Gender Identity and Gender Dysphoria in Autism Spectrum Disorders: A Systematic Review

Abstract

Background: Autism spectrum disorders (ASD) are a set of neurodevelopmental disorders characterised by social-communication deficits and repetitive behaviours. Research on gender differences in ASD has so far been limited although, recently, there has been increased interest in exploring how ASD relates to gender identity (GI) and gender disorders, such as gender dysphoria (GD); in this sense, some studies suggest a significant correlation between ASD and GD, finding that individuals with ASD more frequently exhibit GD traits compared to the general population. This article systematically reviews the relationship between ASD and GD on adults without cognitive impairment.

Methods: The search was performed in the Web of Science (WOS) database, as well as in ScopusElsevier, PubMed, PsycInfo and Embase, with the keywords ”autism” AND ”gender”, “autism disorder” AND “gender”, “ASD” AND “gender”, limiting it by title and published since 2013, after the publication of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition).

Results: The screening process shows a low number of papers (12 articles) with diverse research methodologies and mostly small and convenience samples, composed of individuals from Western societies with a medium-high sociocultural background; four of them have focused on GD, four have studied GI, four both of them. The results indicate a relationship about ASD and diversity of GI, as well as a certain positive correlation between ASD and GD. Some studies also found influence of ASD on sexual orientation and on libido.

Conclusions: It is suggested that ASD may influence GI formation and that may have some influence on GD. The importance of recognising diversity in GI in individuals with ASD, is emphasised for a better clinical support. This review highlights the need for further research with larger samples and more representative samples, including more gender-balanced samples, as most of the reviewed studies focused on males.

The registration number in the International Prospective Register of Systematic Reviews PROSPERO is CRD42024360335.