The first large-scale study on the experiences of autistic transgender people finds that they are more likely to have long-term mental and physical health conditions, including alarmingly high rates of self-harm, data from the Autism Research Center at Cambridge University shows.

Researchers found that these individuals also report experiencing lower quality health care than both autistic and non-autistic people whose gender identity matches their sex assigned at birth.

“These findings add to the growing body of evidence that many autistic people experience unacceptably poor mental health and are at a very high risk of suicide-related behaviors. We need to consider how other aspects of identity, including gender, influence these risks,” said Dr. Elizabeth Weir, a postdoctoral scientist at the Autism Research Center, and one of the lead researchers of the study.

The report is a follow-up to 2020 research from Cambridge that found transgender people are more likely to be autistic and have higher levels of autistic traits than other people. Several studies have corroborated that finding in the interim and show autistic people are more likely to experience gender dysphoria than the general population.

Results from the 2020 study were based on responses from over 640,000 people. The new research, published in Molecular Autism, compared the experiences of 174 autistic transgender individuals, 1,094 autistic cisgender individuals, and 1,295 non-autistic cisgender individuals.

Compared to non-autistic cisgender individuals, autistic transgender people were three to 11 times more likely to report anxiety, “shutdowns” and “meltdowns” related to common healthcare experiences.

Transgender/gender-diverse autistic adults were 2.3 times more likely to report a physical health condition and 10.9 times more likely to report a mental health condition compared to cisgender non-autistic adults.

Only one in ten autistic transgender adults agreed with the statements: 1) They understood what their health care professional meant when discussing their health; 2) They knew what was expected of them when seeing a health care professional; and 3) They were able to describe how bad their pain felt.

The study also confirmed the reasoning behind the recognition of autistic people as a priority group in the U.K. Department of Health and Social Care’s “Suicide prevention strategy for England: 2023 to 2028”: compared to people who are non-autistic and cisgender, autistic transgender people are 5.8 times more likely to report self-harm, just above the equally alarming rate of 4.6 times for autistic cisgender individuals.

“We need to consider how to adapt health care systems and individual care to meet the needs of autistic transgender/gender diverse people,” said Prof. Sir Simon Baron-Cohen, Director of the Autism Research Center and a member of the research team. “Policymakers, clinicians, and researchers should work collaboratively with autistic people to improve existing systems and reduce barriers to health care.”

“Greater recognition of challenges and reasonable adjustments are essential for people with marginalized, intersectional identities in clinical practice,” the study concluded.