Gender-affirming care for transgender autistic youth
By Emily Wampler, LISW-S, Family Therapist with the Center for Autism Spectrum Disorders at Nationwide Children’s Hospital
Research shows that autistic youth are more likely to experience gender diversity and gender dysphoria—the distress that can occur when someone’s gender identity doesn’t align with the sex they were assigned at birth.
Experts are still exploring why these identities intersect so often, but some theories point to different thinking styles, social differences, sensory sensitivities or the idea that autistic people may be less bound by societal norms and more able to express their authentic selves.
What’s clear is that transgender autistic youth face serious health disparities. According to the Trevor Project, they are at 50% greater risk of attempting suicide compared to non-autistic LGBTQ youth and have higher rates of anxiety (77%) and depression (66%).
These challenges often persist into adulthood. Nearly 70% of autistic transgender and gender-diverse adults report needing gender identity-related medical care but being unable to access it—often due to providers' lack of understanding around autism. More than 35% say they were outright refused care by a medical provider.
“Very simply put, gender-affirming care saves lives,” says Emily Wampler, family therapist at Nationwide Children’s Hospital who serves transgender and autistic adolescents. “It reduces symptoms of anxiety, symptoms of depression and suicide risk.”
Q&A with Emily Wampler
In this Q&A, Emily shares insights from her work and offers guidance for families navigating this complex and deeply personal path.
How can gender-affirming care benefit transgender autistic youth?
Autism often involves some social-emotional communication differences. When an autistic adolescent is beginning their gender journey, it can be hard for them to differentiate and articulate their different needs and understand how to communicate that with providers or family members. In my therapy practice, I work with autistic youth to support their communication and self-reflection on their gender journey. I also participate in ongoing trainings and clinical consultation to provide culturally responsive and effective care. As a gender-affirming, but non-transgender (cisgender) provider, I need to make sure that I am learning from evidence-based and best practices, as well as listening to the lived experiences of my clients and their families.
I also support youth with emotional regulation during the stress and frustrations they encounter during their gender journey. The work I do includes solution-focused therapy, cognitive behavioral therapy and trauma-informed therapy. What I enjoy about solution-focused therapy with autistic kids in particular is that it supports their growth and prioritizes acceptance of who they are. Instead of being problem-focused, it focuses on strengths and is very client-centered and client-driven.
I want to clarify that gender-affirming care is not always a medical intervention—it also includes social supports. Not everybody who is trans or gender-diverse wants a medical intervention, although medical interventions can be very helpful and reduce gender dysphoria. It is important for more people to understand how beneficial it is for transgender youth to socially transition, by using preferred pronouns and affirming their identity.
What can autistic individuals and their families expect during family therapy sessions?
In family therapy, there are times when I meet with the client only, the parent or caregiver only, and the entire family together. Parent-only therapy sessions typically support the parents’ process of understanding their child and teach them positive ways to communicate. Client-only sessions and family sessions support the client’s communication goals and help them align with their family members.
Before I even assess youth, interdisciplinary work is key. I talk to the client’s medical team, their parents and the client themselves. I ask client-centered questions like: What do you feel right now? What do you need? When did you realize you were transgender? When do you feel like things are working for you? How do you envision your future? This is where the solution-focused approach comes in.
I also talk to parents about local LGBTQ resources in their area and help them discover ways to improve their child’s positive self-image. For example, I encourage parents to get their children involved in an activity that they love, whether it’s chess club or robotics, to help build their self-confidence.
Throughout these conversations, I use the clinical guidelines outlined in the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.
How can parents support their transgender autistic kids?
Recent research shows that family support improves the outcomes for children during their gender journey, so the more parents can be accepting, socially engaged and positive with their children, the better the outcomes for those kids.
It’s important for mental health professionals to validate parents’ concerns and help them normalize and acknowledge the differences in their child’s gender expression. Family therapy can be helpful with that as an emotional processing space. There are also gender-affirming care support groups and spaces for families.
Parents may have an additional layer of challenges understanding their child’s gender expression because of their autism, so helping parents understand the ASD-associated difficulties their child might have with executive functioning and communication, and how that can impact when and how gender disclosure is given, can be helpful.
Lastly, it can be impactful and uplifting for families to advocate and gather within their local communities to support each other. In Central Ohio, we are very lucky to have the Kaleidoscope Youth Center (KYC), which is a drop-in and social space for queer youth, including transgender and gender non-conforming youth. KYC is an excellent model of what can be done in your community.
Check out Autism Speaks’ Find your Community resource to explore other community groups in your area.
How can families access gender-affirming care?
The best way to find gender-affirming care is to reach out to local LGBTQ organizations and consult their lists of local providers. Another resource that may be helpful is the Human Rights Campaign (HRC) interactive map of clinical care programs for gender-affirming care in the U.S.
Access to autism-specific mental health care and gender-affirming care varies significantly by state. Ideally, autistic transgender youth should have interdisciplinary support from gender specialists and autism specialists. However, it might be easier to find a mental health autism specialist than one who provides gender-affirming care.
Families can also request their provider has completed training on appropriate gender-affirming care. Providers should be flexible with adapting services appropriately for autistic needs and be mindful to not use stigmatizing language. Lastly, providers should also not assume or describe an autistic person’s gender identity as an “obsession,” but with an understanding of gender dysphoria.
If families and children don’t live in an area with a lot of resources and local LGBTQ-specific supports, there are some really good national resources online like the Trevor Project and TrevorSpace. There is also a Gender-Affirming Pediatric Care Toolkit published by the National LGBTQIA+ Health Education Center that families can bring to their pediatrician or medical provider. Another option is to see if you can connect with your local Human Rights Campaign (HRC) chapter to support equality and connect with others. You can also learn more about gender identity through the HRC or at Gender Spectrum.
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