An Update to Legislative Action Eroding Autistic LGBTQ+ Rights

About the Author

Jay Eveson-Egler, BA (they/them) is an Autistic self-advocate and parent. They’ve worked with neurodiversity-based organizations and individuals in a variety of age groups and stages of life. They have a depth of knowledge of LGBTQIA2S+ issues in the Autistic community. They have prior experience founding and facilitating neurodiverse peer support groups and remain active as an adviser with the Neurodiverse Students Association at Mount Holyoke.

Accurate as of 5/28/2024

Within the past two years, the LGBTQ+ community has seen a wave of legislative efforts aimed at stripping away their rights, particularly those of Transgender individuals. 2024 has been off to a rough start, with the number of bills introduced in all of 2023 nearly doubling just within the first part of the year. The LGBTQ+ community has, since late 2023, also been experiencing a great deal of anxiety as Congress threatens to bargain away LGBTQ+ rights within proposed funding bills. Many states have passed legislation limiting public accessibility, access to healthcare, and even proposed legislation that would limit access of students to their own schools. With the election approaching, however, there have seen some major moves towards progress for the LGBTQ+ community with the election approaching that give cause for cautious optimism.

All of these threats, victories, and changes hold particular relevance for the Autistic community as transgender and non-binary individuals are more likely to share Autistic traits or even to share a diagnosis. One specific study shows that as many as 1 in 4 transgender or non-binary individuals may also be Autistic. Many of the laws that have been enacted or proposed in the last 2 years have sought to strip away the Autistic LGBTQ+ person’s rights to self-determination.

Anti-Transgender Legislation in 2024

In April of 2023, the Attorney General for Missouri issued an emergency ruling limiting access to certain procedures for transgender residents. This could impact adults depending on whether or not they are Autistic or have a mental health diagnosis, such as depression or anxiety. The ruling goes so far as to state that, “It is an unfair, deceptive, fraudulent, or otherwise unlawful practice for any person or health organization to provide a covered gender transition intervention to a patient (or refer a patient for such an intervention) if the person or health organization:… Fails to ensure that the patient has received a comprehensive screening to determine whether the patient has autism.”  

In just the first few weeks of 2024, we witnessed proposed legislation in Indiana that sought to eliminate the ability of transgender people to obtain state driver’s licenses or identification cards that accurately reflected their identities, and Utah had already passed legislation prohibiting many transgender people from using restrooms in public schools that were consistent with their gender identity. A policy maker in West Virginia introduced a bill that would have allowed transgender people to be prosecuted for simply being around children by limiting their proximity to schools. That bill would have also restricted the ability of transgender students to attend school. Iowa proposed legislation to prohibit transgender prisoners from being safely housed.

In the midst of this flurry of legislation, however, there has been some significant progress towards ensuring the rights of LGBTQ+ individuals. In January, the Biden administration successfully repealed the Trump era “license-to-discriminate” HHS ruling, and in April they finalized Title IX guidance, adding protections on the basis of gender and sexual identity, as well as finalized Affordable Care Act rules mandating nondiscrimination in health care and insurance coverage for LGBTQ+ Americans. 

That isn’t to say that these victories come without their challenges. Some Republican leaders have announced intentions to sue over the Title IX changes, and some leaders, like Governor Ron Desantis, have continued to sign anti-LGBTQ+ bills into law. However these wins have thrown important hurdles at anti-transgender and anti-LGBTQ+ politicians. Because of recent federal changes, laws that have been proposed, such as those mentioned in this article, have largely been defeated, and older laws enacted within the past few years have been rendered obsolete or unenforceable in some states.

The Cass Review

During Autism Acceptance Month this year, a research review conducted by Dr. Hillary Cass for the National Health Society (NHS) took aim at gender affirming care services within the NHS system. Under the guise of providing guidance to practitioners to enhance care, the Cass Review evaluated a sample of the current literature supporting pediatric gender affirming care. The report frames its importance and relevance by citing a surge in referrals, shifting patient demographics, and the intersection of multiple factors in the care of gender diverse individuals, stressing the need for a holistic, individualized care approach. However, the report’s cautious stance on medical interventions, such as puberty blockers and hormones, as well as its criticism of the existing research quality, poses significant concerns regarding human rights and access to what has already largely been considered life-saving care. 

In the report, as well as an interview with WBUR, Dr. Hillary Cass cites autism and mental illness as reasons to be cautious of providing gender affirming care, though does not go into detail as to why. 

She calls for comprehensive assessments, which include mental health, autism, and ADHD screenings, and requests further research into this intersection, which might inadvertently endorse biases against transgender individuals. This may potentially lead to broader discrimination and reduced access to essential treatments, which are already broadly inaccessible to begin with. 

While the review emphasizes individualized care, it critiques the current affirmative models and international practices, raising concerns about medicalizing children without addressing their holistic needs or seeing them as whole individuals. This approach risks marginalizing young people who urgently require intervention and poses significant risk of reinforcing harmful narratives that invalidate their gender identities and exacerbate their mental health struggles.

Nearly 35.7% of LGBTQ+ Autistic people report being denied adequate mental health care. In a study conducted in 2022, Autistic participants reported that their experience of their own gender was often undermined or invalidated by professionals who told them that their autism didn’t allow them to have a proper understanding or to fully embody what gender or being transgender meant – effectively positioning them as unreliable narrators of their own experiences and identities. Participants in the same study reported that clinicians and medical providers often did not have intersectional knowledge, and that this often caused barriers to receiving not just adequate mental health supports, but medical supports beyond gender affirming care as well. Creating more barriers to care, particularly for individuals at the intersection of Autistic and LGBTQ+ identity, could have unthinkable consequences for the health of the broader community.

It is important to emphasize that while Dr. Hillary Cass could not provide a reasonable explanation for this intersection of identities or even give a comprehensive reason as to why it should be cause for caution in giving care, the review has the potential to have very dire consequences for individuals not just in the UK, but globally. Socially, people even here in the US are starting to see the influence such a biased review can have, and many people within this intersectional community cite fear over how this review could be leveraged within the current political environment to further restrict access to care – so much so that the Endocrine Society and the World Professional Association for Transgender Health (WPATH), as well as other organizations that broadly make up the US Medical Establishment have written responses and doubled down on their stances that gender affirming care is important and life saving.

Getting Involved

Taking action against anti-Transgender and other anti-LGBTQ+ legislation has never been more important than it is now in protecting the freedoms and rights of everyone. These laws are passed because they are believed to affect a minority of people, but the erosion of rights and freedoms always means the erosion of rights and freedoms for others. A movement that started with banning transgender athletes from sports has evolved into legislation that is now threatening the very rights Autistic people have to agency and self-determination, eroding not just the rights of the LGBTQ+ community, but the rights of Autistic and disabled people as well.

We are in an election year and the outcome of this election could determine the course for LGBTQ+ for generations to come. Now more than ever, consider reaching out to your state senator or congressional representative, getting involved with LGBTQ+ organizations, participating in local Pride, attending local protests, and voting in this year’s federal election to further prevent the erosion of LGBTQ+ rights. You can find more information on registering to vote, finding your polling place, or registering for vote-by-mail by clicking here.

If you or someone you love identifies as Autistic and Transgender, AANE offers an assortment of peer facilitated support groups and resources. You can find out more by exploring our website or contacting us either by scheduling a free call or filling out a contact us form.