Gender Identity and Gender-Related Medical Outcomes of Autistic Young Adults Who Experienced Transgender Identity as Adolescents.

Purpose: We examined gender identity and gender-affirming care outcomes of autistic transgender adolescents followed into young adulthood, as well as relationships between gender-related medical care receipt and mental health across time.

Methods: This longitudinal two-timepoint study was conducted between 2018 and 2024, with 4 years between timepoints. Twenty-seven autistic transgender youth participated, with one lost to follow-up. Measures included self-reported gender, interest in and receipt of gender-related medical care, LGBT-related stigma (via the LGBT Stigma Scale), and anxiety and depression symptoms (via the Achenbach System of Empirically Based Assessment). Intelligence quotients were estimated using the Wechsler Abbreviated Scale of Intelligence-2. We employed data visualization of gender and gender-related care trajectories and multiple linear regression to understand the relationships between care trajectories and mental health.

Results: Most youth remained gender-diverse at Time 2. Two of 26 identified as cisgender as young adults. Half of the sample moved toward nonbinary identities either as an additional component to a binary identity (e.g., transgender nonbinary woman) or shifted from a binary identity to a nonbinary identity. For those who wanted gender-related care, earlier care receipt was associated with a significant reduction in anxiety across time. Care timing was not significantly related to changes in depression across time.

Conclusion: A majority of autistic gender-diverse youth (24/26; 92.3%) remained gender diverse into young adulthood. Unlike previous studies of autistic youth entering adulthood, which report worsening mental health, participants showed reductions in anxiety across time. Earlier receipt of gender-related care was associated with fewer anxiety symptoms at Time 2.