Extreme Male Brains and Impossible Women: Transmisogyny in Autism and Trans Research

• In Event: Transgender and Queer Embodiments

Abstract

Autistic transgender people report struggles accessing gender-affirming care, facing longer wait times, stricter scrutiny, and service denials due to their autism diagnoses (Adams and Liang 2021; Rios 2025). Yet little is known about the mechanisms behind this increased scrutiny. This paper analyzes scientific literature on autistic transgender people to understand how scholars conceptualize this intersection and what assumptions shape their knowledge production and clinical recommendations, to understand this differential access to desired embodiments.
I conducted qualitative content analysis of 51 scientific articles examining the intersection between autism and transgender identity, drawn from psychiatry, psychology, child development, medicine, and sexology journals. Using discourse analysis, I examined how authors explain the co-occurrence, patterns of differential treatment by gender, and clinical recommendations.
I find systematically differential treatment: transmasculine identities are conditionally legitimized when conforming to masculine stereotypes, while transfeminine identities face structural barriers to legitimation and pathologizing tropes rooted in transmisogyny. The Extreme Male Brain (EMB) theory—positing autism results from masculinized brains due to prenatal testosterone—provides a legitimation pathway for transmasculinity. Practitioners validate transmasculine patients exhibiting stereotypical masculine traits. However, EMB renders transfeminine identity theoretically incoherent. Despite studies showing trans women exhibit autistic traits at comparable rates to trans men, researchers ignore contradictory findings or propose different causal mechanisms rather than questioning EMB, revealing investment in biological essentialism and transmisogynistic assumptions.
Unable to make transfemininity coherent through biological frameworks, researchers deploy pathologizing tropes, invoking concepts like autogynephilia, characterizing trans women as delusional, and dismissing trans girls as "boys" with feminine "obsessions." Transmisogyny fundamentally shapes the research enterprise, influencing which theories gain prominence, how evidence is managed, and which identities are legitimized. I contribute to sociology of the body by demonstrating how transmisogyny and ableism converge in medical-scientific discourse, using autism constructions to differentially regulate trans embodiments and bodily autonomy.

Author

• Nic Rios, Barnard College