Written by Sam Rose¹ with Melanie Heyworth
In recent years, it has become widely accepted that there is a considerable overlap between the Autistic and the LGBTIQA+ communities (Davidson & Tamas, 2016). However, a corresponding effort to support the Autistic-LGBTIQA+ community has not been forthcoming, and there is a striking lack of resource allocation, acceptance, and support for this intersectionality (George & Stokes, 2018b; Hillier et al., 2020; Strang et al., 2014, 2018; Telfer et al., 2018).
Due to stigma and discrimination perpetuated by the media, conservative views of gender and sexuality, and misunderstanding of Autistic lived experiences, Autistic-LGBTIQA+ people face multiple barriers to realising their authentic identities, including their sexual and gender identities (MacKenzie, 2018). These barriers are further increased for members of diverse ethnic and cultural backgrounds, such as First Nations peoples and migrant communities, who face racial discrimination in accessing the LGBTIQA+ community and supports (Hill et al., 2021). Despite these compounded vulnerabilities, we also know that, with adequate family, psychological and medical supports, access to peers and role models, and autonomy over decisions regarding one’s own identity, Autistic-LGBTIQA+ individuals can experience belonging and welcome, achieve resilience, optimism and wellbeing, and ultimately thrive (Gratton, 2020).
There are no inherent barriers to living authentically as Autistic-LGBTIQA+ and achieving active citizenship and happiness (Purkis & Lawson, 2021). Many members of the community at this intersection can and do live as authentic and active citizens (Sparrow, 2020), but too many others are not receiving the support that they need and deserve.
Reframing Autism is passionate about promoting authenticity, autonomy, and acceptance for all Autistics, and these values are particularly relevant to those with intersectional identities.
This position statement argues that:
Research has found that Autistic individuals are more than seven times more likely to be T/GNC than their neurotypical peers (Strang et al., 2014). In addition, up to 70% of the Autistic community have been found to identify as non-heterosexual (George & Stokes, 2018b). These statistics highlight the diversity of the Autistic community, and should serve as a reminder that an Autistic individual’s gender and sexuality should not be assumed.
Two renowned Autistic Australian advocates, Yenn Purkis (non-binary) and Wenn Lawson (trans), both describe the empowerment experienced in “coming out” and making sense of their gender identity. Purkis (2021) says:
In 2018 I came out as non-binary. I viewed this as a massive liberation and one of the most important things which had ever happened to me.
Purkis captures the life significance of coming out, and the impact of being able to express their genuine gender identity. It is positively life-changing when Autistic individuals are supported to discover and embrace their authentic gender identity and expression.
Lawson (2021) shares a similar sentiment to Purkis:
Having come to understand who I am, and where I fit, (which is with me), I am a more whole and complete person. I’m home, which I’ve never experienced before.
It is difficult to overstate the value in these experiences. Yet, many individuals are not afforded the same opportunities for self-discovery and self-expression. Assumptions that Autistics are, collectively, either asexual, hypersexual or hyposexual, combined with patronising tendencies to infantilise Autistic adults as dependent and unable to access, realise or act upon their sexual and/or gender identities reliably, problematises Autistic efforts to explore and express their identities authentically (Barnett, 2017; Lehmann & Leavey, 2017; Mackenzie, 2018).
It is imperative that all Autistic individuals are given the opportunity to experience authentic identity expression in order to feel whole, welcome, and to thrive. Authentic gender expression is extremely individualised, as is the case with expression of sexuality. LGBTIQA+ identity affirmations include:
These affirmations are valid and should be available to all. Prevention of these affirmations harms gender and sexuality acceptance, and imposes shame on the individual and their community, ultimately contributing to the isolation, stigmatisation, exclusion and mental complications associated with being Autistic and LGBTIQA+ (Brown, 2017).
Currently, there are inadequate supports for T/GNC individuals in general, Autistic-LGBTIQA+ individuals more specifically, and Autistic-T/GNC individuals in particular (Strang et al., 2018; Telfer et al., 2018; Giordano, 2020).
The mental health outcomes for Autistic-LGBTIQA+ young people are shocking.
A recent survey of LGBTIQA+ Australian youth found that one in eight neurodivergent and LGBTIQA+ young people reported a suicide attempt in the past year. More than one in three reported a suicide attempt in their lifetime. This rate is more than twice as high as LGBTIQA+ young people without a disability, and five times as high as the same age group who are neither LGBTIQA+ nor disabled (Hill et al., 2021, p.154).
In Strang et al., (2018), young T/GNC Autistics reported feeling their gender identity was denied or doubted due to their Autism diagnosis. The authors concluded, “in spite of such vivid feelings and urgency, study findings suggest that Autistic gender minority youth are at risk for being misunderstood in terms of their gender and gender needs” (Strang et al., 2018, p 4050). When this study is considered alongside the statistics on mental health, it becomes clear that knowledgeable, respectful supports are crucial since their provision will mitigate the harm caused by misunderstanding and identity neglect.
Whilst there is currently a greater focus on children and adolescent support, we also note that Autistic adults across all life stages need adequate support, particularly as our community encompasses a range of developmental trajectories that do not always align with neurotypical milestones.
We call for an articulation of the ideological agendas of agencies currently providing support to Autistic-LGBTIQA+ individuals, as well as a significant increase in the tailored services and resources provided, including specialised training for schools, families, individuals and professionals who work with individuals who may be LGBTIQA+ and Autistic.
Associate Professor Michelle Telfer (2020) recently wrote a submission into the Senate’s inquiry into media diversity and bias. In it, she criticises numerous reports published by The Australian newspaper as damaging to the T/GNC community as well as to the medical professionals working to affirm them. She states that,
the publications were consistently of a highly critical nature and were repetitious in their false, inaccurate, unfair and unbalanced information … Telfer (2020)
Telfer reports that none of the stories published by The Australian sought comment from those with lived experiences, and individuals were frequently misgendered with incorrect pronouns (Telfer, 2020). These articles set an unethical standard of behaviour and treatment towards the T/GNC community, and further marginalise, stigmatise, exclude and undermine multiply vulnerable communities, who already struggle to have their voices heard.
Autistic-LGBTIQA+ individuals are the preeminent experts in living as both Autistic and LGBTIQA+. Their expertise and their experiential knowledge should be valued and respected as indispensable and vital when we design and deliver supports to our communities. Lived experience provides deep, personal and evidence-based information on the Autistic-LGBTIQA+ community, and what it needs to achieve emancipation, citizenship and empowerment. Personal narratives “express the value of speaking their own experience, rather than having that experience represented by others” (Frank, 2009, p. 107).
There are many LGBTIQA+ Autistic advocates who share useful resources and insights regarding this intersection. Allies, professionals and anyone seeking to increase their understanding of the community should refer to Autistic-LGBTIQA+ advocates, such as (but not limited to) Wenn Lawson, Yenn Purkis, Lydia XZ Brown, Stevie Lang, Lyric Holmans, Amethyst Schaber, Emily Brooks, Maxfield Sparrow, Kris Quin, Cyree Jarelle Johnson, Aaron Ansuini, Ellen Murray, and the late Mel Baggs.
As noted above, it is well established that there is a considerable overlap between the Autistic and the LGBTIQA+ communities (George & Stokes, 2018a; Hartmann et al., 2019; Heylens et al., 2018; Hillier et al., 2020; Murphy et al., 2020; Strang et al., 2014; Warrier et al., 2020). This appendix summarises the current research focusing on this intersectionality, which forms the foundation for this position statement.
The most striking aspect of the lived reality of most Autistic-LGBTIQA+ individuals is the many gaps in and barriers to the adequate provision of supports specific to this cohort (George & Stokes, 2018a; Strang et al., 2018; Telfer et al., 2018).
The Autistic-LGBTIQA+ population is uniquely vulnerable to discrimination and susceptible to receiving inadequate support because of:
Despite these endemic and systemic challenges, there are no intrinsic barriers to the Autistic-LGBTIQA+ community living authentically and autonomously.
The conditions needed for the community to thrive include:
Autistic individuals are seven times more likely to be trans or gender nonconforming (T/GNC) than their neurotypical peers (Strang et al., 2014), and up to 70% of the Autistic community have been found to identify as non-heterosexual (George & Stokes, 2018a).
Testimonies from self-advocates provide insights into the individual lives of those living at these intersections (e.g., Ansuini, 2020; Lang, 2020; Lawson, 2021; Neurodivergent Rebel, 2020, 2021; Purkis, 2021a). Lived experience perspectives are being increasingly valued in developing appropriate person-centred health support (Fulford et al., 2013). Listening to, and indeed prioritising, the evidence of individuals who have personal lived experience and are the targets of support not only facilitates the autonomy and authenticity of the Autistic-LGBTIQA+ community, but equally gives directions to appropriate research and support options (Fulford et al., 2013). The voices of T/GNC, and non-heterosexual Autistics provide details into their subjective, dynamic, human experiences of their intersectional identities, and such voices are utilised alongside clinical and academic research throughout this appendix.
Wenn Lawson, an Autistic and trans psychologist and advocate, describes his gender identity development via a range of media including poetry, YouTube videos, blog posts and presentations. He recently posted a YouTube video describing his experience of gender dysphoria as an Autistic person (Lawson, 2021). In it, he details his journey towards gender affirmation, and the eventual empowerment of living authentically: “having come to understand who I am, and where I fit, which is with me, I am a more whole and complete person. I’m home, which I’ve never experienced before”.
Lawson emphasises the importance of being able to understand and accept one’s gender identity. A lack of self-acceptance of gender and/or sexual identity is associated with significant negative impacts on mental health (Hill et al., 2021; Telfer et al., 2018). Conversely, the experience of feeling like a “… whole and complete person” describes a kind of “gender euphoria”, a term used antithetically to the experience of “gender dysphoria”, to describe the overwhelming feeling of happiness and comfort when one’s gender is affirmed and accepted.
Gender euphoria is similarly described by Yenn Purkis, who writes regularly on their experiences as a non-binary Autistic self-advocate in their blog, and in numerous online presentations (Purkis, 2019, 2020, 2021a, 2021b). In these self-reflections, they describe the significance of “coming out” as authentically Autistic and LGBTIQA+: “in 2018 I came out as non-binary. I viewed this as a massive liberation and one of the most important things which had ever happened to me” (Purkis, 2021a). Purkis highlights the empowering significance of accepting their gender identity and embracing their gender expression. Self-acceptance has allowed them to live authentically and forgo binary gender roles that are perceived as redundant, reductive, or restrictively normative in the eyes of many Autistics.
Stevie Lang (2020), another self-advocate, posits some advantages for Autistic individuals to embrace non-traditional relationship structures, such as polyamory, asexual romantic relationships, and living separately: “the reasons for this may relate to Autistic people’s tendency to pursue authenticity at the expense of social norms, and also the fact that non-traditional relationship styles allow Autistic people to tailor a relationship to their needs, desires and capabilities”. In other words, heteronormative, cisgender social conventions can be too rigidly binary and incongruent with aspects of Autistic culture and identity.
Indeed, Autistic young people, regardless of gender identity, have been found to have a “lower gender identification and gender self-esteem than typically developing people” (Cooper et al., 2018). Such gender fluidity may be, as Aaron Ansuini (a trans Autistic advocate) suggests, due to the Autistic tendency to miss or ignore social cues that work to construct and socialise a person’s gender within a binary framework (2021). Thus, conforming to a confined, assigned and prescribed gender may feel disempowering, as gender fluid advocate Neurodivergent Rebel (aka Lyric Holmans) puts it, like wearing a piece of ill-fitting clothing. As Lang (2020) advocates, then, Autistic individuals should be encouraged to explore what works organically for Autistic neurology, rather than being constrained by mainstream narratives.
Such exploration has led to the understanding of a uniquely Autistic gender identity, “Autigender”, exclusive to the Autistic community (LGBTA Wiki). Autigender is a relatively new term used to describe an Autistic individual’s perception of their gender identity as inexplicably intertwined with, and fundamentally dependent upon, their Autistic neurology, which releases gender from any predetermined construct, even a nonbinary one (LGBT Wiki). Although the majority of Autistic individuals do not currently identify as Autigender, as the theory evolves, more Autistic individuals may choose to adopt the Autigender label which captures this intrinsic intersectionality.
Lived experience advocates note significant and systemic gaps in support options for Autistic-LGBTIQA+ individuals, and highlight the unique vulnerabilities of the population. Such experiential knowledge has been substantiated by research (Hartmann et al., 2019; Heylens et al., 2018; Hill et al., 2021; Hillier et al., 2020; Nabbijohn et al., 2019; Telfer et al., 2018; Warrier et al., 2020).
As the theory of intersectionality would suggest, Autistic-LGBTIQA+ individuals are subject to discrimination, stigmatisation and social injustice not just because they belong to a neurominority or because they belong to gender and/or sexual minority, but specifically because they belong to both simultaneously.
Hill and colleagues (2021) recently conducted the largest ever national survey on Australian LGBTQA+ youth which included responses from Autistic and neurodivergent LGBTQA+ youth. Respondents described experiences of discrimination, self-harm and suicidality, barriers to accessing gender- affirming therapies, and positive experiences, like support from family and friends.
Hill et al.’s survey showed that, with support and acceptance, instances of self-harm and suicidality reduced dramatically, and resilience was fostered (Hill et al., 2021; Smith et al., 2014). However, the survey also found that:
over half of LGBTQA+ young people (n = 339) who identified as Autistic or otherwise neurodivergent (n = 866) felt unsafe or uncomfortable in the past year in their educational setting,
one in five (n = 124) had experienced physical harassment or assault based on their sexuality or gender identity in their lifetime, and
over one in ten (n = 68) had experienced harassment or assault in the past twelve months.
Regarding self-harm and suicide attempts, one in eight (12.6%; n = 81) Autistic/neurodivergent young people reported a suicide attempt in the past year, and over one in three (35.6%; n = 229) reported a suicide attempt in their lifetime. This rate is more than twice as high as LGBTQA+ young people without a disability (15.7%; n = 498), and five times as high as the same age group who are neither LGBTQA+ or disabled (Hill et al., 2021, p. 154).
These statics, however, are correlative, not causative: Autistic-LGBTIQA+ identity doesn’t cause negative mental health. Rather, lack of access to appropriate supports and lifelong exclusion and stigmatisation, are the root causes of the increased risk of poor mental health. Mitigating this risk is thus a priority.
Gender affirmation and validation are evidenced to have positive effects on the mental health of T/GNC people (Giordano, 2020; Telfer et al., 2018). T/GNC people nevertheless are regularly addressed using incorrect pronouns and their “deadname” (an individual’s previous given name), which undermines and invalidates their authentic identity. Purkis (2021b) describes the impact of being regularly misgendered, saying “people are constantly misgendering me and calling me a ‘lady’. It is extremely frustrating and upsetting. I am proud of my non-binary identity so having people just dismissing it is very hurtful”.
It is difficult to overstate the negative impacts that denial and erasure of identity have on an individual. Hill et al., (2021) found that T/GNC Autistic and neurodivergent young people experience misgendering by family members, friends, teachers, and professionals, as well as being systemically denied access to gender-affirming hormones and surgeries, despite evidence proving their efficacy and benefits (Giordano, 2020; Telfer et al., 2018).
Inaccurate media representation exacerbates the tendency to offer what is, in effect, substandard and unacceptable care and support to Autistic-LGBTIQA+ individuals. It is unfortunate that media outlets often rely on individuals without the requisite lived or professional expertise to provide comment on the provision of care to the Autistic-LGBTIQA+ community (TARA, 2020; Telfer, 2020; Contrapoints, 2021). For example, in response to numerous “misleading” and “factually incorrect” articles written by The Australian newspaper, Dr Michelle Telfer (2020), head of the Royal Children’s Hospital Melbourne’s Gender Clinic, writes that The Australian effectively “… undermined the trust patients and families had in their treating clinicians and caused concern and trepidation for families who were yet to seek professional support and medical care. It also sought to influence political opinion and decision making at the highest levels of government”.
Uninformed, reductive stereotyping of T/GNC individuals gives voice to, and perpetuates, culturally accepted transphobia. Negative media representation maintains the existing hostile environment that prevents T/GNC people from accessing necessary medical support, especially when the specialised medical teams supporting them are publicly vilified (TARA, 2020; Telfer, 2020).
To counter these vulnerabilities, the Autistic-LGBTIQA+ community needs specific, tailored supports and accommodations (George & Stokes 2018a; Telfer et al., 2018).
As Lawson (2021) and Purkis (2021a) have described, it is empowering and liberating to be able to determine and express one’s authentic and holistic identity. Such realisation has immeasurable positive effects on self-efficacy, self-determination, self-knowledge and self-acceptance. As Jae Evergreen (2020) writes, “when I was younger I didn’t get the chance to explore my gender and sexuality. Independence really gave me the ability to explore myself without being judged, and without having to hide my feelings and my identity”.
More opportunities can and should be provided for young Autistic people to explore their gender and sexual identities (e.g., I CAN Network, 2020; Strang et al., 2020; Ward, 2020). Individuals who experience safe, accepting, non-judgemental and secure attachments with peers, family, medical professionals, and the broader community have the essential conditions to explore, develop and realise their authentic identity. Such attachments are also protective factors against the generally poor mental health and wellbeing outcomes of T/GNC, Autistic, and LGBTIQA+ youth (Telfer et al., 2018, p. 2; see also I CAN Network, 2020; Ward, 2020).
A necessary condition for any person to thrive is the ability to exercise autonomy (or self-determination), including bodily autonomy. Although current clinical guidelines for caring for T/GNC children and adolescents vary by state in Australia, many options for gender affirmation exist, including hormone replacement therapy (HRT). Often, clinical guidelines dictate, or medical professionals assert, delaying starting HRT. When decisions are made a priori and without reference to an individual’s circumstance, it is “medical gatekeeping”, and denies an individual the capacity to make their own decisions regarding treatment. While in some cases delaying HRT is indicated, since it allows for emotional maturation to occur, there is also a potential for harm:
Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications. (Telfer et al., 2018, p. 5).
It is therefore imperative that the individual is consulted with and is given autonomy over their decision-making regarding their gender transition. In cases where informed consent might be difficult to obtain, such as when an individual has a co-occurring intellectual disability, it is the responsibility of that individual’s multidisciplinary team to ensure that the individual is fully informed and their bodily autonomy preserved (Telfer et al., 2018, p. 17). In this context, we note that in the Hill et al. survey, LGBTIQA+ respondents with an intellectual disability showed similar, and sometimes higher reported mental health vulnerabilities to Autistic and neurodivergent respondents (2021, pp. 153-155).
Having access to peers and community is another important aspect of empowering Autistic-LGBTIQA+ individuals (Evergreen, 2020; Strang et al., 2020; Telfer et al., 2018; Ward, 2020). Strang and colleague’s’ study (2020) suggests that T/GNC youth are seeking connections with other gender divergent peers as well as greater exposure to role models who can support their gender journey. Peer support groups provide a space for individuals to share their experiences and explore their identities (Strang et al., 2020; Ward, 2020). The Autistic, autism and LGBTIQA+ communities have a collective responsibility to facilitate opportunities for Autistic-LGBTIQA+ people to have their identities celebrated and represented in their peer group (Ong, 2020).
The single most important step to identity emancipation is for multiply marginalised, intersectional and vulnerable voices to be sought, valued and amplified. By listening to individuals with lived experiences, a deeper and more authentic narrative can be woven into public attitudes, fostering genuine understanding and acceptance.
The mental health of Autistic-LGBTIQA+ people is unacceptably and unnecessarily poor, and the community is struggling to find supports that meet their unique needs. Promising efforts are being made to support the community through participatory research, peer support groups, and the work of clinicians and service providers who help individuals to access evidence-based treatment options with autonomy and self-determination.
With an increased general understanding of these needs, and with an emphasis on the importance of authenticity, acceptance, and autonomy, the Autistic-LGBTIQA+ community will experience welcome, belonging, and respect, all of which are cornerstones of mental health. This approach needs to be holistic and systemic, with positive roles for media, clinicians, governments, funders and communities to play (Strang et al., 2018b, 2020; Telfer, 2020; Telfer et al., 2018).
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¹Sam (they/them) is an Autistic and nonbinary advocate who works with young Autistic LGBTIQA+ people at the I CAN Network. Sam is passionate about making information around mental health and identity accessible to the wider public.
The Reframing Autism team would like to acknowledge the Traditional Owners of the lands on which we have the privilege to learn, work, and grow. Whilst we gather on many different parts of this Country, the RA team walk on the land of the Birpai, Awabakal, Wattamattagal, Whadjak, Amangu, Bunurong and Kaurna Yarta peoples.
We are committed to honouring the rich culture of the Aboriginal and Torres Strait Islander peoples of this Country, and the diversity and learning opportunities with which they provide us. We extend our gratitude and respect to all Aboriginal and Torres Strait Islander peoples, and to all Elders past, present, and emerging, for their wisdom, their resilience, and for helping this Country to heal.