Female-To-Male Transsexual People and Autistic Traits
The ‘extreme male brain’ theory suggests females with Autism Spectrum Conditions are hyper-masculinized in certain aspects of behaviour. Jones and colleagues (2007) predicted that females with Gender Identity Disorder would have elevated Autism Spectrum Quotient (AQ) scores.
AQ scores from five groups were compared: the first group consisted of 61 transmen (female-to-male transsexual people, the second of 198 transwomen (male-to-female transsexual people), the third one of 76 typical males, the fourth of 98 typical females, and the fifth of 125 individuals with Asperger Syndrome (AS).
Autism Spectrum Conditions (ASC) are characterized by difficulties in social interaction and communication, alongside restricted interests and repetitive behavior (APA 1994). The diagnosis of ASC is more common in males. The Extreme Male Brain (EMB) theory of autism proposed by Baron-Cohen and Hammer in 1997 attempted to explain this . According to the EMB individuals with an ASC display an extreme of the typical male pattern of cognition and behaviour.
Studies on females with ASC have found that they are hyper-masculinized in specific aspects of behaviour and cognition. Also, women with ASC report higher rates of tomboyism in childhood (Ingudomnukul et al., 2007). Also, female-to-male (FM) transsexuals (referred to as ‘transmen’) follow a handedness pattern more similar to genetic males (less exclusively right-handed) (Green & Young, 2001) and the same has been found among women with ASC (Soper et al., 1986).
Jones et al. used the AQ to test the specific prediction from the EMB theory that transmen will have more autistic traits than typical women, and that a higher proportion will score in the ASC range for autistic traits. Their scores were compared to maleto-female transsexual people (‘transwomen’).
The AQ is a self-report questionnaire published by Baron-Cohen and colleagues in 2001 and consists of 50 item. It assesses social skills, communication skills, imagination abilities, attention switching, and attention to details.
Scores on the AQ can be used to categorise individuals as having the ‘broader autism phenotype’ (BAP: defined as AQ 23-28), ‘medium autism phenotype’ (MAP: defined as AQ 29-34) or ‘narrow autism phenotype’ (NAP: defined as AQ 35+) (Wheelwright et al. 2010). The transmen had significantly more autistic traits than control men and their mean AQ score lied in the BAP range. Approximately 30% of the transmen group had an AQ in the MAP or NAP range. Transmen had a 11-fold increase in the rate of NAP relative to typical males.
This study confirms clinical case studies and reports in adolescents and children that genetic females with Gender Identity Disorder (GID) have an increased number of autistic traits. The results of this study show that transmen relative to control women exhibit more autistic traits. In addition to that, transmen had more autistic traits than control men, and their mean AQ score lies in the Broader Autism Phenotype (BAP) range.
The authors speculated:
that this increased number of autistic traits is likely to have made the transmen (in their childhood and adolescence) less able to assimilate in a female peer group, instead gravitating towards males. This may also have led to difficulties socializing in a female peer group, and a feeling of belonging more in a male group, thus increasing the probability of GID.
Very interesting findings but what I’ve been thinking while reading the paper was the possible effects of hormone treatment on the AQ scores. Jones et al. had an answer to that:
…a proportion of the transsexual groups were taking hormone treatments and for obvious ethical reasons it was not possible to control for this factor but it is of interest that analysis comparing those on or off testosterone treatment did not lead to significantly different AQ scores.
They go on suggesting that current sex steroid levels do not seem to affect AQ, which seem to depend mostly on foetal levels of sex steroids.
Jones RM, Wheelwright S, Farrell K, Martin E, Green R, Di Ceglie D, & Baron-Cohen S (2011). Brief report: female-to-male transsexual people and autistic traits. Journal of autism and developmental disorders, 42 (2), 301-6 PMID: 21448752