Abstract Introduction Over recent years, empirical research has increasingly demonstrated an overrepresentation of gender-diverse identities among individuals with Autism Spectrum Conditions (ASC). A recent meta-analysis estimated a global prevalence of approximately 11% for co-occurrence, markedly higher than expected by chance. This intersection challenges traditional deficit-based models and supports a neurodiversity-informed framework that views both autism and gender diversity as natural expressions of human variation. Despite growing clinical encounters involving both ASC and gender incongruence, knowledge remains fragmented regarding developmental trajectories, psychosocial outcomes, and best clinical practices. Objective To integrate international evidence with local clinical experience in a Gender Diversity and Sexology Unit, examining prevalence, shared mechanisms, and implications for mental health assessment and care in individuals presenting with both ASC and gender incongruence. Methods A narrative synthesis was conducted of 36 peer-reviewed studies (2012–2024), including quantitative, qualitative, and mixed-methods research, complemented by clinical data from our Gender Diversity and Sexology Unit, which provides multidisciplinary care to adolescents and adults experiencing gender incongruence. Clinical data were retrospectively reviewed to determine the prevalence of co-occurring ASC, diagnostic pathways, and psychosocial correlates. Results Across international studies, the estimated global prevalence of ASC among gender-diverse individuals is around 11%, while data from our clinical sample showed a 13% co-occurrence, aligning closely with global findings. Autistic gender-diverse individuals demonstrated developmental profiles comparable to those of neurotypical transgender peers, with nuances including age of self-awareness of gender diversity showing delayed or more gradual social transition processes, often influenced by sensory sensitivities, anxiety, communication barriers or lack of social support Thematic analyses of clinical interviews indicated that autistic individuals tend to conceptualize gender in less socially conventional and more abstract or fluid terms. Importantly, the authenticity and stability of gender identity among autistic individuals were equivalent to those observed in non-autistic populations. Methodological limitations in the literature persist, including reliance on screening tools instead of structured diagnostic measures, small samples, and parental-report biases. Conclusions Both international and local clinical data confirm a robust and meaningful association between ASC and gender incongruence. This co-occurrence should be understood through a neurodiversity-affirmative lens, recognizing that neither condition implies pathology but reflects variation in cognition, identity, and social experience. Clinically, it underscores the need for individualized, sensory-informed, and gender-affirmative care, supported by multidisciplinary collaboration. Future research must address longitudinal outcomes, intersectional factors (e.g., sexuality, relational diversity), and the impact of minority stress across developmental stages. Disclosure No
Marques et al. (Mon,) studied this question.