Autism Diagnoses Among Patients Undergoing Gender-Affirming Genital Surgery: Analysis of a Statewide Database

Purpose: We aimed to assess rates of autism spectrum disorder (ASD) diagnoses among patients who underwent genital gender-affirming surgery (GAS) using a statewide dataset. Methods: Using the California Department of Healthcare Access and Information ambulatory-surgery database (2012–2018), we identified individuals who underwent vaginoplasty, phalloplasty, or metoidioplasty via International Classification of Diseases-9/10 procedure codes. ASD diagnoses were identified with corresponding diagnosis codes. Rates of ASD among patients who underwent genital GAS were compared to the general adult population. Results: We analyzed 1226 patients (869 vaginoplasty; 357 phalloplasty/metoidioplasty) with a median of two years of observation before and after surgery. ASD was documented for 4 vaginoplasty patients (0.5%) and 3 phalloplasty/metoidioplasty patients (0.8%); this difference was not significant ( p = 0.70). Overall, ASD prevalence in the surgical cohort (0.6%) fell below the 2.2% estimate for the general adult population. Conclusions: ASD prevalence among transgender and gender-diverse individuals undergoing genital GAS was lower than both general population estimates and broader TGD cohort reports. This finding may reflect differences in access to care or selection factors and warrants further investigation into care pathways for individuals with ASD. Further research is needed to clarify these disparities and to develop neurodiversity-informed care pathways that promote equitable access to GAS.