(124) GENDER EXPRESSION AND GENDER AFFIRMATION PROCESS IN INDIVIDUALS WITH SUSPECTED ASD: A CASE REPORT
Authors: Santos LA , Tavares R , Dornelas B 
Published: December 2024

Abstract

Introduction
Gender incongruence (GI) arises when an individual’s reported and experienced gender diverges from their assigned biological sex, potentially leading to gender dysphoria (GD) when it induces significant distress. Individuals with Autism Spectrum Disorder (ASD) frequently encounter challenges in socio-communicative skills, which can influence their expression of gender identity. Recent studies suggest a increased prevalence of GI/GD among individuals with ASD or autistic traits compared to the general population. The higher prevalence is believed to stem from difficulties in articulating internal mental states. Supportive strategies can be executed to better address the specific needs of individuals with ASD grappling with gender identity issues.

Objective
To delineate the challenges and support strategies employed during the gender affirmation process experienced by a transgender woman with suspected ASD.

Methods
A case report detailing the gender affirmation process of a transgender woman, potentially with ASD, receiving care at a sexual health outpatient clinic in northeastern Brazil.

Results
The patient, a 20-year-old biologically male individual, identified as female and expressed a keen interest in gender transition. Over the course of eight years, she received psychiatric care due to psychotic episodes and a clinical suspicion of ASD. Notably, she displayed introspection, social anxiety, concrete thinking patterns, and difficulties in face-to-face social interactions, along with challenges in understanding abstract concepts such as gender, love, desires and also articulating her emotions. Her identification as a woman stemmed from a preference for feminine clothing, makeup, absence of body/facial hair, and long hair. Communication-wise, she tended towards succinct responses with evident speech tension. The patient found solace in virtual platforms like forums and chats, where she openly embraced her transgender identity. Her interests in anime and video games mirrored her affinity towards characters undergoing transformative journeys, albeit with apprehension regarding societal judgment towards her feminine expression in public spaces. Suicidal ideation loomed as she contemplated potential setbacks in her gender transition. Throughout her care journey, sexual education was provided through individual and group sessions, incorporating both objective gender insights and subjective reflections. Bi-weekly individual appointments spanning a year, coupled with psychoeducation sessions involving family members, facilitated her integration of feminine elements into various settings. Progress was evident in enhanced social communication, reciprocal emotional engagement, and consistent usage of her chosen social name.

Conclusions
The case underscores the intricate interplay between ASD and gender identity, wherein individuals may encounter heightened challenges in affirming their gender. The narrative accentuates cognitive rigidity and difficulties in emotional recognition prevalent in such individuals. An empathetic approach integrating individual, familial, and group interventions, alongside tailored sexual education, proved instrumental in fostering a positive gender affirmation journey.

Disclosure
No.