Autism Spectrum Disorder and Gender Dysphoria/Incongruence. A systematic Literature Review and Meta-Analysis.

The studies used different ways to identify ASD, including screening questionnaires, patient records and self-report, and they used different cutoff scores. The rates are not directly comparable. Most ASD diagnosis information came from records or self-report rather than standardized diagnostic assessment. In the only study using a diagnostic tool, only 12.7% of the gender-referred sample received that assessment. Both meta-analyses had very high heterogeneity. The prediction intervals were wide, so the overlap could be much smaller or larger in some groups or settings. The prevalence estimate was higher in population-based and gender-incongruent samples than in clinical and diagnosed samples. Part of this may come from self-reported diagnoses in population samples. The review cannot show whether ASD leads to gender dysphoria or incongruence, or the reverse. It reports co-occurrence. Some subgroup analyses were underpowered. A lack of significant moderators does not prove that age or control-group source is irrelevant. Gender-related self-report measures suggested for clinical use have not been validated in autistic people. For ASD diagnoses, smaller studies raised the pooled estimate. Limiting to the 10 largest studies still gave 0.08.

The supplied funding and conflicts section states: Funder named: University of Kent PhD scholarship.

Do not assume that every patient with gender dysphoria or incongruence has autism, or that the pooled prevalence applies unchanged to your clinic. The studies varied widely in samples, measures and diagnostic sources, and the prediction intervals were very wide, so the size of the overlap is uncertain.