Autism and Gender Variance: Is There a Cause for the Correlation?

Autism and Gender Variance: Is There a Cause for the Correlation?

This is a guest post on a subject very close to my own heart that I commissioned from Sparrow Rose Jones via this Fiverr gig. Sparrow is well-known as the author of the blog Unstrange Mind and the book No You Don’t: Essays from an Unstrange Mind, which I am taking the opportunity here to recommend to anybody who has yet to encounter them.

Regular readers will know I hardly ever publish guest posts or reblog, but I made one of my few exceptions (my blog, my rules) because I have long valued Sparrow’s writing on subjects that I care deeply about and wanted very much to take the opportunity to gain a fresh perspective on the intersection of autism and gender. And now, over to Sparrow…

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Holding Out For A Hero

Holding Out For A Hero

It’s really hard to be inspired by people. To find somebody you can look up to as a role model. A hero. Hey, I’m hard to satisfy but that doesn’t mean I’m going to stop looking.

What am I looking for in a hero? I need somebody I can relate to. Someone whose life has enough parallels to my own that I can identify with them. And I’ve got to say that as an autistic trans woman that’s a hell of a tall order!

There are people I admire greatly. Lynn Conway and Sophie Wilson are both incredibly talented engineers who are also trans women. But the very fact of their exceptional contributions to electronic engineering and computing sets them too far above anything I could dream of achieving.

It seems everywhere I look my candidates for hero have talents I do not share. Fantastic autistic writers like Sparrow Rose Jones, M Kelter and Michael Monje Jr. Outspoken activists and advocates like Morénike Umoye, Fiona O’Leary and Lydia X. Z. Brown.

I dismiss myself as an average wordsmith, an armchair supporter of my own rights, somebody who would tentatively raise her hand but would never be the first to raise her voice.

No, I found my own hero closer to home. There is one person I have known, and known very well, that I continue to look up to and admire. Someone who set an example with her own life to the extent that when faced with a dilemma I can ask myself, “What would she do?”

It’s no big surprise. That person was my mother. Of all the people I have known she was the one I want to emulate. Such generosity and love towards others, and yet with an uncompromising strength at her core. Even at the end of her life, after years of suffering with a brain tumor that left her unable to care for herself at all, she had moments of snappiness but still managed to think of others before herself.

So I do have a hero. I do have someone to look up to. And every time I fall short of her example (which is more often that I’d like to admit) I think about her.

She didn’t give birth to me but I was her child. She loved me unconditionally, always believed in me and supported me. Nothing in her power was too much trouble for her if I needed it. If I was with her I would always be safe. And if I ever need to consider what would be the “right” thing to do I need only think, “What would mum do?”

Edge Cases, or Why Binary Categories Are Broken

Edge Cases, or Why Binary Categories Are Broken

People have a habit of putting everything they encounter into categories. It makes language-based communication possible. If I tell you about the tree at the end of the road you can imagine a scene: you know what a tree is, what a road is, and how the two fit in relation to each other. But you don’t imagine the same scene that I have in mind.

When I write about an older man with a deep, resonant voice, do you think of Orson Welles, James Earl Jones, Richard Burton, Morgan Freeman? They all fit the description, the category. Even though the terms I used are pretty vague: what does “older” mean? Older then you? Than me? Over 50? 60? Showing signs of age such as gray hair or lines on his face?

“Older” must be meaningful in this context or else why would I use it? You see, everybody knows what it means, but you’d not be able to find a consensus, a common definition. Where do you draw the line between older and not-older? It’s a simple binary choice after all.

For argument’s sake, let’s say that older means older than me. That’s easy, right? Oh, you want to know how old I am? Well, I’m not old: I’m middle-aged. So maybe someone who’s close to my age shouldn’t be referred to as older. Let’s change the definition of older to mean an age ten or more years greater than mine. Oh, you still want to know my age?

I guess this is more difficult than it first seemed. Welcome to the territory of the edge case, the point at which we cut from one category to another. The problem arises because our category, older, can’t be defined unambiguously. There is no clear boundary between older and not-older.

That’s not to say that older is useless: it works well as a convenient shorthand, a stereotype. It’s just that the degree to which it applies varies. Morgan Freeman is an older man; George Clooney is less so, Ryan Reynolds probably isn’t, and Daniel Radcliffe is almost certainly not.

And yet older seems such a simple concept. As simple as tree or road. Thinking about trees, you know what a tree is, right? As opposed to a shrub or a bush, or some other plant? And a road: it’s not a freeway, or a track. Right? Or not? There’s some overlap: these terms we use casually, that we understand the meaning of very well, nevertheless are fuzzy around the edges.

We learn the meanings through examples, archetypes. A collection of instances that we are told belong to the category. It’s not about definitions such as you find in a dictionary: those are mere simplified descriptions of what most of us mean when we use a word. When you think about trees you don’t give much, if any, thought to the definition: you just know what a tree is.

It’s the same principle when it comes to gender. You learn about men and women as two mutually-exclusive categories, and you’re taught that everybody fits into one or the other. But just as with any other category, gender has edge cases. There is such a range of variation among humans that there is no characteristic, or set of features, that unambiguously assigns a person to either a male or female gender.

Yes, there are physical characteristics that apply to the majority: these are what are used at birth to decide whether to write M or F on a birth certificate. And for most people that’s fine. But there are edge cases. People who don’t have distinct physical gender characteristics, or people who look like they are male (or female), but are actually female (or male) or neither, or both.

These edge cases, intersex and transgender people, are a minority but not an insignificant one: reliable conservative estimates put the number of transgender people at around 1 in 500, meaning that we account for roughly 15 million people around the world. As a comparison, that’s about the same as the number of Jews worldwide, and more than the population of Greece, Belgium or Sweden.

That’s a lot of people for whom the gender categories don’t properly work. These people exist; gender is an invention. Which do you think might be “wrong”? The sad fact is that there are a lot of people who think of gender, male or female, as absolute binary options: each person has to fit one or the other. Reality doesn’t work that way. It’s not neat or convenient.

Believe me, as a woman myself I’ve tried long and hard to come up with some objective criteria to define womanhood. And for every single characteristic I thought of there are exceptions. It’s not a matter of definitions, it’s a matter of knowing. I have encountered many examples of women in my life and they have shaped my understanding of what a woman is. The same goes for every person who identifies as a woman. It’s an understanding that transcends words. So that is how I know I am a woman.

Changing Your Mind – Thoughts on TMS

Changing Your Mind – Thoughts on TMS

Over the past year, and especially since the publication of Switched On by John Elder Robison, there has been a lot of attention around a therapy called TMS (or rTMS–Repetitive Transcranial Stimulation).

It’s something I have deep reservations about but others have written passionately and eloquently on the subject. What I want to consider is why somebody would choose to undergo such a therapy that literally changes their mind.

I’m no stranger to the negative feelings that arise when considering the gap between how I perceive myself and what I see when I look in the mirror: that’s a big factor in my gender dysphoria.

I also know first-hand how it feels to be teased and ridiculed for hand flapping, physical clumsiness, social awkwardness, unusual speech patterns and eclectic interests. I’ve had life-long difficulty making and maintaining interpersonal relationships, and I have times where I feel keenly the lack of people with whom I feel comfortable opening up about my problems and feelings.

I understand the drive to make physical changes to one’s body. After all, I’m in the process of seeking treatment to modify my own body, bringing it into closer alignment with what I see in my mind by erasing or concealing male characteristics and developing female ones.

There are two parts to my gender dysphoria. First there is my need to have other people respond to me as a woman, reinforcing my gender identity. Second there is my need to see my own body physically match the mental image I hold.

So as a trans woman I am actively seeking treatment to make changes to my body. This is in contrast to my feelings about my autism. Both my gender identity and my autistic identity go to the very heart of who I am.

The thing is, although I will happily modify the physical characteristics of my body I wouldn’t consider altering my mind. My neurology is inextricably tied to my identity: I feel that changing my mind would make me into a different person.

There’s a line there. I’ve put a foot over that line a few times, testing the water so to speak. I’ve experienced the effects of drugs that affect the workings of the brain: alcohol, marijuana, amphetamines, SSRIs (anti-depressant).

Some of them have positive aspects. For example, alcohol reduces my social anxiety. But there are negatives too: I make poor decisions under the influence of alcohol because it inhibits my self-control and risk-aversion: I’ve gotten myself into some dangerous situations as a result.

Speed (amphetamine) left me unable to concentrate, marijuana was relaxing but caused mild hallucinations and a degree of paranoia. The SSRIs reduced the intensity of my emotions, leaving me feeling numb: in the end I had trouble focusing and engaging with things in my life.

These were all temporary effects: my mind returned to its usual functioning state in time for which I was grateful. You see, I wasn’t myself when under the influence of any of these drugs.

I guess my point is that given the complexity of the human brain and the way its many regions interact it is not possible to adjust one aspect without affecting others. Just as a particular drug affects a small number of electro-chemical interactions in the brain with wider-reaching side-effects, so a therapy like rTMS that alters a small region must cause knock-on changes across the entire organ.

My opinion is that it is not like tuning an engine, a relatively simple system with a limited degree of interconnection and feedback between its components. It’s more like introducing a foreign species into an existing ecosystem. The effects can be slow to manifest, and predictions are error-prone due to the complexity and chaotic nature of the system.

There is no way to know what other effects rTMS would have. It might reduce my social anxiety, but even if that was all it did it would make me respond differently to people I interact with (like alcohol). And if my thoughts and behavior are changed then I’m no longer the same person.

I don’t want to change who I am: I’m comfortable with my identity as an autistic trans woman with all that entails. Changing my body doesn’t affect my personality, my thoughts: I remain me. Changing my mind makes me into somebody else. I would lose the essence of what makes me this particular unique individual, and the thought of that fills me with dread.

This leads me to suppose that for somebody to even contemplate such a thing they must not like who they are. Internalized self-hatred, blaming their neurology for what they see as their failings. It’s like body dysmorphia projected onto the ego, the sense of self. The antithesis of neurodiversity’s principles; an inability or refusal to accept one’s differences.

I see this as a result of thinking colored by the medical model of autism that sees it in terms of pathological deficits, as opposed to the social model which instead looks to society’s failures to provide suitable accommodations and acceptance as the causes of disability.

There’s nothing wrong with my mind: I have no reason to change it. I can’t say the same for the society I live in.

School Reports and My Past

School Reports and My Past

I often look through my old school reports. It’s been difficult the last couple of years because they all talk about Ben and refer to that boy, someone who, although it used to be me I no longer recognize.

I recognize the words and know they refer to me, but whenever I read that name or those male pronouns I feel a cognitive dissonance. It was me, but at the same time (and strongly) it is not me. Not the person I am now.

And yet… I still open that old folder and read those words.


IMAG0280IMAG0281The subjects (from top to bottom) were Chemistry, Design, English, French and Geography.

I can’t emphasize enough how hard it is to read “he” and “his”, or to see “B” or “Ben”. Imagine reading something about you that refers to you as someone else. Not only that, but someone of a different gender!

I know these reports are mine, I know they are referring to me, but I’m a woman called Alexandra; these reports about some boy called Benjamin feel emotionally like they’re about someone else although I know rationally that they refer to me.

I’ve had conflicted thoughts about my daughter. I know she has a mother and a father, but I am not comfortable describing  myself as her father. I’m one of her two parents, sure, but I can’t bring myself to think of myself in such male terms as a father.

She calls me Alex, not “Dad”, which I’m happy about: I feel very uncomfortable with the male implications of father but I also recognize that I am not her mother. There’s a word missing from English, one to describe a female parent who did not give birth to the child.

To say it hurts is such an understatement. It tears my heart to pieces, leaves me crushed and beaten. I tell people she’s my daughter but I feel inhibited from saying that I’m her “parent” because I can’t say I’m her mother and I don’t believe “father” is appropriate.

Technically speaking I am her father, but emotionally I can’t accept that label. I can’t accept anything that suggests a male identity I don’t identify with. It’s frustrating, but I can’t find an answer to my conundrum.

Looking Beyond The Binary

Looking Beyond The Binary

Like the overwhelming majority of people I was immersed from my earliest days in a world divided into two. It is so pervasive that it doesn’t seem at all strange; most people never have cause to even think about it.

In the blue corner we have everything male. Boys, men, anything electronic or mechanical, big or loud. Football. Beer.

And in the pink corner we have the supposed polar opposite, female. Soft, delicate, dainty, quiet. Embroidered cushions and flowers. Ballet. Prosecco.

Take a moment to think about how much of the world is seen in terms of masculine or feminine. It’s even ingrained in many languages such as Spanish, French, German, Russian.

Who do you see when you imagine people in various jobs? Flight attendant, nurse, engineer, bricklayer, plumber, mechanic, secretary, truck driver. Are the examples you think of primarily male or female?

How about when you see a person at the mall or in the street? Do you find yourself automatically thinking of them as she or he? Making an unconscious decision about their gender simply based on a quick glance, a fleeting impression?

It’s so deeply ingrained in our culture and society that it’s hard not to. And when somebody doesn’t seem to fit into either category we can find ourselves wondering, “Are they…?” Does that make you uncomfortable? How would you address them?

Good news: there’s a solution. It’s not easy because you have to make an effort and learn to see things differently. But you can teach yourself to look at people without the need to put them in a box labeled M or F.

Go on, try it. Watch the TV, scroll through Facebook, whatever, and deliberately keep an open mind about the gender of everyone you see there. Avoid “he” and “she” in your thoughts; use the neutral “they” by default.

After a while you find that it becomes easier, the conscious effort becomes an unconscious reflex. And you discover something unexpected: you still see aspects that suggest male or female, but your overall impression is a blend of the two. You see both simultaneously!

And it strikes you that the whole dyadic division is an illusion, a pernicious lie.

Cis Actors As Trans Characters – Why The Fuss?

Cis Actors As Trans Characters – Why The Fuss?

You might have seen some of the fuss from trans advocates and activists about The Danish Girl‘s casting of Eddie Redmayne as trans woman Lili Elbe. I know I did, and it made me realize that even I find it hard to explain why a problem even exists here.

Now, if I’m having trouble putting my unease about it into words you can bet most cis (non-trans) people don’t get it. So I figured I should try, and hope this ends up coherent!

I’ll start by saying that I’ve not seen The Danish Girl myself but this is only because I haven’t had the opportunity. I do intend to watch it when it becomes available through my satellite subscription. My objections are not to the movie itself or to Eddie Redmayne.

No, the problem I (and many others) have is that when casting such roles the default is to cast an actor whose gender matches the assigned gender of the character rather than their identified gender.

For all that acting involves a degree of pretence, the actor becoming another person with different attributes, we as the audience can’t help but see both actor and character, imbuing the portrayal with our knowledge of whoever is playing the part.

So when we see a male actor playing a trans woman we see them, at least in part, as a man. Even if it’s at a subconscious level it reinforces the incorrect idea that a trans woman is a man.

I’m not trying to argue that a man can’t play a woman, or vice versa. Linda Hunt won an well-deserved Oscar for her role as Billy Kwan in The Year of Living Dangerously. My point is that this is very much the exception, whereas with trans characters it’s the rule.

I don’t want anybody excluded from a given role on the grounds of gender (or anything else); what I want is for those casting roles to primarily choose actors who are a close fit for the characters’ gender as much as their race, build and other characteristics.

The current situation with trans characters is equivalent to the days when Native American or Asian characters were almost exclusively played by white actors. This is now rightly seen as discrimatory and unacceptable and I want the same attitude to prevail when it comes to trans roles.

My Response to the Care Quality Commission

My Response to the Care Quality Commission

I received a letter back in December from the CQC regarding my “experience of receiving care and treatment at the Charing Cross Gender Identity Clinic”. This was my response.

Ref: INS1-2206743716


I’d like to tell you about my experience of Charing Cross Gender Identity Clinic. I was referred to them early in 2014. I heard nothing for months and phoned the clinic a couple of times to make sure that they had received my referral. I finally had my first assessment (with Dr. Lenihan) in December of that year – about a 9-10 months wait.

After seeing her, on my way out I made an appointment for my second assessment in May 2015 with Dr. Lorimer. At the time, given how long I had waited for my first appointment, I thought a mere five month wait wasn’t too bad!

However, a few weeks before the date I received a phone call from the clinic telling me that the doctor was unavailable due to a holiday and they would have to cancel my appointment. It’s difficult to express just how crushing a blow this was. I had expectations of finally getting approval for the treatment that would allow me to move forward with my life and for that to be taken away from me was devastating.It triggered months of severe depression, affecting my physical health, my work and the relationship with my wife. Things only started to improve after I finally received a letter giving me a new date to see Dr Lorimer, on January 15th (last Friday).

So, I turned up at the clinic (45 minuted early because of the vaguaries of public transport into London) only to be told that I didn’t have an appointment: hadn’t I gotten the message the week before telling me that it had been cancelled (again!).

Obviously I hadn’t got the message; there’s no way I’d endure the travel into London just for fun! I don’t think it’s acceptable to simply leave a voicemail with no guarantee that it will be picked up. For me communication by letter or email would be better (I have anxiety issues using the phone and don’t pick up calls where the number is withheld or unknown to me; I also do not answer calls during work hours).

Anyway, I’m currently here, over 13 months since my first assessment, fighting depression again with no end in sight for this limbo I find myself in. Given what I was told by the admin staff about Dr. Lorimer’s health problems I really can’t see at the moment that I’ll ever progress to the point where I can begin to receive treatment (HRT, surgery). All this waiting is beyond unreasonable.

I don’t think the woefully inadequate level of service provision for trans people is in any way acceptable. In what other sector of the health service would such waiting times be remotely acceptable, especially given the hugely detrimental effect it has on people’s well-being and quality of life?


Alex Forshaw (Ms.)

How To Come Out As Trans – Part 1

How To Come Out As Trans – Part 1

You’re trans. You intend to transition from your current assigned-at-birth presentation to live your life in a way that feels right. What next?

Where to start?

Most of us have family, maybe a partner, maybe children. The people who are closest to us, the ones who believe they know us. One way or another they’re going to find out at some point that we’re not the person they thought they knew.

The first step is the hardest. Telling the first person involves a whole lot of trust. You hope with all your heart that they will accept you but you fear deeply that they will reject you.

I started by dropping increasingly broad hints to friends I felt I could trust, gauging their reactions. If it had gone badly I think I’d have been reluctant to move forward and I’d have maybe given in to the stirrings of suicidal thoughts: I felt so strongly that I couldn’t go on pretending to be someone I’m not.

A couple of weeks later I told a close online friend how I felt, who I really was, and they were wonderfully supportive. At this point my depression was putting such a strain on my marriage that we were at breaking point: we were practically separated. I came out to my wife: at that point I figured things couldn’t get worse whatever her reaction.

I didn’t have a plan beyond that moment. I didn’t know if I’d lose everything, be on my own. That was no longer as important to me as living the rest of my life as a woman. Some people called me brave but I don’t accept that. I did what I had to do to survive the crisis in my life. If I’d been brave I’d have come out earlier instead of hiding it for decades because of my fear of rejection.

For may trans people in relationships coming out breaks that bond. It’s not easy to accept but it’s the truth that most marriages will not last long after one of the partners comes out as trans.

Being open and coming out might be “the right thing” but telling your partner that the person they are with, that they thought they knew so well, is not who they believed them to be will be a huge shock. People react differently but it’s not uncommon for there to be anger, grief, denial and other emotions that are very similar to losing a loved one.

The trouble is that not being honest about who you are can be equally destructive. If it is revealed by somebody else it undermines trust on top of their other reactions to finding out the truth. If you continue to hide it it will damage your mental health and the effects of that can also destroy a marriage, even lead to your death.

It’s such a hard call to make and I can’t tell anybody else what to do for the best. My personal feeling is that it is best to be honest and to tell your partner sooner rather than later. Yes, there is a significant risk that they will reject you and that can be devastating. But the alternatives are equally bleak.

If they find out from someone else then you are guilty of keeping a huge secret from them, destroying feelings of trust. If you continue to deny the truth of your gender identity you will probably harm yourself mentally.

Even if they accept you as trans that does not mean that your relationship is secure. Gender is a factor in sexual attraction for many people and a partner who is strictly hetero- or homosexual may find it difficult if not impossible to remain attracted to you.

If this all sounds very negative and hopeless then I’m sorry, but for the majority of trans people in relationships when they come out, the relationship does not survive. Some do: mine did, and indeed is stronger than before. But mine is the exception. The uncomfortable, brutal truth is that you cannot expect your relationship to continue after coming out. Even if it does then it will almost certainly be in a different form.

A Day In The Life

A Day In The Life

It’s a miracle I ever find time to write. Between corrupting the young and working towards the downfall of civilization you’d think I’d never have even a couple of minutes to freshen my lipstick. Ah, the trials and tribulations of being a trans woman.

I’m kind of sorry to admit that the truth is a little less interesting. I get up in the morning, brush my teeth, take my meds and eat breakfast before showering. Then I shave the hated stubble from my face, dress in work-appropriate clothes, make a cup of tea and breakfast for my wife.

Once that’s done I can make up my face, tidy my hair and head off to work. Doesn’t sound much, but I can usually stretch it out beyond an hour and a half. By the time I get to work it’s 8:30. Straight in front of the keyboard to check the results of overnight tests and catch up on emails, and then 8 hours of miscellaneous software development.

I’ll admit I do pop off from time to time for a little chat with the girls and an occasional smoke (I’ll have to be giving that up before they’ll sign off on my HRT). Oh, and I do visit the bathroom now and then. I’ve even been known to get a drink of water or eat lunch!

Before I know it it’s nearly 5 and time to drive home. Maybe I’ll call in at a local store for some groceries, or maybe I’ll head straight home. Once in the door it’s time to change into my PJs and take off the makeup. I cook dinner for the two of us. OK, that’s an exaggeration: I usually just pop something in the microwave because I can’t be bothered!

I spend a bit of time with my wife, a bit of time online, and a bit of time watching my current series on Netflix (it’s Luther at the moment; before that was Jessica Jones) and all too soon it’s 10pm and time for bed where we read for a while before lights out.

Yup, that’s my life (and I enjoy the comfortable, regular routine of it). Now I don’t have intimate knowledge of what other trans women get up to in the privacy of their homes but I’d be willing to put money on it being as utterly normal as my own life.

You see, that’s the shocking truth of it: trans people are not any different from other folk. I sometimes (when I get a spare few minutes) wonder what some people imagine we get up to: what I’ve heard of their fantasies seems to suggest we’re some kind of sexual equivalent of Olympic athletes, but with S&M gear and a fixation on teasing straight men.

Well, I’m not averse to a bit of bondage myself but I’m a happily married woman with no desire to seek out any other sexual partner. And if I’d wanted a relationship with a man that’s what I’d have looked for (and hopefully found). As for teasing, I wouldn’t know flirting if I tripped over it on the sidewalk.

Oh, yes, I do sometimes wear a short skirt and knee-high leather boots. Why? Because I like it. There’s a certain confidence and power that comes from dressing in a way that can draw attention, that emphasizes particular attributes of my body. It makes me feel good about myself, which as far as I’m concerned is a damn good reason for doing it. I honestly don’t care what anybody else thinks of it!

When I was still pretending to be male I wore all black, nondescript shirt and jeans, trying not to be noticed. I didn’t think much of myself back then. Maybe I’m compensating for that now, but the way I see it is that at over 6 ft in heels I’m going to stand out regardless so I might as well feel comfortable and confident doing it.

The thing is, as I wrote in the past, I used to feel I was hiding behind a mask. That what people saw wasn’t the real me. I’m not hiding these days: what you see is pretty much the image of myself I carry in my mind. I never realized the strength and confidence I’d feel once I settled into presenting authentically.

It’s not that I don’t feel the same anxiety I always did when around other people. It’s that I am able to handle that anxiety because I’ve not got some secret I’m trying to maintain. I’m free to be myself, and I’m having a whale of a time!