Cont: Transwomen are not women - part XI

[Upchurch]

If someone is upset about deadnaming or misgendering, they are upset about a verbal act of mislabeling. Thus, they lack a casual attitude regarding labels. While they might well say "labels are silly," they are not living it.

Are you suggesting that people exist in homogenous groups where they only have one set of opinions about a topic?

 

[d4m10n]

I'm suggesting that "labels are silly" isn't nearly as applicable as you seem to think. The generation that came up with dozens of new gender identities is actually fairly obsessed with labeling.

 

[Nick Terry]

Well that's the point. If condition A is being misdiagnosed as condition B and there is a dramatic increase inthe understanding of and detection of condition A them.you should see a drop in the diagnoses of condition B.

Since autism is being understood and recognised more than ever and we are not seeing a drop in diagnoses of GD then it is extremely unlikely there was ever any significant misdiagnosis of autism as GD.

It's not an issue of misdiagnosis, it's an issue of comorbidities, which despite its grim sound is a neutral medical term for conditions that frequently accompany other conditions.

There was a steady rise in the number of children, teenagers and adults diagnosed with autism or ASD through to the 2000s. In the same era, diagnoses of gender dysphoria were extremely rare; autism was far more common, as were ADHD, depression and other conditions.

In the 2010s, there was an explosion of teenagers presenting with gender dysphoria. There was also a general degeneration in the mental health of teenagers, with higher rates of reported depression, anxiety disorders, etc.

Among the ROGD cohort of teenagers of the past 10-12 years, a very high proportion were already diagnosed with ASD.

The number of children and teenagers identifying as trans is not easily established, but it appears to be on average lower than the number diagnosed with ASD. However, there are clusters of trans identifications in peer groups, specific schools, rather than a truly even distribution as one might expect with something rooted in neurology or fundamental personality. Social approval/disapproval might explain some of that, but there is much evidence to suggest there is a social contagion element, as with anorexia, which should not be difficult to accept, since anorexia and gender dysphoria both involve discomforts with one's physical body.

Moreover, the ROGD cohort follows a short-lived pro-ana (pro-anorexia) scene on Tumblr a decade or so ago, this was fairly rapidly shut down, whereas trans identities and the gender umbrella were celebrated and encouraged.

Since boys are overrepresented among ASD diagnoses, it's truly concerning when girls are now the majority of gender dysphoria referrals, yet the proportion of trans teenagers who *also* have ASD is very disproportionate to their share of the population. IIRC in one of the Tavistock GIDS chorts - not all patients, but in a year or two during the rise - it was as high as 28%, versus 2.3% for the US youth population as a whole around the same time in the 2010s.

In other words, trans-identifying British teenagers in one cohort were well over 10 times more likely to have been diagnosed with ASD than the average teenager, but if one factors in the male disproportion of ASD diagnoses, then this could be 40 times more likely for teenage girls identifying as trans boys t be autistic than the average for all teenage girls.

Trans-identifying teenagers are most likely to be same-sex attracted, very likely to be neurodivergent and very likely to have other mental health conditions. Disentangling chicken and egg with these children - working out if they were already depressed/anxious and then seized on gender identity as a way out, or if distress over their gender dysphoria made them depressed or anxious - is evidently not very simple.

That is the take-home lesson from the Tavistock GIDS centre in London, as discussed by Hannah Barnes in Time to Think and as confirmed in multiple whistleblowing cases, lawsuits, and the Cass Review, here in the UK.

The UK's national health service rations healthcare while making much of it free, versus the US system being a combination of Medicare and private healthcare. Whether in a rationing-based or market-driven healthcare system, there will be immense pressure to reduce the amount of time needed to deal with a patient. It is much, much easier for doctors to prescribe SSRIs and other drugs than organise talk therapy; it is also much, much easier to affirm a patient's gender dysphoria and start prescribing puberty blockers then hormones. It is obviously much more expensive to carry out extended therapy to work through multiple comorbidities.

The fact that there are now 100 gender clinics in the US makes this big business within healthcare. Some of that is certainly down to increased genuine demand, but it's only two decades since Oxycontin and other painkillers were over-prescribed by US doctors, kickstarting the opioids epidemic. It would be extremely arrogant to think that medicine and psychiatry, which have screwed up repeatedly in our lifetimes, got this one entirely right when they've messed up spectacularly in the past 25 years.

Overly rapid gender affirmation and medicalisation has not been happening on quite that scale, where entire high school/college football teams were decimated by overdoses within 5-10 years, but enough that there is now caution in northwest Europe (England, Sweden, Finland and potentially Norway) and a wave of bills in red states in the US, attempting to ban outright any form of gender identity medicine for children and teenagers.

As d4m10n said up-thread, political polarisation in the US is making all of this worse, because red states want to ban teenage transgender medicine while blue states set themselves up as trans sanctuaries and aim to ban 'conversion therapy'.

Neither model is the one now being proposed in northwest Europe and Scandinavia, despite some of the countries having permitted youth transition for as long, or even longer, than the US, like Sweden. There is a trend to restrict drugs and surgery for under-18s among medical professionals and health services in Europe, which means self-regulation, rather than allowing politicians to intervene with legislation and bans.

The chief reason for caution is the extremely low quality of research monitoring what amounts to a realtime experiment over the past decade on a distinctive cohort of teenagers with gender dysphoria, some of whom are now seriously regretting opting for medicalised transition, others of whom are displaying the negative side effects of the drugs and surgery.

It's quite likely that trans identification will start to fall somewhat, as teenagers learn and realise just what the side effects and consequences are. Hannah Barnes' book on Tavistock was a history, and there were many reports of families and children even as recently as 5-7 years ago not being aware of the possibilities - of the availability of puberty blockers or what their side effects might be. Many detransitioners feel they were not properly informed of them, or that they were too young to properly understand what they might be.

And indeed, Jazz Jennings, who was the literal poster child for trans kids over the past decade, is now extremely unhappy with the results of surgery.

 

[Robin]

It's not an issue of misdiagnosis, it's an issue of comorbidities

Co morbidities are not a problem per se, they are a feature of all diagnoses throughout medicine

If they are not leading to misdiagnoses then what exactly is the problem?

I would rather you say this concisely rather than give a long post which skirts about the issue.

 

[Nick Terry]

Co morbidities are not a problem per se, they are a feature of all diagnoses throughout medicine

If they are not leading to misdiagnoses then what exactly is the problem?

I would rather you say this concisely rather than give a long post which skirts about the issue.

Hardly skirting around the issue, when the point is you are wrong to think in either/or terms about diagnoses of ASD and gender dysphoria. There are overlaps.

1. Diagnoses of ASD are more common and have been well before the explosion in gender dysphoria among teenagers in the 2010s
2. Teenagers presenting with gender dysphoria typically have many comorbidities around social/family situations, mental health and neurodivergence
3. A high proportion of teenagers presenting with gender dysphoria are already diagnosed as autistic; others might be later diagnosed with ASD

There are many reasons to be extremely concerned at the more-than-exponential growth in teenage gender dysphoria referrals to clinics around the western world which took off after the early 2010s.

One of those reasons for concern is that teenagers with ASD have a tendency to rigid or black and white thinking, can be perseverative and tend towards obsessions, and can mistake their discomfort with social interactions for other things, bearing in mind all of these issues are changing with puberty and with the differing development rates expected with ASD diagnoses - it is after all a spectrum not an either/or condition. Therefore, if a teenager presents with gender dysphoria, and also has ASD, or indeed if they even show signs of it when meeting with a clinician, the risk of gender dysphoria being a misdiagnosis is significantly increased.

Over the next 5-10 years, we'll probably have a lot more data from, hopefully, monitoring or following up with the 2010s ROGD cohort, to see whether the anecdotes and reports from families, detransitioners and clinicians add up to any specific patterns. It could be that a properly constructed survey of detransitioners finds above-average numbers with ASD compared to a parallel survey of gender dysphoria referral cases, a before/after study as it were. In which case the gut feeling voiced by many clinicians at the Tavistock GIDS centre based on years of experience and hundreds of cases they dealt with individually, that ASD can mislead teenagers into thinking wrongly that they're really trans, would be confirmed.

The fact that there are more detransitioners than was claimed some years ago, the fact that detransition was being more or less denied by the spokespeople for trans lobbies and clinics, the fact that clinics don't actually follow up and monitor all of their cases, not least because of youth vs adult service swap-overs at 18, means there are clearly at least some misdiagnoses of gender dysphoria. Therefore, simply taking a child or teenager's word for it that they are trans, is bad medical practice.

This is why northwestern Europe is backing away from the uncritical affirmation of gender dysphoric teenagers. Half of the US will look out of step with the other half, as well as an increasing proportion of the western world, regarding gender identity medicine for teenagers.

One of the reasons why northwestern Europe has backed away is noting the above-average number of ASD diagnoses among gender dysphoric youth.

 

[Nick Terry]

^
Just to add: one of the things I most admire in Hannah Barnes' book Time to Think is she is unafraid to say 'we don't know' or 'we don't know the exact data', because the data is not really being properly gathered. The data exists in multiple snapshots, smaller research projects on year cohorts or the past few years before the Cass Review. Some of the record keeping was bad enough to make a systematic case review harder than it should be.

The patterns and trends are clear enough to say there are correlations, e.g. between gender dysphoria referrals and ASD diagnoses, but not clear enough to know whether they are causations. There are many comorbidities which might as well be chicken-and-egg, as one can argue either way which came first or which conditioned what.

 

[Nick Terry]

A quote from Norway's evidence review concerning youth gender dysphoria, in turn relying on research in Sweden:

“The suicide risk was significantly higher than in the general population, but at the same level as the suicide risk in common mental disorders such as depression, bipolar disorder and autism. Since these mental disorders are so common among people with gender incongruity, it is not possible to determine whether the increased suicide risk is due to gender incongruity itself or is a consequence of mental disorders. There are also no studies that provide evidence that the risk of suicide is reduced as a result of gender-affirming treatment, or that the risk of suicide increases if gender-affirming treatment is not given.”

translation from p.28 of the PDF downloadable at the bottom of this page:
https://ukom.no/rapporter/pasientsikkerhet-for-barn-og-unge-med-kjonnsinkongruens/sammendrag

“Selvmordsrisikoen var betydelig høyere enn i den generelle befolkningen, men på samme nivå som selvmordsrisikoen ved vanlige psykiske lidelser som depresjon, bipolar lidelse og autisme. Siden disse psykiske lidelsene er så vanlige blant personer med kjønnsinkongruens, er det ikke mulig å avgjøre om den økte selvmordsrisikoen skyldes kjønnsinkongruens i seg selv eller er en konsekvens av psykiske lidelser. Det finnes heller ikke studier som gir belegg for at selvmordsrisikoen reduseres som følge av kjønnsbekreftende behandling, eller at selvmordsrisikoen øker hvis kjønnsbekreftende behandling ikke gis”.

 

[Brainster]

At the rate things are going, there will be some states in which there is almost no serious medical or psychological evaluation prior to the puberty blockers / cross-sex hormone pathway and some other states where even the most consistently dysphoric youth cannot access any gender-affirming care. Federalism plus political polarization is going to bless us with the both of worst possible outcomes.

The laboratories of the states in action.

 

[Robin]

If someone is upset about deadnaming or misgendering, they are upset about a verbal act of mislabeling. Thus, they lack a casual attitude regarding labels. While they might well say "labels are silly," they are not living it.

Hard to say without an example of someone saying both things.

I think labels are rather approximate things, but then I will answer to "Hi!" or any loud cry.

 

[Robin]

Hardly skirting around the issue, when the point is you are wrong to think in either/or terms about diagnoses of ASD and gender dysphoria. There are overlaps.

Of course there are overlaps. I already said that. Overlaps aren't a problem per se.

We have already established that the problem is not misdiagnoses.

What is the actual problem?

One of those reasons for concern is that teenagers with ASD have a tendency to rigid or black and white thinking

Not so, being on the spectrum sometimes gives one a rather literal interpretation of things and also there can be a rigidity in thinking there is only one way to do things.

But, far from being black and white thinkers, autistic people process on a number of levels.

But the point is that autistic people today understand their own condition better than ever and know exactly the source of their discomfort with social situations.

So if people on the spectrum mistook their discomfort in social situations for something else in the past, there should be a dramatic decrease in that happening today.

 

[Robin]

Incidentally any psychologist who refers to being on the spectrum as a disorder without qualifying that is certainly not worth listening to.

The DSM-5 may be lagging on this, but that's no excuse for researchers to lag.

 

[Samson]

Could Ritalin be to blame for dysphoria?
Serious question after talking to friend with gay/transgender? son.

https://lgbt.foundation/news/viewpoint-the-pill-that-turned-me-gay/152

 

[Matthew Best]

Of course there are overlaps. I already said that. Overlaps aren't a problem per se.

We have already established that the problem is not misdiagnoses.

No, we haven't.

 

[Robin]

No, we haven't.

I was talking to NicK Terry who said that the problem is not misdiagnosis due to autism.

You can make a separate argument that people with autism are being misdiagnosed with GD, however you would have to explain why GD diagnoses are not falling with the increased awareness of autism and the almost disappearance of stigma around it.

 

[Nick Terry]

I was talking to NicK Terry who said that the problem is not misdiagnosis due to autism.

You can make a separate argument that people with autism are being misdiagnosed with GD, however you would have to explain why GD diagnoses are not falling with the increased awareness of autism and the almost disappearance of stigma around it.

Neither the numbers not the chronology add up for the bolded part to make any sense.

Autism diagnoses are much more numerous, and the rise in these diagnoses preceded the rise in diagnoses of gender dysphoria.

Autism is still diagnosed significantly more frequently than gender dysphoria, so even if there is a disproportionate number of GD diagnoses who have also been diagnosed with ASD, this means only a small proportion of autism diagnoses overlap with gender dysphoria. That much should be statistical common sense.

Since children and teenagers can be diagnosed with both autism and gender dysphoria, this also isn't an either/or situation.

A survey of subscribers to Autism Parenting Magazine found 5.7% of autistic children were gender diverse, many non-binary - so not the same cohort that actually is referred to gender clinics.
https://www.autismparentingmagazine.com/autistic-children-gender-identity/

There's clearly no either/or situation here; the diagnoses sit alongside each other in such cases.

Moreover, despite the significant disproportion of ASD diagnoses among teenagers presenting with gender dysphoria, they are still a minority within the overall GD cohort, despite the well-proven overlap.

 

[Nick Terry]

Of course there are overlaps. I already said that. Overlaps aren't a problem per se.

We have already established that the problem is not misdiagnoses.

What is the actual problem?

Not so, being on the spectrum sometimes gives one a rather literal interpretation of things and also there can be a rigidity in thinking there is only one way to do things.

But, far from being black and white thinkers, autistic people process on a number of levels.

But the point is that autistic people today understand their own condition better than ever and know exactly the source of their discomfort with social situations.

So if people on the spectrum mistook their discomfort in social situations for something else in the past, there should be a dramatic decrease in that happening today.

From a not untypical piece about the connection - similar comments have been made repeatedly in the literature, from all perspectives; these are the most frequently-advanced hypotheses:

Several hypotheses have been proposed to causally link autism to gender dysphoria, but there is no consensus regarding a clear link or a reason for a link.

Let’s look at some of these hypotheses:

1. According to the extreme male brain theory, women are wired to think in more empathetic terms; whereas, men are more systematic in their thinking. According to this hypothesis, high levels of testosterone (a male hormone) in the womb results in an extreme male brain or male pattern of thought, which leads to both autism and gender dysphoria. This hypothesis only potentially applies to females who develop ASD and gender dysphoria.
2. Difficulty with social interactions has also been used to explain the development of gender dysphoria in children with autism. For instance, a boy with autism who is bullied by other boys might come to dislike other boys and identify with girls.
3. People with autism have difficulty communicating with others. This deficit may contribute to others missing social cues about assigned gender which might increase the chance of developing gender dysphoria. In other words, because other people don’t pick up on cues of a child’s assigned gender, then the child isn’t treated in a fashion concordant with this assigned sex and may, therefore, be more likely to go on to develop gender dysphoria.
4. Gender dysphoria could be a manifestation of autism, and autistic-like traits could drive gender dysphoria. For instance, a child with a male-assigned gender and autism may become preoccupied with female clothes, toys, and activities. In fact, this apparent gender dysphoria may not be gender dysphoria at all but rather OCD.
5. Children with autism can demonstrate rigidity with respect to gender differences. They may have a hard time reconciling the difference between their assigned and experienced or desired gender. This increase in distress could possibly exacerbate gender dysphoria and make it harder for them to manage these feelings.
6. Confusion in the development of gender identity or an altered pattern of gender identity development might contribute to gender dysphoria in children who have ASD.
7. Deficits in imagination and empathy, which are common in people with autism, may make it hard for people with autism to recognize that they belong to a certain gender group.

https://www.verywellhealth.com/gender-dysphoria-and-autism-4134405

The piece (updated in December 2021) recommends that children with autism who express gender dysphoria be treated both by gender clinicians and autism specialists.

Several of the points above hint at ways that autism spectrum behaviours could be mistaken for 'true' gender dysphoria, others suggest an overlap where the gender dysphoria is true.

One additional possible factor with girls experiencing gender dysphoria is the correlation between autism and PCOS (Poly Cystic Ovarian Syndrome), which produces above-average levels of testosterone in PCOS sufferers.
Noted here and here:
https://www.bayswatersupport.org.uk/gender-issues-for-autistic-girls/
https://www.psychreg.org/mainstream-media-talk-about-detransitioners/

 

[Robin]

Several of the points above hint at ways that autism spectrum behaviours could be mistaken for 'true' gender dysphoria, others suggest an overlap where the gender dysphoria is true.

Earlier you were saying it is not an issue of misdiagnosis, now you are saying it is an issue of misdiagnosis. Which is it?

Again you are avoiding the point I was making. Over the past 20 years there has a significant increase in understanding of autism and how to treat it. There has been a significant decrease in the stigma associated and importantly kids on the spectrum today mostly understand their condition and the reasons for their social disconnect. The average autistic 12 year old today probably understands autism a lot better than you do.

So if it was ever true that autism spectrum behaviours were mistaken for gender dysphoria then we would expect to see a significant drop in gender dysphoria diagnoses over the past 20 years.

If we do not see a significant drop in gender dysphoria diagnose over the past 20 years then it is extremely unlikely that there was any significant number of cases where autism spectrum behaviours were mistaken for gender dysphoria.

 

[Robin]

Neither the numbers not the chronology add up for the bolded part to make any sense.

Your opinion noted, for what it's worth.

Autism diagnoses are much more numerous, and the rise in these diagnoses preceded the rise in diagnoses of gender dysphoria.

Autism is still diagnosed significantly more frequently than gender dysphoria, so even if there is a disproportionate number of GD diagnoses who have also been diagnosed with ASD, this means only a small proportion of autism diagnoses overlap with gender dysphoria. That much should be statistical common sense.

Since children and teenagers can be diagnosed with both autism and gender dysphoria, this also isn't an either/or situation.

A survey of subscribers to Autism Parenting Magazine found 5.7% of autistic children were gender diverse, many non-binary - so not the same cohort that actually is referred to gender clinics.
https://www.autismparentingmagazine.com/autistic-children-gender-identity/

There's clearly no either/or situation here; the diagnoses sit alongside each other in such cases.

Moreover, despite the significant disproportion of ASD diagnoses among teenagers presenting with gender dysphoria, they are still a minority within the overall GD cohort, despite the well-proven overlap.

Again you are not paying attention to what I am saying, in fact you are confirming what I am saying.

I am saying that the increase in diagnosis of gender dysphoria cannot be due to mistaking symptoms for GD. Such mistakes, if they ever occurred, would have been all but wiped out by now.

You repeating over and over again that there is an overlap between autism and GD because I have stated again and again that I already know that. Please stop pretending I didn't say that and try to focus on the argument I am actually making.

I am not repeat not, denying that there is any causal connection between the increase in GD diagnoses and the increase in spectrum diagnoses. I am just saying that it cannot be due to mistaking autism symptoms for GD symptoms.

 

[Elaedith]

Earlier you were saying it is not an issue of misdiagnosis, now you are saying it is an issue of misdiagnosis. Which is it?

Again you are avoiding the point I was making. Over the past 20 years there has a significant increase in understanding of autism and how to treat it. There has been a significant decrease in the stigma associated and importantly kids on the spectrum today mostly understand their condition and the reasons for their social disconnect. The average autistic 12 year old today probably understands autism a lot better than you do.

So if it was ever true that autism spectrum behaviours were mistaken for gender dysphoria then we would expect to see a significant drop in gender dysphoria diagnoses over the past 20 years.

If we do not see a significant drop in gender dysphoria diagnose over the past 20 years then it is extremely unlikely that there was any significant number of cases where autism spectrum behaviours were mistaken for gender dysphoria.

What you are saying doesn't make sense. You are implying that if people understand and recognise symptoms of autistic spectrum conditions, that will lead to them not being misdiagnosed as gender dysphoria. It doesn't follow. Clinicians can recognise autistic symptoms and still misdiagnose somebody with GD or label them as being transgender, because they are pressured to affirm whatever a child or adolescent states about their gender identity, and to adopt the ideological position that terms such as 'girl' and 'boy' refer to identification with a gender rather than to sex. For example if they tell a male child that being a boy just means he is male, but boys can have any personality, interests, gender expression, preferences etc (what was previously meant by accepting gender non-conforming before this ideology took hold) they risk being accused of conversion therapy or transphobia for not engaging in sex denialism.

Nor will understanding one's own autistic spectrum condition lead to not self-identifying as trans, if being gender non-conforming correlates with autistic traits and society promotes the idea that being GNC means being trans. People latch on to whatever idea is socially promoted to explain feelings of being different.

 

[Nick Terry]

Earlier you were saying it is not an issue of misdiagnosis, now you are saying it is an issue of misdiagnosis. Which is it?

It's an issue of treatment first and foremost. If gender clinicians don't pay attention to comorbidities and over-rapidly affirm a child's gender identification, then they risk prescribing treatments which will not in the medium and long run actually help. That is why the article I linked to above recommended that both gender and autism specialists be involved in any cases where the two conditions overlap.

If a child is autistic, then there are several ways in which they might latch onto the notion of being born in the wrong body or feeling different, because they already feel different, or come to see gender identity as a solution to other problems. Some might find easier social acceptance and overcome social awkwardness that way by joining a ready made identity community. In some cases this would be the wrong path to take, in others it won't be. The accounts of detransitioners and desisters (as well as ther families) echo this repeatedly.

Again you are avoiding the point I was making. Over the past 20 years there has a significant increase in understanding of autism and how to treat it.

A decade of which precedes the upsurge in gender dysphoria referrals. Autism diagnoses were already reaching 1% by the end of the 2000s in many countries/regions, at a time when there were still negligible numbers of gender dysphoria cases.

There has been a significant decrease in the stigma associated and importantly kids on the spectrum today mostly understand their condition and the reasons for their social disconnect. The average autistic 12 year old today probably understands autism a lot better than you do.

So if it was ever true that autism spectrum behaviours were mistaken for gender dysphoria then we would expect to see a significant drop in gender dysphoria diagnoses over the past 20 years.

If we do not see a significant drop in gender dysphoria diagnose over the past 20 years then it is extremely unlikely that there was any significant number of cases where autism spectrum behaviours were mistaken for gender dysphoria.

Once again: the either/or in your argument here is false, because you continue to ignore the chronology and the size of the respective cohorts.

Firstly, diagnoses of gender dysphoria were extremely low as recently as 2010, but they have risen exponentially within the past 12-13 years in the 2010s and 2020s.

Gender dysphoric children and teenagers in these recent cohorts of the 2010s and 2020s are reported from multiple sources as experiencing above-average rates of:
1) social/family disruption, being in care, sexual abuse - traumatic events
2) mental health conditions - depression, anxiety, etc
3) neurodivergence - ASD but also ADHD

Gender dysphoric teenagers remain disproportionately same-sex attracted, as was the case with the previous cohort of early onset gender dysphoric children, almost all of whom desisted and grew up to be gay or lesbian.

The rise in diagnoses of gender dysphoria coincides with
1) social acceptance of trans identities
2) their celebration in schools
3) the growth in social media communities available to anyone who feels they identify as gender non-conforming, trans, etc

The rise in diagnoses of gender dysphoria also coincides with
1) worsening rates of teenage depression, anxiety and mental health conditions - a generalised teenage mental health crisis

If we're asking, what is driving the undeniable increase in gender dysphoria diagnoses, then the key factor is the availability of the idea, of the apparent solution or key that unlocks and appears to explain the distress of the teenager to the teenager in question. This is socially and culturally driven.

Moreover, the rise is mostly reflected in teenagers presenting with gender dysphoria, which breaks the previous pattern of childhood gender dysphoria manifesting itself before puberty. This is now basically inarguable, although it has been denied and obfuscated. 'Rapid Onset Gender Dysphoria' is as good a label as any, and it coincides with 1) increased availability of smartphones, 2) teenagers accessing social media both historically (after 2012) and biographically (as they reach puberty).

As we're discussing teenagers and children, then the chance that they will mistake the distress they feel experiencing puberty and the changes in their bodies, navigating adolescence, developing social skills and also exploring their sexual orientations, for something it's not, is very high. For some it really will only be 'a phase', just as early onset gender dysphoria in pre-adolescent childhood desisted to the tune of 60-80% after puberty, being also just 'a phase'. Clinicians have repeatedly stated that there is currently no diagnostic tool able to predict who among childhood or teenage gender dysphorics will identify as the opposite sex into adulthood.

Autism is just one of many confounding factors in this mix, along with same-sex attraction (sexual orientation), mental health conditions, and social/family situations.

These confounding factors are what bothered many clinicians in England's Tavistock GIDS centre, when they saw how other clinicians were not addressing the comorbidities and exploring what was causing the genuine, real, serious distress of the teenagers presenting with gender dysphoria. Which for the record boiled down to any teenager mentioning anything to do with gender or trans identity was immediately referred from regional services to GIDSs.

For a variety of reasons, some of which have been given, the precise weight of which cannot be established at this time, an above average number of autistic teenagers now identify as gender non-conforming, as of the start of the 2020s.

In 2003, this wasn't the case. Many might not have been diagnosed as autistic, but for sure there were very, very few who would have identified as trans, and none who could possibly have identified as non-binary since the identity hadn't even been invented yet.

So what has been happening is among a rising number of autism diagnoses, a subset cohort of autistic teenagers has joined in with other cohorts of teenagers to identify as trans or gender non-conforming. They do so at above average rates, and there are various explanations why this is the case.

The kicker is the flipping of sex ratios. Autism is disproportionately diagnosed among boys, to a discrepancy of 4:1 compared to girls. But gender dysphoria referrals saw females become the majority in the 2010s, whereas hitherto early onset gender dysphoria was predominately observed among boys. Diagnosing autism among girls was trickier for some time as it can present in different ways. The figures given for overlaps between autism and gender dysphoria are not usually broken down between natal sexes.