Key Takeways
You may already know both things about yourself. Or one of them, and the other is something you have been noticing, turning over, not quite sure what to do with. Autistic, or wondering. Trans, nonbinary, gender-expansive, or still finding language. Both at once, often in a way that is not quite two separate stories.
A lot of what arrives in my practice comes from people who are both. Many have tried therapy before. Many stopped because their therapist knew one part of them but not the other, and they were quietly holding the other alone. I am a Vancouver-based therapist working online across Canada, and this is the work I want to write about here.
When autistic and gender-diverse are not two separate stories
More than a research footnote
The numbers show a real overlap. Autistic people are more likely to be trans or nonbinary than non-autistic people. Trans people are more likely to be autistic than cis people. The rates vary by study, but the pattern is consistent enough that most researchers have stopped calling it a coincidence.
What matters more is what the overlap feels like from the inside. The autistic writer Lydia X.Z. Brown coined the term gendervague to describe a particular version of this: a gender experience that cannot really be separated from being autistic. Not that autism causes gender identity. More that the two shape each other in ways that make the usual neat categories harder to apply from the outside, and sometimes from the inside too.
Autistic researcher Wenn Lawson has described it another way. The non-autistic world runs on social and traditional expectations, and autistic people sometimes do not notice those expectations, or do not see them as important. That can be freeing. It can also mean you grew up without "what girls do" or "what boys do" being quite real to you in the first place, which can make gender feel more fluid, more confusing, more yours to work out from scratch.
When masking covers both
Many autistic adults grow up masking. Matching facial expressions. Rehearsing the small talk. Doing the things that would make you stand out less at school, at work, at family gatherings. If you were also assigned a gender that did not quite fit, you were probably masking that at the same time, maybe without calling it that. Wearing what was expected. Holding your body in a way that was expected. Performing a version of yourself that felt plausible to other people.
Devon Price, autistic psychologist and author, writes about masking as a kind of internalised survival. It starts as protection. It becomes a whole way of moving through the world. And it costs a lot. People who mask heavily are lonelier, more anxious, more prone to burnout, and more likely to have long stretches where they cannot quite find themselves.
When you are both autistic and gender-diverse, masking often covers both at once. They get braided. This is part of why, for many people, unmasking one brings the other into view. You start taking off the "easier to deal with" mask, and something else underneath shows up. A body that has not really been yours. A way of speaking that does not fit. A name that lands differently than the one you have been using.
What the body has been saying
Gender, for many autistic people, is first a sensory experience, not an idea or a label. The feeling of clothes against skin. The pull of a fabric that is wrong. The relief of a haircut that is right. The change in your own voice that you did not ask for and could not quite live with. For a lot of people who are both autistic and gender-diverse, the body has been sending information all along, often before there were words for any of it.
Because I work from a somatic and experiential lens, this matters in the room. We go slowly with what the body is saying. We do not override the sensory information, and we do not race to interpret it either. Sometimes what lands clearly in your nervous system is the first honest thing in a long time. Sometimes it takes a while to trust it.
Unmasking, at your own pace
There is a long and painful history of therapy trying to extinguish the things that made autistic people and gender-nonconforming people hard for the surrounding culture. Some of the behavioural "treatments" used on autistic children and the conversion therapies used on queer and trans youth share a common origin. The logic in both was: if we can just make you stop being different, you will be fine. We know now that this did enormous harm.
What I offer is a different orientation, and I want to be specific about it. I am not here to help you stop being autistic. I am not here to help you settle into a gender you are not. I am here to help you listen to what you already know, and to not feel alone while you do it. Some weeks the work moves. Some weeks it rests. Both are part of it.
What this kind of therapy can hold
It is okay to not know yet. It is okay to have known for a long time. It is okay to have words for one part and not the other. It is okay to not have words at all and to use images, objects, writing between sessions, or quiet. It is okay to come in tired.
Some things this work can make room for:
- Sensory accommodations during sessions — lighting, sound, camera off when needed, typing instead of speaking, longer pauses, breaks. Online often makes these easier to arrange than in person.
- Gender exploration without a performance of certainty. No label, timeline, or plan for what happens next is required to begin.
- Body-based work that goes at your pace, not the pace of what a body is "supposed" to feel. Dissociation from the body is common when autism and gender sit together, and we treat that gently.
- Creative ways in, including art therapy when it helps. For some people who are both autistic and gender-expansive, a sketchbook can say what a sentence cannot.
- Care that does not ask you to choose which part of yourself to bring in first.
This is part of why I describe my work as gender-affirming therapy online that is also neurodivergent-affirming. The two are not optional add-ons to each other. They are one piece of care. There is also a companion post on therapy that fits an autistic nervous system that covers the practical side in more detail, including what to ask for and what to notice going into a first session. For a broader community perspective, the Autistic Women and Nonbinary Network is an excellent starting place.
What becomes possible
Something shifts when both parts of you are met in the same room. You can stop translating. You can stop deciding which version of yourself is safe for the therapist. You can come in as all of it. That is not a small thing. For many of the people I work with, it is the first time they have not had to edit themselves on the way into the session.
You do not need a formal autism diagnosis to work with me. Self-recognition is enough. And you do not need to arrive with your gender already sorted. You can arrive as you are, and we can begin there.
Frequently Asked Questions
Do I need a formal autism diagnosis to work with you?
No. Many autistic adults, especially those missed in childhood, come to self-recognition long before any clinical assessment. That is particularly common for people who are also trans or nonbinary. Self-recognition is enough. If a formal assessment would be useful for other reasons, like accommodations at work, I can help you think through options. It is not a gate to this work.
I already know I am trans. I am not sure if I am autistic. Can I still work with you?
Yes. A lot of people come in clear about their gender and with a quieter, more uncertain sense that autism might also be part of the picture. We can go gently. Sometimes it turns out to be relevant. Sometimes not.
Is your approach the same as ABA or other behavioural therapies?
No. ABA and the tradition it comes from were designed to make autistic children behave more like non-autistic children, often through reinforcement and punishment. Many autistic adults describe it as harmful. My work is the opposite orientation. The goal is not to reduce autistic traits. It is to help you live more fully as yourself, with more room for what your body and nervous system actually need.
What if I do not know my gender yet?
That is a common starting place. Autistic cognition often examines things from first principles rather than taking social categories for granted, which can mean gender takes longer to settle into language. We can hold "I do not know yet" for as long as it takes.
Can we do art therapy even if I am not good at art?
Yes. Art therapy is not about skill. It is about using images, colour, shape, and material as another way to say what words sometimes cannot reach. Some of the most useful sessions I have had with clients involved pencil scribbles on a napkin, or a single colour filling a page.
