About the Author
Meredith Maroney, PhD (she/her/hers) is an Assistant Professor of Counselling Psychology at the University of Calgary, and will be moving to the University of Massachusetts Boston beginning in September 2023. She is a Licensed Psychologist in New York and Alberta. Dr. Maroney directs the Double Rainbow Lab, which is focused on LGBTQ mental health and the intersection of autism and LGBTQ+ identities. She is passionate about conducting social justice-oriented research in partnership with communities and individuals with lived experience.
As I write this post, the Trans Legislation Tracker reports that in 2023 there have been 549 anti-trans bills, 23 national anti-trans bills, with 71 anti-trans bills that have passed (see https://translegislation.com/). These bills are far-reaching and are aiming to block access to public spaces like bathrooms, sports, visibility in public schools, and restrict health care. These bills are devastating for transgender, nonbinary, and gender diverse (TNG) people and their families (see Abreu et al., 2020), and disproportionately impact those with intersectional oppressed identities, such as race, class, disability. TNG people are more likely to be Autistic (Warrier et al., 2020), and Autistic TNG people have been particularly targeted with harmful rhetoric surrounding gender affirming care (ASAN, 2020).
Autistic TNG people may choose to pursue gender affirming medical care, which can include puberty blockers, hormone therapy, or surgery that allows them to live more authentically as themselves (Boyle, 2022). This may also include counseling and support, but does not include attempts to change a person’s transgender identity (APA, 2021). In general, there are many barriers to accessing gender affirming care for TNG people, including financial barriers, geographic distance, and lack of integration across specialities (Puckett et al., 2018). Autistic TNG people may experience these barriers, along with specific barriers related to their autism and stigma about Autistic people. For instance, Autistic TNG people may be denied the right to explore options for gender affirmation or may feel like they have to choose between either mental health care or gender affirming care (Rodriguez, 2022)
In fact, in studies focused on the experience of Autistic TNG people, participants have reported feeling as if they were denied gender affirming care because of their autism (Coleman-Smith et al., 2020), and have had their gender identity invalidated or questioned because of an autism diagnosis (Maroney & Horne, 2022; Strang et al., 2018). This was also the case for a participant in a study I conducted where they shared: “People would cut me off, ‘oh because of your autism [your gender identity is] all in your head you need to let it go” (Maroney & Horne, 2022). Limited provider knowledge and training about how to best support Autistic TNG people, and a lack of awareness of one’s internalized biases, are both areas that can largely impact how providers respond to requests for gender affirming care.
Autistic TNG people report feeling frustrated with the many barriers they face when accessing gender affirming care, like coordinating with professionals across systems (Cooper et al., 2022). Once connected with gender affirming care providers, Autistic TNG people may experience differences in communication, which can complicate the interaction and cause additional stress. A youth participant in one study reported that although they made an effort to communicate in the provider’s preferred communication style, they felt that the clinician did not accommodate them (Cooper et al., 2022).
In a recent review of the challenges and recommendations for health care providers serving Autistic TNG people, authors discussed the importance of adapting their approach to ensure clients understand and can communicate in a manner that works for them (Gagnon et al., 2023). This might include written communication over verbal, building in time for Autistic TNG people to process what has been shared with them, and asking Autistic TNG people in advance how they would like to approach conversations focused on their healthcare. In work that I have done, participants have shared that providers should be sure they are using the correct language (e.g., participant’s pronouns, name, labels) and take steps to educate themselves on areas they are less familiar with (Maroney & Horne, 2022).
The landscape of anti-trans bills and gender affirming care is changing rapidly and can be confusing and scary for clients and providers. Providers can use their privilege to support Autistic TNG people in navigating oppressive systems and misinformation. It is important to connect with trusted organizations to seek out trainings and supports and to determine how to approach restrictions as a licensed provider, as they will vary by state. Organizations that center Autistic voices and needs, have clearly condemned these bills and are working to organize advocacy efforts (ASAN, 2023; McCabe, 2023).
In addition to creating a space for Autistic TNG people to safely explore their identities without fear of judgment or being dismissed, providers can also support Autistic TNG people and their families in navigating these barriers, and partner with organizers to advocate for human rights and access to healthcare. Providers can play an important role by challenging anti-LGBTQ rhetoric and amplifying messages of support and resistance. I came across these wonderful resources yesterday through a professional listserv (created by Dr. Glenda Russell and members of the Out Boulder County’s Advocacy and Public Policy Committee) and hope you will find it helpful in your work supporting Autistic trans people: https://www.outboulder.org/blog/guest-post-hanging-posters-up-for-a-better-community.
Abreu, R. L., Sostre, J. P., Gonzalez, K. A., Lockett, G. M., Matsuno, E., & Mosley, D. V. (2022, March 24). Impact of gender-affirming care bans on transgender and gender diverse youth: Parental figures’ perspective. Journal of Family Psychology. Advance online publication. http://dx.doi.org/10.1037/fam0000987
American Psychological Association. (2021). APA resolution on gender identity change efforts. Retrieved from https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf
Autistic Self Advocacy Network (ASAN). (2023, March). ASAN condemns restrictions on gender-affirming care. ASAN. Retrieved from https://autisticadvocacy.org/2023/03/asan-condemns-restrictions-on-gender-affirming-care/Boyle, P. (2022, April). What is gender-affirming care? Your questions answered. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered
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