Transgender and gender-diverse (TGD) individuals demonstrate higher autism prevalence compared with cis-gender peers, yet face delayed diagnosis due to masking, assessment bias, and attribution of traits to minority stress. Autism assessment practices historically center cisgender white male presentations, creating systematic barriers for TGD individuals with more subtle presentations. This review examines the assessment and treatment of autistic TGD individuals without intellectual disability from a neurodiversity-affirming perspective. We synthesize current evidence and offer recommendations for selecting autism screening and diagnostic tools, conducting a clinical assessment of autism, counseling and providing psychoeducation about autism, weighing the risks and benefits of having a formal diagnosis, and adapting psychotherapeutic and psychopharmacologic interventions. A neurodiversity-affirming approach values the diversity of human minds, centers lived experience, supports authentic expression, prioritizes self-understanding, addresses co-occurring conditions, and advocates for necessary supports and accommodations. Clinicians should recognize that autism and gender diversity frequently co-exist, requiring specialized, affirming care approaches.
Zhou et al. (Mon,) studied this question.
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