‐trans community as a quantified social group, a ‘kind of person’ (Hacking 1986) meriting collective rights and recognition. As psychiatrisation and medical management types construct autism as a form of deviance to control, claimsmakers utilising the affirmation and reclamation type positively value this challenge to normativity. This strategy not only stabilises autism and trans identities as categories of divergence but also produces an intersectional kind of ‘looping effect’ (Hacking 1986) that imbues their relationship with a personally and politically empowering meaning.

5.2. (De)Medicalisation as Discursive Tools

We conceptualise the explanations (i.e., medical vs. social) and evaluations (i.e., legitimising vs. delegitimising) applied to the autistic‐trans intersection as separate dimensions with varied implications for social practice, illuminating the complex relationships between medicalisation, demedicalisation and social control (Conrad 1992; Zola 1976). Medicalisation operates differently across the psychiatrisation and medical management types. As critical scholarship emphasises, psychiatric medicalisation often serves to undermine the reality of non‐normative experiences (Wardrope 2015), including trans identities (Schoenike 2023). Psychiatrisation accordingly presents presumed pathological deficits in autistic people's self‐understandings as explanations for their trans identities.

In other cases, medicalisation can legitimise socially contested experiences, including autism (Barker and Galardi 2015) and trans identities (Johnson 2016), within the confines of a diagnosis. Medical management constructs the autistic‐trans intersection as a genuine ‘co‐occurrence’ while confirming the medical institution's jurisdiction to treat both categories. By directing GAC providers to evaluate whether autistic trans clients meet criteria for gender dysphoria independently of their autism, this discursive type conditionally validates some autistic trans identities according to medical standards. Relatedly, proposals of more extensive assessment and treatment deliberation for autistic clients amplify the ‘slowing down’ logic that dominates the GAC field (Davis et al. 2016). Slowing delivery of GAC allows providers to increase their own confidence in the legitimacy of their clients' identities (Davis et al. 2016); medical management reasserts an intensified need for this strategy with autistic clients. Thus, medical management regulates autistic trans embodiments even outside of an exclusively psychiatric framework.

Comparing the affirmation and reclamation and repressive protection types reveals varying functions of demedicalisation discourses. The affirmation and reclamation type challenges medicalised accounts by embracing autistic trans identities as non‐pathological, intersecting forms of diversity. By asserting a natural link between neurological divergence and divergence from a socially constructed sex/gender binary, this type blends biological determinist and social constructionist frameworks in service of demedicalisation, a strategy that merits further sociological attention. Autistic trans individuals, advocacy organisations and other commentators deploying this type also emphasise autistic trans people's epistemic authority over their own experiences, challenging a paternalistic model of GAC that gives medical providers exclusive control over access to desired treatments. As in the broader neurodiversity (Chapman 2020) and trans health (Hanssmann 2023) movements, this version of demedicalisation rejects medical frameworks of autistic and trans experiences without rejecting autistic and trans individuals' choices to engage with medical resources.

In contrast, the repressive protection type contests medical authority by characterising the GAC ‘industry’ as negligent and predatory, accusing providers of subjecting autistic youth to inappropriate medical procedures. These accusations generally conflate estimates of autism among individuals who identify as trans with rates of medical transition and disregard the already‐restrictive internal regulation of GAC. Such discursive twists produce what Elster (2022) calls an ‘insidious concern’, describing how backlash against perceived threats to the dominant gender, sexual and racial order is often couched in expressions of care. Repressive protection espouses the progressive‐sounding goal of protecting vulnerable populations from an unrestrained profit‐driven medical system. In practice, anti‐trans/gender‐critical activists, conservative political organisations and right‐wing legislators alike use this discursive type to extend state control over access to GAC rather than improving the quality and inclusivity of care. This type illustrates how ‘demedicalisation’ can constitute a reorganisation of social control that expands state power, rather than empowering de/medicalised populations.

5.3. Autistic‐Trans Science and the Politics of Uncertainty

Our analysis of discourses surrounding the autistic‐trans intersection also offers insights into the politics of scientific/medical knowledge and uncertainty. In our analysis, several texts presented correlational data as scientific support for causal speculations attributing the autistic‐trans intersection to pathological deficits and/or social contagion. Some scientists have responded by discouraging uses of research on the autistic‐trans intersection to promote anti‐trans policies and sentiments (Gratton et al. 2023). However, to adequately understand and potentially address unintended applications of research findings, it is important to dissect how these applications work. We argue that the autistic‐trans intersection plays a significant discursive role in mobilisations against trans rights and healthcare because it facilitates appeals to expert uncertainty.

Research on the autistic‐trans intersection allows interested parties to foreground uncertainty in two significant ways. First, the interpretation that many young people seeking GAC may be autistic and not trans bolsters characterisations of GAC as dangerously uncertain (Wuest and Last 2024). Importantly, all medical interventions and all scientific claims involve some degree of uncertainty. Exaggerating expert uncertainty is one common strategy that political actors use to advance their interests, from industry lobbyists who seek to evade regulations by misrepresenting anthropogenic climate change as an unsettled scientific controversy (Ceccarelli 2011) to lay activists who amplify discredited research questioning vaccine safety (Goldenberg 2021). Likewise, anti‐GAC campaigns may use statistical estimates of the autistic‐trans intersection to misleadingly inflate the risk that allowing any youth to access GAC will expose them to the ‘wrong’ treatment.

Second, our analysis shows that some researchers, medical authorities and publics construct autism itself as an inherent source of uncertainty. Even when it is accepted that autism and trans identity can legitimately co‐exist, as in medical management, the presence of autism always invites greater scrutiny of an individual's stated gender experiences. Furthermore, current medical and cultural understandings that autism is not always externally obvious extend this scrutiny to all trans people. Scientific claims that trans individuals are, for example, up to six times more likely than cisgender individuals to be autistic (Warrier et al. 2020) provide a rationale for resisting the recognition of trans people in general when combined with the assumption that autism diminishes one's epistemic standing.

Despite the idealisation of quantitative research as being less susceptible to human biases than other modes of knowledge production, science is never value‐neutral (Epstein 1996). The very designation of the autistic‐trans intersection as a research problem—an uncertainty to be resolved—reflects the implicit status of non‐autistic cisgender experiences as a comparative norm (Jackson‐Perry 2020). Therefore, the politicised ‘misrepresentation’ of research on this intersection cannot be treated as separate from the site of research production, from the kinds of questions that are (not) asked and from the subjects who are (not) included.

5.4. Limitations and Future Research

Several limitations should inform interpretations of our results. We prioritised depth over breadth in our qualitative analysis by using a small, purposive textual sample. These texts do not represent every instance of relevant discourse, nor do they indicate the relative frequency of each discursive type within arenas and over time. Future studies using computational methods such as word frequency, word association and sentiment analysis could provide insights into such trends. For example, although we did not examine social media content, social media is an important site where lay actors produce and circulate claims about the autistic‐trans intersection. In fact, Warrier et al.'s (2020) study measuring autism among trans adults appeared in nearly 2000 unique posts on the platform X by the end of 2023 (Altmetric 2024). Computational analyses of such datasets could describe and quantify the discursive patterns that characterise online engagement with scientific claims about autism and trans identities.

Our sample of psychological literature included studies that made claims about the quantified relationship between autism and trans identities. However, a growing qualitative literature focuses on autistic trans people's diverse and often non‐binary understandings of gender (Voltaire et al. 2024), along with their experiences of navigating intersecting forms of stigma (Maroney and Horne 2022). Future sociological research might examine how this turn toward experiential knowledge may be reshaping psychological constructions of autistic and trans identities. Additionally, the autobiographical narratives included in our sample do not necessarily represent the perspectives of all autistic trans individuals. Further research examining how autistic trans people understand and navigate their identities should explicitly consider the diversity of this community with respect to binary and non‐binary gender identities, transition experiences, disabilities, race and ethnicity, age and other axes of difference.

Finally, our analysis focuses primarily on the US context when considering the legislative impacts of discourse surrounding the autistic‐trans intersection, and we restricted our sample to English‐language texts. However, reactionary anti‐trans movements in the United States are connected to a global rise in anti‐trans and anti‐gender politics (Amery and Mondon 2024). Discursive movements, including rights‐based and reactionary discourses, work to solidify categories of people (Towle and Morgan 2002). Because religious, political and activist organisations campaign against trans rights efforts across the world, there is a need for international analyses of how autism and disability are positioned within anti‐trans mobilisations.

6. Conclusion

Our study traces how social actors construct the autistic‐trans intersection in ways that promote divergent social practices by de/medicalising and de/legitimating differences. Some researchers, medical experts and political actors construct the intersection of autism and trans identities in ways that medicalise both categories, either as causally related psychopathologies or co‐occurring medical conditions. Meanwhile, competing social and political movements use this intersection to pursue ‘demedicalisation’ in two senses: transferring power from the medical institution to the state; and rejecting medical control over autistic and trans experiences. These contestations ultimately foreground political demands for a resolution to the uncertainties of autism and trans identities. We encourage an alternative approach that interrogates how and why certain intersections of difference become demarcated as new scientific, medical and political objects.

Author Contributions

Maddie Kerr: conceptualization (lead), data curation (lead), formal analysis (lead), funding acquisition (lead), investigation (lead), methodology (lead), project administration (equal), validation (equal), visualization (lead), writing – original draft (lead), writing – review and editing (equal). Rebecca Ewert: conceptualization (supporting), data curation (supporting), formal analysis (supporting), funding acquisition (supporting), investigation (supporting), methodology (supporting), project administration (equal), supervision (lead), validation (equal), visualization (supporting), writing – original draft (supporting), writing – review and editing (equal).

Supporting information

Supporting Information S1

Data Availability Statement

The data collected for this study come from publicly available documents included in the references list. Additional data, including coded materials and analysis protocols, are available from the corresponding author upon request.