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Transgender and non-binary people are up to six times more likely to have autism

AYESHA RASCOE, HOST:

People who are transgender or nonbinary are more likely to be autistic. One large study found that it's three to six times more common. Researchers are working to understand the connection and how society can be more accommodating to people who live at this intersection. Lesley McClurg from member station KQED in San Francisco has more.

LESLEY MCCLURG, BYLINE: Underneath towering oak trees, Izzy Dier closes her eyes as she leans back on a green bench in Buena Vista Park.

IZZY DIER: I'm just always really tense - a tension that never really goes away.

MCCLURG: The 23-year-old clutches her rainbow-colored purse to her chest. This is Dier's favorite spot in San Francisco. Normally, when she's walking around, she has to have on headphones.

DIER: Otherwise, my anxiety spikes, and it's just - I can't help but, like, gasp at every little thing and just, like, jitter and jolt.

MCCLURG: Dier was 3 years old when she was diagnosed with autism. Her teachers said she was impulsive and hyperactive. As a little girl, she hated sundresses and loved Hot Wheels. She says she started questioning her gender as early as 4 years old.

DIER: I think growing up, I had a hunch, always, that I was way more masculine than my other female peers.

MCCLURG: As she's gotten older, Dier has wondered if her testosterone is higher than average. Today, she identifies as genderfluid.

DIER: I always had bushy facial hair in these little spots on my chin.

LAWRENCE FUNG: Maybe there is something that is related to the biology.

MCCLURG: Dr. Lawrence Fung is a psychiatrist at Stanford University. He is studying why people who are transgender or nonbinary are also more likely to have autism. He says hormones may be a factor.

FUNG: Females on the spectrum seem to have more testosterone and masculine features on their faces. On the other hand, males on the autism spectrum - they have more feminine features.

MCCLURG: For example, clinicians have noticed that males with autism can have a high-pitched voice. Fung's research also shows that the brains of autistic men and autistic women are different. The part of the brain responsible for sensory and motor functions may hold the key to this sex difference. Eventually, neuroscience could help explain why people with autism are more likely to question their sex assigned at birth. There is a clear overlap between these groups, but a lot more research is needed to understand the roots of what could be at play. Danielle Sullivan is curious what scientists will discover about her lived experience.

DANIELLE SULLIVAN: I didn't really like being a woman. I didn't feel like a woman. I don't really feel like a man or a male either, which is why I've sort of settled in the agender bucket.

MCCLURG: Sullivan is autistic. She counsels others on the spectrum in Lafayette, Colo. She's a 37-year-old neurodiversity coach. She was diagnosed with autism five years ago. It was relieving because it explained why she'd always felt a little like an outsider.

SULLIVAN: A lot of people seemed to have, like, a handbook that I had missed somehow for, like, how to date, how to talk to people, how to dress.

MCCLURG: Today, Sullivan is comfortable in her own skin as an agender or non-binary person with autism. But growing up, it was hard.

SULLIVAN: And it felt like I was failing constantly, and, like, I just couldn't do it. And there was some kind of internal brokenness about me.

MCCLURG: She wishes society was more accepting and more accommodating to people with autism. Sullivan has two children who are both on the spectrum.

SULLIVAN: One of their, quote, unquote, "behaviors" - they're yelling. They're shaking their hands. They're rocking. It's, like, they're fine. They're happy. Leave them alone. I just wish there was less judgment around that and more curiosity and interest.

MCCLURG: She says the autistic brain is not a problem or something to be feared. In many ways, her mind is more open and less hindered by society's typical structures.

SULLIVAN: There's something about autism or about the autistic brain that, at least in many of us, makes us really question norms and, like, why norms exist and what they're for. A lot of that has encouraged me to think through like, well, where is gender sneaking in there? Where is sex in the body sneaking in there?

MCCLURG: Many experts say the psychology that Sullivan is pointing to may be driving the overlap between autism and gender identity.

ARON JANSSEN: Some of the strengths that many people with autism have is looking at systems that are done because we've done them that way forever and calling it out as BS.

MCCLURG: Dr. Aron Janssen is a psychiatrist at Northwestern University Feinberg School of Medicine.

JANSSEN: And saying, this doesn't make sense to me. This isn't my experience. And I don't have the same kind of social pressure or expectation or buy-in to those social pressures and expectations.

MCCLURG: That is definitely true for Izzy Dier, back in San Francisco, sitting at Buena Vista Park.

DIER: There's something about having a place on the spectrum and feeling othered by the world but still just being here no matter what. That really just, like, over the years kind of strengthens your skin.

MCCLURG: Dier says her greatest gifts are her uniquely wired brain and her gender fluidity. Together, they are the roots of her resilience. For NPR News, I'm Lesley McClurg in San Francisco.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Lesley McClurg