New cohort study: autism significantly overrepresented among gender-diverse children — and access to care is unequal

A new cohort study published in the scientific journal Autism Research raises questions about how gender clinics deal with autistic children and adolescents. Researchers led by Erez Topaz examined the medical records of 786 transgender and gender-diverse children and adolescents aged 4 to 19, who were referred between March 2013 and May 2025 to a national referral center for gender care in Israel. The findings confirm a pattern that has been emerging in the literature for some time: autism is significantly more common in this group than in the general population, but the study goes a step further by examining what this means in practice for access to care and psychological well-being. An extensive discussion of this study, including what the figures do and do not show, can be found on genderautisme.nl.

Earlier research had already shown that autistic traits are more common among young people who present with gender dysphoria than among their peers in the general population. The new study by Topaz and colleagues adds something significant: not only does autism occur more often alongside gender diversity, but autistic young people within the gender care pathway are also treated and served differently from their non-autistic peers.

Same milestones, unequal access to care

In the study, autistic and non-autistic gender-diverse young people reached important gender-related milestones at roughly the same age, such as the point at which they first expressed their gender identity. However, this developmental similarity did not translate into equal opportunities for care. A higher socioeconomic status was associated with earlier access to the clinic only among non-autistic young people. Among autistic young people, a more favorable socioeconomic background therefore made no difference: they apparently encountered barriers that their parents’ money and education could not remove. This points more toward a structural problem in how gender clinics deal with this group than toward an individual access problem that can be solved through the right connections.

Autistic girls: less often receiving medical transition care, more psychological problems

One striking finding concerns young people who were registered female at birth and are autistic: they were significantly less likely than other groups in the cohort to begin medical transition care, while at the same time carrying a considerably heavier psychiatric burden. In other words, the very group with the most underlying psychological problems was least likely to gain access to the pathway that, according to the prevailing care model, is intended to alleviate those problems. This raises the question of whether gender dysphoria in these girls can always be viewed separately from their autism, and whether the current clinical pathway sufficiently distinguishes between the two — a criticism that opponents of the affirmative care model have been making for some time, but which is now also emerging from this kind of quantitative research.

Researchers call for autism expertise in gender clinics

The researchers themselves draw a cautious conclusion: gender clinics should integrate autism-specific expertise and improve collaboration with pediatricians, mental health professionals, and developmental specialists. This acknowledges that the current approach falls short for a group that is doubly vulnerable — both autistic and gender-diverse — but it leaves unanswered why that expertise has been lacking until now, and whether simply expanding the team is enough as long as the underlying model continues to treat referral for medical transition as an assumed endpoint. For clinics outside Israel, where autism and gender dysphoria also frequently occur together, this is a reason to look beyond the age at which a child presents and to use careful diagnostic assessment to thoroughly rule out psychiatric and developmental problems before considering a medical pathway.