THREAD FROM ELSEWHEREI'm not an expert or anything, but as an autistic person who received informed consent hormones/surgery, regrets it, and doesn't feel like my consent was truly informed...here's how I, personally, think things could be improved to help autistic people make informed choices.First, I've gotten yelled at before for people misreading me re: autism before, so to be crystal clear: none of this is saying autistic people don't have autonomy, nor is it infantalizing them (us?) or implying they can't be trusted to make choices about their own lives. HOWEVER
there ARE differences in how autistic people work, & acknowledging that allows things to be MORE accessible. Many autistic people are very capable but perceive things differently than non-autistics intend, and that can be accommodated for by changing how information is presented.
I don't think autistic people are stupid, I think we think differently than others (which is why there's a name for our neurotype at all...) Anyway, disclaimer out of the way, here's what I think might help.
^1: Acknowledging that many autistic adults — particularly females and PoC — do not know they're autistic. I don't think it's reasonable (or necessary) to give everyone seeking transition related healthcare a full evaluation, but I think screening with something like the raads-r-
could be a jumping off point for either further evaluation OR just further discussion and working with the assumption that the person may benefit from an autism centred approach.^
2: Making it explicitly clear to the patient that an autism diagnosis will NOT disqualify them from receiving transition related procedures or medication, or remove their autonomy to choose, so that they are willing to freely discuss it and to disclose if they have a diagnosis.
3: Ensuring that doctors are aware that two very common autistic traits are being highly trusting and highly literal, and how this might affect an autistic individual's expectations of what the treatments they're seeking will do for them.
I think doctors need to be very forthcoming and blunt about what these treatments will and will NOT do. Eg "testosterone might make you feel more comfortable in your body, and might make it easier for other people to see you as male, but it is not capable of changing your sex -
and is not guaranteed to make you pass as male.
The effects are highly variable and you are not guaranteed to get all of the ones you desire to the extent you desire". Additionally, doctors need to be aware of some very common sentiments in trans spaces that are not true -
eg. "nobody actually regrets transitioning" and "cis people don't ever think about their gender", and ensure that autistic patients understand that these statements have political undertones, no evidence behind them, and cannot be taken as literal fact.
Some autistic people are quite adept and differentiating between literal and figurative (or simply misleading) statements, but many are not, so it's not safe to assume that things like that are obvious. I was told (& believed) that T makes everyone pass, for example. It doesn't!
4: From that, understanding that feeling disconnected from peers/society/the self is fairly common among autistic people, trans or not, and exploring other potential causes of dysphoria while remaining explicitly open to the idea that transition is the best path for the patient.
The ways autism can mimic dysphoria (sensory issues, literal interpretation of gender roles, not understanding gendered socialization) should be discussed, and whether those factors are impacting the person's experience. Again, solely for their own understanding of themselves.
There should also be an understanding that many autistic people have difficulty interpreting their emotions, so they should be encouraged to consider multiple angles even if they still end up landing on their original interpretation. It shouldn't be assumed that they already have
5: Doctors need to be blunt about there being multiple types of "passing" — people thinking you are biologically the gender you identify as, and people understanding what you're going for and respecting it. Not in the sense that the former is BETTER, but again: literal & trusting
It needs to be explicitly clear that being treated as the gender one identifies as does not ALWAYS translate into being seen as that gender by society at large, and that they will never stop being trans. It's not a tragedy, but they need to KNOW. Literal thinkers may not.
They need to be able to make informed choices and that includes the kind of sucky knowledge that that they very well might be seen as trans forever. That might be totally fine with them — and there's nothing wrong with that — but they can only decide that if they're aware of it.
Basically, I think people deserve to know if they're autistic before making decisions like this and deserve to have all the facts, and to have them presented in an accessible way. I think autistic people deserve the opportunity to discuss the impact of their autism without fear.
As autistic people we DO have strengths, and one is that we tend to be highly logical. I think that, given the opportunity to discuss the reality of our situation without judgment or fear of losing access to care, we can really explore ourselves. Healthcare providers can assist!
In my ideal world autistic people (everyone, actually) would get a whole lot of mental health care and treatment for our very common comorbidities (depression, anxiety, etc) before doing informed consent, but the above are simply things I think could be fairly easily implemented.
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