When we talk about gender-affirming healthcare, we like to imagine a space where people are respected, heard, and supported. But for many autistic and neurodivergent people, that version of care feels very far away.

During my Masters in Research and our paper Exploring the Experiences of Autistic Transgender and Non-Binary Adults in Seeking Gender Identity Health Care we explored what it’s really like for autistic people navigating gender identity services — and what came up time and time again was a sense of frustration, exhaustion, and constant self-questioning.

Here’s what we learned.

“Do I Tell Them I’m Autistic… or Not?”

One of the biggest themes was around how healthcare professionals respond when someone mentions they’re autistic.

Several people described how a doctor’s attitude suddenly shifted the moment they disclosed their autism. Before that, they were treated like any other adult having a conversation about their health. But once autism was mentioned, the tone changed—voices became softer, slower, and… patronising.

One participant shared that their doctor even started speaking to their friend instead of them, assuming the friend was their guardian. When they corrected the doctor, the reaction wasn’t apologetic—it was annoyance.

That kind of treatment leaves people feeling trapped. If you don’t mention your autism, you might miss out on the support you need. But if you do mention it, you risk being treated like a child.

Many participants said they’ve stopped disclosing their diagnoses altogether. Some said they go into appointments hyper-aware of everything—how they’re sitting, whether they’re making too much or too little eye contact, if they’re smiling the “right” amount.

One person summed it up perfectly:

“I kept wondering, am I personing correctly?”

Carrying that kind of worry into a medical appointment. It’s hard to focus on what’s being said, let alone make important decisions about your healthcare.

When “Accessible” Care Isn’t Actually Accessible

Even when people can access gender identity healthcare, the logistics can be overwhelming.

For example, in Wales, there was no gender identity clinic established until 2019. Patients had to travel all the way to London for every appointment—sometimes a five-hour trip each way. And these weren’t one-off visits; they were ongoing. You might have to go for therapy, for blood tests, for consultations with specialists… over and over again.

Some people would have to do this journey without the use of a car, or whilst juggling work or childcare. It’s not just tiring—it’s impossible for many.

In the U.S., it’s often even worse. Without insurance, gender-affirming care can be financially out of reach. One participant admitted they nearly gave up seeking care altogether because they couldn’t afford to start something they might not be able to finish.

“It’s just too upsetting,” they said. “What’s the point if I can’t keep going?”

Accessibility isn’t just about having clinics—it’s about making sure people can actually get there, afford it, and cope with the experience.

“You’re Not Doing Gender Right” — The Non-Binary Experience

Another big issue was how many gender clinics still see gender through a binary lens: as simply trans men and trans women only. If you’re non-binary—or if your transition doesn’t fit a binary path—you might not be taken seriously.

One autistic, non-binary person told us that their clinic literally removed them from treatment, saying they “weren’t a priority” because they weren’t transitioning from one gender to another in the “traditional” way.

Others said they were questioned for wanting top surgery but not bottom surgery, as if there’s only one “right” way to be trans.

“It’s like they were saying, you can’t really be trans,”

And when you add autism into that mix, some practitioners even question whether you “really understand” your gender at all. To suggest we don’t understand ourselves because we’re autistic isn’t just ignorant—it’s cruel.

Curiosity Shouldn’t End with a Degree

One of the biggest takeaways from this work was that healthcare professionals need to stay curious.

A degree, even a PhD, doesn’t make someone an expert forever. Language evolves, research changes, and communities grow. If you’re working in gender identity care—or any kind of care—you have to keep learning.

That doesn’t necessarily mean going back to school. It means following autistic and trans advocates online, reading up on current community issues, or even just listening to what your patients are saying. As one person put it:

“Knowledge isn’t static. People change, society changes, and care has to change with it.”

This is the foundation of inclusive care.

So Where Do We Go from Here?

Gender identity healthcare is supposed to be about affirmation, safety, and dignity. But for many autistic and neurodivergent people, it’s still full of barriers.

Being treated with respect shouldn’t depend on whether someone “acts” the way a doctor expects. Accessing care shouldn’t mean traveling hundreds of miles or proving your gender in a way that fits someone else’s checklist. We can—and must—do better.

That starts with curiosity, empathy, and a willingness to unlearn. It starts with asking questions, and understanding that accessibility isn’t a privilege—it’s a right.