Cambridge, UK. A new study found for the first time that previously diagnosed female-to-male transsexual people have a higher than average number of autistic traits, as measured by the Autism Spectrum Quotient (AQ) scores taken from interviews with the study participants.

The claim has important implications for the clinical management of men born transsexual with, as the authors characterize it, gender incongruence that persists into adulthood, and for the extreme male brain theory of autism.


The extreme male brain theory suggests that females with conditions on the so-called autism spectrum have certain behavior aspects that are hyper-masculinized. Applying the theory, the researchers predicted that masculinized females with Gender Identity Disorder (GID) would have higher AQ scores.

The researchers compared AQ scores from five groups, two of which were characterized as transmen or transwomen. The "trans-" groups were recruited on the Cambridge Psychology website and at the Charing Cross Gender Identity Clinic. This was not a large-scale longitudinal study but limited to a view of conditions in a specific local area and clientele.

Participation

Professor Simon Baron-Cohen, Director of the Autism Research Centre at the University of Cambridge led the study with Rebecca Jones, now at the Weill Cornell Graduate School of Medical Sciences.

The research team included members who in some quarters are recognized as experts, including Professor Richard Green (transsexualism) and Dr Domenico Di Ceglie (gender incongruence in young people).

Also present is Emma Martin, a clinical psychotherapist who reports she is a post-corrected woman.

Their findings appear in the Journal of Autism and Developmental Disorders.Participant selections for the "trans-" groups were based on answers recorded on a completed online interview that included standard questions such as age and occupation, supplemented by whether they had received a diagnosis of an intersex, transsexual or other DSM-IV major axis condition. [Note: The revision, DSM-5, is in circulation as a draft for comment.]

Stated here using the authors' classifications, the complete participant group breakdown included:

• 61 transmen (mean age 34.0; range 19–52.7). Within this group, "10 reported having lived as their perceived gender for less than 12 months, 27 for between one and 4 years, and 24 for more than 4 years"; 48 reported testosterone usage.
  
  
• 198 transwomen (mean age 45.1; range 16–75). Within this group, "43 reported having lived as their perceived gender for less than 12 months, 94 for between one and 4 years, and 61 for more than 4 years"; 170 reported estrogen usage.
  
  
• 76 typical males;
  
  
• 98 typical females;
  
  
• In the aggregate, the 76 males and 98 females had a mean age of 37.0 (range 18.1–60.0).
  
  
• 125 individuals with Asperger Syndrome (AS), of which "110 had a diagnosis of Asperger Syndrome (AS) and 15 a diagnosis of High Functioning Autism (HFA). The data from 69 males and 56 females shiwed a mean age of 37.6 (range 17.6–71.1).

They found transmen had a higher average AQ than typical females, typical males and transwomen, but lower than individuals with AS.

Simon Baron-Cohen interpreted the results as saying that

"Girls with a higher than average number level of autistic traits tend to have male-typical interests, showing a preference for systems over emotions. They prefer not to socialise with typical girls because they have different interests, and because typical girls on average have more advanced social skills.

Both of these factors may lead girls with a higher number of autistic traits to socialize with boys, to believe they have a boy's mind in a girl's body, and to attribute their unhappiness to being a girl."

Rebecca Jones added

"If such girls do believe they have a boy's mind in a girl's body, their higher than average number of autistic traits may also mean they hold their beliefs very strongly, and pursue them to the logical conclusion: opting for sex reassignment surgery in adulthood."

Domenico Di Ceglie, Director of Training and Research at the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust in London, commented:

"These are important findings in the field of gender incongruence, which need to be replicated. The awareness of the presence of autistic features may help these young people to explore the reasons behind their perceptions, and help them make more informed decisions about treatment."

Emma Martin, who runs a Gender Identity Support and research group in Little Downham, UK, welcomed the new findings, but added two important caveats:

"This new research reminds us that gender incongruence is incredibly complex. Every possibility should be discussed with new clients, but should not delay what can be a painfully slow process for those affected."

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