Background: Autistic people are more likely to report gender dysphoric traits, and transgender and gender-expansive individuals frequently report higher scores on self-report measures of autistic traits. Despite the clear association between autism and gender diversity, there is a dearth of qualitative research exploring the lived experiences of autistic adults.Methods: This study contributes to the evidence base by exploring the strengths and challenges of the intersectional experiences of autism and gender diversity in adulthood. Twelve transgender/gender-expansive autistic people participated in an online semi-structured interview or an open-ended survey, and reflexive thematic analysis was used to analyze the data.Results: Three main themes were identified: (1) Navigating a gender journey, (2) The impact of social context on self, and (3) Provision of health care.Conclusion: The findings highlight the importance of acknowledging the unique experiences of being both an autistic and transgender/gender-expansive person to further understand the intersection between autism and gender diversity. Community briefWhy is this an important issue?Qualitative research investigating the experiences of autistic people who identify as transgender and gender-expansive (TGE)* is limited. However, the overlap between autism and gender diversity is evident. Transgender and gender-expansive people often score higher on measures of autistic traits, and autistic people score higher on measures of gender dysphoric traits. The lack of qualitative research investigating this overlap needs to be addressed to understand how individuals navigate being an autistic transgender/gender-expansive (ATGE) adult.What was the purpose of this study?We aimed at identifying the experiences and needs of an underserved community. The questions developed for this study aimed at capturing an understanding of the intersection of autism and gender diversity in adulthood, beyond gender dysphoria.(dagger) By focusing on the needs and preferences of ATGE adults within health care, this study aimed at informing future policy, research, and clinical practice.What did the researchers do?We recruited 12 ATGE adults through social media. Participants answered questions about their experiences of being an ATGE adult through a semi-structured interview or an online open-ended survey. We then analyzed their interviews and identified patterns and themes in what they said. All the data was then combined to tell the story of this sample of ATGE adults.What were the results of the study?The adults in this study said that exploring their gender identity as an autistic person was a different journey to neurotypical cisgender people. Some described how being autistic had led them to differences in understanding gender, and many participants described how being a part of two marginalized groups led to increased discrimination and invalidation. Despite this, participants described a strong desire to be their authentic selves regardless of societal expectations. Having access to friendships with ATGE peers was useful for reducing isolation and providing a safe outlet for discussion. These friendships were essential, as many spoke about their strained relationships with familial and romantic/intimate bonds. Participants described their frustration with the health care system when working with ATGE adults and expressed their desires for good health care.What do these findings add to what was already known?The study adds to our understanding of the experiences of ATGE adults; in particular, the impact that being ATGE can have on intimate/romantic relationships. The ATGE adults also describe increased resilience against the effects of dual marginalization. Some participants also felt that their understanding of their gender identity was not impacted by being an autistic person.What are potential weaknesses in the study?A key weakness of this study was the lack of ethnic/racial diversity of the sample. The use of qualitative surveys could be considered a potential weakness. However, by offering participation through an online semi-structured interview or an online open-ended survey, this study promoted the inclusion of autistic adults in research.How will these findings help autistic adults now or in the future?Our findings show that it is important for medical providers and academics to listen to ATGE adults. Their voices should also be highlighted within academic research to further understand the overlap between autism and gender diversity. Participants said that they were happy that people were talking and willing to learn more. This helped them understand themselves more, which, in turn, can help other autistic people to understand themselves.</sec>
