The Intersection of Autism and Gender Diversity in the Canadian Clinical Context: Characterizing a Sample of Adults Referred to Canada's Largest Publicly Funded Adult Gender-Care Service: Intersection de l’autisme et de la diversité des identités de

BackgroundResearch indicates a significant overlap between transgender and gender-diverse (TGD) and autistic identities. This intersectional population has higher risks of mental health challenges and worse mental health outcomes than individuals with just one of the two identities. Limited research focuses on adults at this intersection and their care access needs. To better characterize this population in the Canadian context, this study examines the population referred to Canada's largest publicly funded adult gender-related care clinic and compares demographic and diagnostic characteristics between those with and without a pre-existing autism diagnosis.MethodsThe data come from the medical records of 1,843 adults referred to the Gender Identity Clinic (GIC) at the Centre for Addiction and Mental Health in Toronto, Canada, between January 2020 and March 2025. The prevalence of autism diagnosis prior to entering the clinic was calculated. Average age, sex-assigned-at-birth composition, prevalence of gender dysphoria diagnoses and of additional mental health and neurodevelopmental diagnoses were compared between autistic and non-autistic groups. Changes across time in the number of autistic individuals referred to the GIC were analyzed.ResultsApproximately 6.3% of adults referred to GIC had a diagnosis of autism. The autistic and non-autistic groups had no difference in average age. The groups had no differences in sex-assigned-at-birth distribution. Autistic adults had greater rates of gender dysphoria. Autistic adults had higher rates of each category of mental health and neurodevelopmental diagnoses examined.ConclusionsThis study is a first step in developing a holistic understanding of the experiences of autistic TGD adults seeking clinical gender-related care in the Canadian context, providing a starting point to addressing needs and barriers to care for this population, as well as insight into the substantial mental health challenges experienced by this population.