Aspergers and Transexuality (gender dysphoria)

[aerogal]

New here.  My son is an Asperger and asked me what it was called when a boy likes a girl but also wants to be a girl.  I listened first, and then summarized Tony Attwood's findings on this topic  - i.e., many AS kids move to other sexual groups during adolescence (for reasons he provides).  But I was left wondering if this was enough.  It did not seem so.  Even Attwood's explanation, while appealing to common sense, was not air-tight for me.  I did some homework.  And I want to provide the results for others who are searching on this topic since it involved cross referencing new research in both fields. I would - of course - support the final direction my son takes.  But I am going to give him the following information first and let him decide:

According to Psychoneuroendorinology (2009):
There is "normally a surge in cortisol upon awakening.......Now UK researchers report that this response is absent in adolescent boys with Asperger Syndrome..."

According to Gender Dysphoria Organization (re: Sex Hormone Tests) on Testosterone:
..."Most cases of congenital adrenal hyperplasia are caused by 21-hydroxylase deficiency which is associated with excessive androgen production.  The enzyme deficiency blocks cortisol synthesis..."

FINALLY.. Searching on Congenital adrenal hyperplasia due to 21-hydroxylase deficiency, I find:
                ..."genetic males .. simply need hormone replacement..."

So all this tells me that AS males do NOT produce cortisol due to a deficiency in 21-hydroxylase enzyme.  But hormone replacement therapy can help.

I don't want to quote-unquote change my son because I could care less if my kids are transsexual, homosexual, bisexual, etc.  But if this situation is caused by a hormone deficiency secondary to his Aspergers, then it seems to make sense that I should give him the information and option of hormone replacement therapy - and let him decide. 

[cynthialee]

I am intrigued.
I have it mildly (aspbergers) and have heard there is a loose conection between the two.
I do know that most of us that are transsexual would not take a cure that made them happy with the body they have. (we have polls on just such topic somewhere on this site.) We want what we want, what we are. I highly doubt that increasing cortisol could treat dysphoria. I would not consent to said treatment I wouldn't want to be happy being a male. I am female and any messing around with my mind would make me not be me. Being trans sucks but it is a blessing in a curse and in a way it is precious too me. I can not even begin to explain to a cisgender how much more of the world we see because we are trans.
I wish you and your child the best resolution to this issue you can find.

[rejennyrated]

It's a fascinating thought but I think you have to bear in mind that being Transsexual is a bit like having cancer.

We routinely talk about cancer as if it were a single condition with a single cause and a single prognosis. The fact is there are many different causes, many different types of cancer, and indeed even if untreated, many different prognoses.

I firmly believe that our condition is EXACTLY the same. We are simply not all the same. For example as far as I know I never suffered with any other developmental condition other than mild dyslexia - which I was actually cured of - ironically by being sent on a speed reading course.

What I am absolutely NOT saying is that any of us are any more or less genuine, or indeed worthy. What I AM saying is that treatment has to take into account the wishes of the individual concerned AND just importantly that I hope one day we will all wake up to the idea the the "one set of rules fits all" approach of the international standards of care is woefully inadequate.

I think you must talk to your child about this and find out what they want. After all it is their life, but at the same time I do have to say that if you are looking for a quick fix then I fear you may be dissappointed. If it was that simple I honestly think someone would have realised by now.

[Little Dragon]

Any advise anybody has for Aspergers Syndrome people wishing to become a transgirl/boy would be most helpful, I have AS and its making my transition rather difficult and complex..

The problem is that the two dont go together well, since ->-bleeped-<- is all about change, whereas autism is fearful of change.. Becoming a girl fo rme is very scary for me because of the anxieties and nervous-issues that my autism brings..

Thanks in advance for any words of wisdom <3

[tekla]

woefully inadequate

Well said.  I've used the cancer analogy myself, saying that treatments range from a simple out-patient scraping to 'pick out your tombstone.'  Life's a long time, and there are some things that take longer to work out than others.  Quick fixes rarely are.

[no_id]

First off all; thanks for taking the time to make this thread. It's an interesting topic, and definitely one pondered over as you can see in the replies above.

I think it's definitely worth discussing with a professional. Perhaps his state of mind is influenced by a biological factor, but as Jenny points out; there isn't one set trigger. Nevertheless, in my opinion it's very-much worth investigating to what extend the lack of cortisol is a major player in this. Say it is the major player then that definitely brings your son's gender psychology on a whole different discussion plateau.

Personally I have often wondered in the past if my gender dysphoria was linked with my pdd-nos so definitely an interesting read.

[spacial]

If I may, I will say this.

It really doesn't matter if your son has Asperger or anything else. The psuedo science mombo jumbo is irrelevant.

All that matters is what he wants to do with his life and how he is going to achieve it.

May I suggest, that if his interest continues, you offer to buy him an outfit?

He can choose what he wants, within limits of course. He can try it on. He can wear it round the house. He can go outside, if that's what he wants.

And if you don't mind, may I make a second point?

You are a great mother.

[findingreason]

This is a most interesting thread....there could be a connection. As mentioned before, it's up to your child about what to do and such, because it is their life. I whole heartedly agree with Little Dragon about her issues with AS getting in the way of transition, and for me it's been a long road of bumps and potholes getting through this, since as much as my life changes, big changes still intimidate me. (likely why I have not transitioned yet, despite trying on more than one occasion...) 

I will be checking this thread as it progresses.... ; )

[Flan]

Thanks in advance for any words of wisdom <3

other then a *competent* therapist, acceptance of the situation at hand is (usually) the first step in adapting to situations.

just my opinion, but it's all and dandy knowing why something happens, but it doesn't change that something has to happen.

I don't want to quote-unquote change my son because I could care less if my kids are transsexual, homosexual, bisexual, etc.  But if this situation is caused by a hormone deficiency secondary to his Aspergers, then it seems to make sense that I should give him the information and option of hormone replacement therapy - and let him decide. 

if it was CAH, then a endocrinologist would be better suited to understanding the patients situation then a book author on the internet.

ps: gender identity isn't the same as sexuality, a trans woman can be lesbian too
https://www.susans.org/wiki/Trans_101

[aerogal]

 
I completely agree. The idea is to provide my son with the information upon which to make an informed decision.  The best choices are those made with a full understanding of all the options and ramifications.  I have a good background in AS and full library.  It did not take me long to gather this research and piece it together.  I'm not sure why others have not.  I've sent this conclusion others in the field and hope someone will take it from there.  I'd like to hear from an endocrinologist who might have insight into this.

[Jasmine.m]

A correlation does not equal a cause. For example, there is a strong correlation between ice cream sales and drownings during the summer months; i.e., both rise sharply. Does either cause the other? No. While the two are vaguely related (correlate), the cause is more likely due to the warm weather.

The same can be said of Asperger's and TG... While there may be a correlation, there is no reason to think there either is causing the other.

At this point, any cause and effect research on the subject of ->-bleeped-<- is merely theoretical; there is no clinically relevant findings on the topic. It's as vaguely studied and defined as the so-called gay gene. You will find those that use both sides and argue everything in between.

[aerogal]

 
Uggh.  Well, my dopey dir.  I replied to one post without realizing so many had responded. 

First I want to be very clear that all my kids know that I love them and accept them no matter who they are or what they do (lets not quibble on lawfulness, etc.  you know what I mean here).  I feel this way about anyone.  It is about who someone *is*.   And sometimes it is not even that if someone is having a bad day. You never know.

Anyway, from what I've seen (and heard in the AS conferences) there appears to be a high correlation between gender issues and AS.  Attwood has his own theories.  When I looked into it I found this new cortisol research.  Since I'm *not* an endocrinologist, I'm going to give my son these papers, see if it makes sense to him, and then see if he wants to see an endocrinologist.  If not.. that's fine with me.  If he does (and all my info turns out to be a waste) then that's fine too.  Either way, it is worth looking into if it means he will have additional information one way or the other.

In the end, I want him happy.  What mom doesn't?  And he asked if I minded if he shaved his legs.  Why would I?  It is his body and his life.
Post Merge: May 04, 2010, 11:58:14 AM

A correlation does not equal a cause.
Math major here!  I know!
Post Merge: May 04, 2010, 01:04:36 PM

just my opinion, but it's all and dandy knowing why something happens, but it doesn't change that something has to happen.

Knowing why something happens is important.  And in many cases knowing and understanding cause can alter the outcome.  If I know I am coughing because of pneumonia (the why), I can take antibiotics and change the outcome (of dying) to survival (and no cough).
https://www.susans.org/wiki/Trans_101

[Just Kate]

How old is your son?

[Asfsd4214]

New here.  My son is an Asperger and asked me what it was called when a boy likes a girl but also wants to be a girl.  I listened first, and then summarized Tony Attwood's findings on this topic  - i.e., many AS kids move to other sexual groups during adolescence (for reasons he provides).  But I was left wondering if this was enough.  It did not seem so.  Even Attwood's explanation, while appealing to common sense, was not air-tight for me.  I did some homework.  And I want to provide the results for others who are searching on this topic since it involved cross referencing new research in both fields. I would - of course - support the final direction my son takes.  But I am going to give him the following information first and let him decide:

According to Psychoneuroendorinology (2009):
There is "normally a surge in cortisol upon awakening.......Now UK researchers report that this response is absent in adolescent boys with Asperger Syndrome..."

According to Gender Dysphoria Organization (re: Sex Hormone Tests) on Testosterone:
..."Most cases of congenital adrenal hyperplasia are caused by 21-hydroxylase deficiency which is associated with excessive androgen production.  The enzyme deficiency blocks cortisol synthesis..."

FINALLY.. Searching on Congenital adrenal hyperplasia due to 21-hydroxylase deficiency, I find:
                ..."genetic males .. simply need hormone replacement..."

So all this tells me that AS males do NOT produce cortisol due to a deficiency in 21-hydroxylase enzyme.  But hormone replacement therapy can help.

I don't want to quote-unquote change my son because I could care less if my kids are transsexual, homosexual, bisexual, etc.  But if this situation is caused by a hormone deficiency secondary to his Aspergers, then it seems to make sense that I should give him the information and option of hormone replacement therapy - and let him decide.

Umm, sorry but I fail to see any relevance to the actual topic here. I'm having trouble connecting the dots here.

Cortisol isn't even a sex hormone and doesn't really have anything to do with sexuality or sexual identification. It has a lot of other functions, such as stress response and immune function, but nothing really to do with sexuality that I'm aware of.

Cortisol levels may have some relationship with aspergers, but it doesn't make a whole lot of sense that it would have much if anything to do with gender issues.

And is aspergers is linked to low cortisol which is linked to high levels of androgen. The only hormone replacement could be of cortisol, or maybe suppression of androgens. None of which seems to have any bearing on gender. And this is just my EXTREMELY uneducated guesses going on what's in your post.

[Sally Martin]

I'm sure there's a connection. I suspect myself to be an asperger and I'm MtF, and have had a lot of social problems all my life. I'm trying HRT and all my autistic symptoms have evaporated more but they come back if T is raging. I'm also genderblind in some ways.

I too came to that I have problems with cortisol as it seems I never really wake up since I entered manhood, other things are that I'm able to feel compassion and I respond toward people with feeling, it's quite amazing. In many ways I don't believe I'm able to socialize well because of my age and anxiety, but I really don't care anymore I need to feel human inside.
regards Sally

[pebbles]

Well It's extremely logical and consistent with our understanding that CAH would cause Autism + Aspergers. Given that the popular theory of Autism is that it's caused by a Hyper-masculinized brain.

The fact that we have a number of MTFs here reporting That they feel they have aspergers or have been formally diagnosed as such would run against all knowledge about what we currently understand in regards to the causes of transsexuallity.

Ie that MTFs are produced by poor neurological Androgen signaling during critical growth periods.

Potentially showing that it's all in our heads and there is no physical root of GID.
I'm just saying. I'm not making physical claims but if there is a connection then transsexuallity is a lie and invented body dysphoria maybe like anorexcia or Body Integrity disorder.

However it would make a great deal of sense that CAH would (And has infact been apprently shown to) cause FTM's to appear and that FTM population would have a higher level of autistic members than a XX control female population.
http://www.ncbi.nlm.nih.gov/pubmed/9047259

Then again it might be the cause that certain transsexuals don't have any neurological cause of there dysphoria but others might. Add Austisic MTFs to this group of seeming paradoxes.
http://www.springerlink.com/content/4w515837q0821487/
http://www.ncbi.nlm.nih.gov/pubmed/20358272
If you have CAIS it's by all measures physically impossible to develop a "male brain" but there they are. I can't deny there exsistence.

It raises an intresting question reading about these cases makes me wounder it seems all the more likley if we do invent a brain scan for detecting transsexuals, I wounder how many post transition pepole will test negative for that mythical factor.

[Just Kate]

While you do a great job of explaining a potential threat to the legitimacy of GID as a biological development, Pebbles, I wouldn't worry too much about it or anyone finding a real connection.

Despite the number of people who claim both some form of autism and GID it is likely anecdotal at best and self-deception at worst.  Even if there is a correlation, co-morbidity is so common in psychology, correlation alone is no real evidence of causation.

Still... if I wanted to oversimplify it at the risk of sounding offensive, is it so hard to believe that people who think they are a gender that is different than their anatomical sex might have some social issues?

[kate durcal]

Eur Child Adolesc Psychiatry. 2005 Aug;14(5):292-6.
Comorbidity of Asperger syndrome and gender identity disorder.

Kraemer B, Delsignore A, Gundelfinger R, Schnyder U, Hepp U.

Psychiatric Department, University Hospital, Culmannstrasse 8, 8091 Zurich, Switzerland. bernd.kraemer@usz.ch
Abstract

The case of a 35-year-old biological woman with Asperger syndrome (AS) and gender identity disorder (GID) fulfilling DSM-IV criteria is reported. Against the background of recently emerging theories of cognitive male pattern underlying autism we present additional psychological assessments in order to discuss any possible interaction or discrimination between AS and GID. Whilst we explain GID as a secondary feature of AS, we examine the assumption of the necessity of treating GID in AS as a primary GID in accordance with international standards. We consider the treatment of GID as compelling, particularly because curative therapy for AS is lacking and with GID treatment in this vein, the patient gains psychosocial improvement

[VeryGnawty]

A correlation does not equal a cause. For example, there is a strong correlation between ice cream sales and drownings during the summer months; i.e., both rise sharply. Does either cause the other? No. While the two are vaguely related (correlate), the cause is more likely due to the warm weather.

I agree.  There is an extremely high correlation between boating accidents in Michigan, and the amount of ice cream consumed in Texas.  However, this does not mean that my massive consumption of ice cream is causing people to be clumsy.  As it turns out, people don't like boating in cold and ice.  By a strange coincidence, people also have a tendency to eat ice cream when it is hot.

More often than not, correlations are caused not by the variables being tested, but by an outside variable.  In all likelihood, GID and other disorders probably don't have much direct linkage with each other, but they are probably the result of a root cause which is neither GID nor Asperger's.

There is also a ludicrously high correlation between the number of fire engines dispatched to a fire, and the amount of damage caused by the fire.  However, this doesn't mean that dispatching fire engines causes damage to buildings.  In fact, it is the opposite:  larger fires do more damage, so more fire engines are dispatched to extinguish the flames.

Determining causation is very difficult.  Even when it is obvious that variables are related, it is often not obvious how they are.  Very often people view the world in terms of fires and fire engines, when the universe is more like ice cream and boats.  Things which correlate readily often have no direct linkage with each other, but they all have a direct linkage with something else which the scientists probably aren't testing for and may not even know about at all.

[Carlita]

@ Aerogal ... This may be an unfashionable or transsexually-incorrect opinion, but if I could have been given a magic pill when I was in my early adolescence and first experiencing the pain and confusion of Gender Incongruity, that would have saved me decades of heartache and made the lives of my wife and children far easier and happier too.

@ Pebbles ... I don't know what you mean by 'invented' psychiatric conditions, but as a parent whose daughter almost died from anorexia I have to tell you that there is nothing invented about that terrible condition at all. The fact is that no one knows what causes anorexia, nor is there any real cure for it, other than somehow keeping the patient alive and bombarding them with care until - with any luck - they find the strength in themselves to begin a process of personal recovery. Personally, I was struck by the similarities in my daughter's experience of body dysmorphia to my own experiences of gender dysphoria. The significant difference, of course, is that the cure for anorexia means overcoming the dysmorphia, whereas that for GID involves acknowledging and acting upon the dysphoria. In both cases, of course, the most important consideration is just keeping the patient alive. Both conditions, after all, have a strong suicidal component and/or risk.