Health and Health Care Access of Autistic Transgender and Nonbinary People in Canada: A Cross-Sectional Study

Background: The existence and health care needs of individuals who are both autistic and transgender and nonbinary (TNB) are increasingly discussed publicly. While research demonstrating a greater prevalence of autism among TNB individuals continues to grow, little captures their experiences with primary, mental health, and gender-affirming care (GAC), particularly between self-identified and diagnosed autistic TNB individuals. This article explores this nexus. Methods: We conducted a subgroup analysis of the Trans PULSE Canada 2019 national survey (n = 2873). We included both individuals who self-reported a diagnosis of autism (n = 230) and those who self-identify as autistic without one (n = 176). We compared participant demographics, health status, and health care experiences by autistic status (diagnosed, self-identified only, or allistic [non-autistic]) using weighted chi-square tests and logistic regression analyses. Results: Of Trans PULSE participants, 14.3% were autistic (8.1% diagnosed, 6.2% self-identified). Compared with their allistic peers, autistic participants were younger, had lower levels of education, employment, and income, and were more likely to identify as asexual. They also reported worse overall general health, a higher rate of unmet health care needs, and significant mental health disparities. While few diagnosed (3.7%) or self-identified (1.1%) autistic participants reported being directly denied GAC due to autism, 25.5% of diagnosed and 36.1% of self-identified individuals preemptively avoided sharing information about it during GAC readiness assessments in the past year. Conclusions: Our findings highlight the need for changes to treatment of autistic TNB people in primary and mental health care. Future research should explore both individual responses and systematic changes to these challenges.