Experiences of autistic transgender and gender diverse adults undergoing gender‐affirming hormone therapy and the influence on occupational identity outcomes

INTRODUCTION: Autistic transgender and gender diverse (TGD) adults often report additional barriers to health-care access and occupational participation. Gender-affirming hormone therapy (GAHT) consists of hormonal medications a person may choose to take to increase alignment of physical features with their gender identity. CONSUMER AND COMMUNITY INVOLVEMENT: This research project was conducted in response to patient and clinician feedback; however, no consumers were involved in the setup or analysis of the study. METHODS: Six autistic TGD adults undergoing GAHT at a statewide tertiary gender endocrinology clinic participated in in-depth semi-structured interviews and underwent an Adolescent/Adult Sensory Profile (AASP) assessment. Secondary analysis of qualitative data utilised thematic analysis and triangulation with AASP results through the lens of the doing, being, becoming, belonging framework to understand how autistic TGD adults achieve occupational identity. RESULTS: Autistic TGD adults experienced improved quality of life, mental health, and occupational identity outcomes as a result of GAHT. Being TGD and autistic posed unique challenges for autistic TGD adults in doing tasks associated with GAHT, including navigating health-care and social environments. Gender-affirming physical changes and experiences increased participants' engagement in gendered occupations and roles. CONCLUSION: For autistic TGD adults who choose to medically transition, GAHT can be an important gender-affirming occupation in enabling occupational identity acquisition. The results of this study highlight a role for occupational therapists within gender-affirming care settings to enhance patient care.