A summary of Jane Galloway's report for Transgender Trend (2022) — an autistic advocate's survey of why autistic children, and autistic adolescent girls in particular, are so heavily overrepresented among the recent surge in gender-dysphoric youth.
Galloway opens from the data the Tavistock itself reported: the current cohort of referrals is the largest and fastest-growing in history, overwhelmingly adolescent girls, who developed dysphoria or adopted a transgender identity after the onset of puberty — frequently in clusters within schools and friendship groups, and in tandem with heavy use of YouTube, TikTok, Tumblr, Reddit and Discord, where identity is rapidly validated by strangers with no knowledge of the child's history or vulnerabilities.
She situates this against a wave of international caution: France's National Academy of Medicine (2022), Finland's COHERE guidance (2020), Sweden's Karolinska Institute (2021, restricting blockers/hormones to clinical trials), and similar moves in Denmark and England — alongside the Keira Bell case, the interim Cass Review, and the CQC's "inadequate" rating of the Tavistock GIDS, whose records often failed to consider the relationship between autism and gender dysphoria.
The report's first part argues that autistic thinking changes how identity is formed and how distress is interpreted. Galloway, herself autistic and diagnosed in her 40s, describes a childhood belief that things were not fixed — that one could, for instance, change one's age or sex simply by saying so — because no one had told her otherwise.
Many autistic people have low interoception (difficulty reading internal bodily signals) and alexithymia (difficulty naming emotions). Hormonally driven, hard-to-identify feelings at puberty may be misattributed to the body itself — so rejecting the body feels like a way to make the feelings stop.
If one thing is learned to be fixed, an autistic child may not extrapolate that everything else is. Simplistic reasoning ("I like wearing a dress, therefore I must be a woman") was documented in GIDS case reviews by clinicians Churcher Clarke and Spiliadis.
Autistic girls can spend so long mimicking peers to fit in that they reach their late teens without a solid sense of self, then try on a series of identities. A ready-made trans or non-binary identity can fill that void — and offer an instant, accepting community.
An identity that encapsulates feeling different, not fitting in, and being gender non-conforming is enticing to a child used to being ostracised — especially one not yet aware they are autistic.
Because autism research was historically built on observing boys, autistic girls are widely under-recognised. Galloway catalogues how they present differently — quiet and "quirky" rather than obviously struggling, socially mimicking, intensely anxious, prone to masking and after-school "explosions," with sensory aversions (including to typically feminine clothing) and frequently gender non-conforming presentation. These same traits are statistically misread as anxiety, bipolar, or borderline personality disorder rather than autism.
Drawing on Erikson, the report frames adolescence as a period of separating from parents and turning to peers, when young people may adopt "ready-made" philosophies until a stable self develops. Non-binary, trans-masc and trans-femme identities are presented as such ready-made options — appealing to autistic youth who are naturally gender non-conforming, but carrying real risks: a belief that one's sexed body or its health implications no longer apply, and an increasing normalisation of medical transition (microdosing hormones, surgery) as a way to consolidate a non-binary identity, marketed even to under-18s.
A central argument is that several conditions overlapping with autism can be mistaken for, or drive, gender dysphoria — and are routinely not ruled out before a medical pathway begins.
A documented OCD presentation (first reported 2015) of intrusive, distressing thoughts about wanting to transition or questioning gender, with compulsive reassurance-seeking (researching transition, reading trans content, asking online communities). In autistic adolescents it is especially hard to disentangle compulsions from autistic routines or self-soothing stimming.
Both gender dysphoria and eating disorders in girls can involve signifying trauma on the body, and both are highly co-morbid with autism (eating disorders often a reaction to sensory issues with food). Psychotherapist Lisa Marchiano notes medicalisation can halt the process of exploration.
BDD (an anxiety disorder of preoccupation with perceived flaws) shares features with autism, including amygdala involvement and difficulty appraising others' emotions. A large twin study found 15-year-old girls reporting BDD symptoms were ~5× more likely to show autistic characteristics. A child may be "reading" body dysmorphia as gender dysphoria through the language they have been exposed to.
Adverse childhood experiences are over-represented (looked-after children make up 0.58% of the population but ~4.9% of GIDS referrals). Autistic children face elevated risk of trauma and PTSD — including a "trauma-like" load from everyday sensory and communication stress (the "coke bottle effect"), bullying, and learned compliance that increases vulnerability to manipulation.
Autism in women is frequently misdiagnosed as borderline personality disorder; mapped against autistic traits, the BPD criteria show extensive overlap. Gillberg's ESSENCE framework argues many adult "personality disorders" are misdiagnosed neurodevelopmental conditions. One detransitioner describes being trans becoming her autistic "special interest."
Puberty is framed as the single biggest "transition" an autistic young person faces — and the one change they cannot control or stop. It commonly triggers gender dysphoria, but Galloway repeatedly stresses that dysphoria is not the same as a transgender identity.
The report questions whether autistic young people — with literal understanding, communication differences, and a tendency to take statements at face value — can meaningfully give informed consent to far-reaching medical interventions. It surveys the external influences shaping identity: online influencers, public-health and support websites, an increasingly pornified sexual landscape, sex-based stereotypes, homophobia (with the disappearance of lesbian role models), peer-group clusters, plastic surgery/body modification, and gender as an autistic "special interest."
The third part turns to institutions: schools guidance and RSE curricula, the National Autistic Society, parenting an autistic child, parenting around identity, suicidal ideation (autistic females, especially with ADHD, show markedly elevated risk — raising the question of how much "trans suicidality" is in fact autistic suicidality), and the growing number of detransitioners, many of them autistic.
Vet externally-supplied RSE materials for evidence and balance across protected groups; allow open, evidence-based questioning; teach LGB identities as same-sex attraction; account for child development; and train staff in how autism actually varies and presents — including adapting RSE/PSHE for SEND, autistic and ADHD pupils, with safeguarding in mind.
Stay current on autism presentation (including autistic boys with a "female" presentation) and co-occurring conditions (anxiety, ADHD, OCD, eating disorders); be alert to communication differences; and make reasonable adjustments (quieter times, longer appointments, predictable arrangements).
"Don't panic." Read widely, including primary research; trust your knowledge of your child; ask for the evidence behind what you're told; offer boundaried support while holding space for them to change their minds; remember dysphoria and a trans identity are not the same; model that stereotypes need not limit interests; and communicate clearly, allowing processing time. Gender clinics are not necessarily autism experts.
The report closes with Galloway's own account: an autistic girl, undiagnosed until her 40s, who from age 13 felt "utterly other," self-loathing and suicidal, with no framework to explain it. She reflects that had she been offered a trans or non-binary identity as an adolescent, she "absolutely would have grabbed it" — not because it was true, but because it would have made her feel less alone. Her argument is not that trans identities are never real, but that for a generation of isolated autistic girls, an explanatory identity arrives before the differential questions are ever asked.