Debunking The Autistic Feminine vs. Masculine

Many pervasive falsehoods are still circulating in healthcare on autism and gender. It isn’t uncommon for diagnosticians to claim that autism presents differently in women to justify the diagnostic gap. An odd statement knowing that autism presents similarly in boys and girls up until the age of puberty (Lai, M. C. et al., 2015). Then how is it possible that women are so ‘difficult to diagnose’ according to practitioners?

In 2002, cognitive scientist, Simon Baron-Cohen, published his notorious ‘Extreme Male Brain Theory’ in autism (Baron-Cohen, S., 2002). The foundation of Baron-Cohen’s theory relies on the juxtaposition of the sex binary and the empathising–systemising (E–S) dichotomy. In other words, the male brain is programmed to systematise while the female brain is designed to empathise. Baron-Cohen argues that autistic brains are an extreme variation of the systematising (male) brain. Some (male) scientists later claimed that the ‘Extreme Female Brain’ leads, not to autism but to psychosis (Brosnan, M. et al., 2009).

These theories have been largely debunked, but the idea that women are more geared towards empathy than men remains. On the basis of this alleged difference, autistic women are generally believed to be…less autistic, more psychotic (Brosnan, M. et al., 2009).

It is only in the past decade that women and non-binary people began to be more generally diagnosed with autism. It was previously thought that the sex ratio for high functioning autism, the ‘most difficult’ type to diagnose, was 1 woman/12 men. As research on autism is becoming more gender inclusive, this diagnostic gender gap has been shrinking. Numbers are in flux but most studies currently suggest a 2:1 or 4:3 ratio. As it turns out women are not less autistic, they were simply less diagnosed until recently.

What was labelled as feminine autism: a better social performance due to supposedly higher empathy, was in fact high masking autism. The truth is that women are not inherently better at masking than men, they have to be better. Past the age of 18, it is estimated that 80% of autistic women remain undiagnosed (McCrossin, R., 2022). It is also common for women to be diagnosed with ‘everything in the book’ despite abundant evidence of autistic traits, before a practitioner realises that women can be autistic too.

Mis(sed)-diagnoses affect any autistic differing from the classic ‘male’ idea of autism. In other words, upholding archaic notions of gender, deprives many autistics from support and answers. It also potentially exposes them to further challenges. The longer autistics are left unsupported and misunderstood, the more struggles they will accumulate. This could lead them to develop severe anxiety, depression, burnout, eating disorders, suicidal ideation etc.

On top of that, 92% of biological female autistics suffer from premenstrual dysphoric disorder (PMDD), which severely affects one’s quality of life (Obaydi, H. & Puri, B., 2008). Without an autism diagnosis, few practitioners connect the dots and PMDDers are left unsupported.

Undiagnosed autistics are not only unsupported, they are also often abused. In childhood, autistics are particularly vulnerable to predators. Molestation is common among autistics regardless of their gender (Douglas et al., 2024). Rather than approaching it as a gender-related issue one should consider it to be ‘extreme autism vulnerability’. The vicious circle of abuse is likely to be repeated without an intervention. A study found that 9 out of 10 autistic women have been sexually abused, often repeatedly and before the age of 18 (Cazalis et al., 2022). Sexual victimisation rates have been shown to range from 27% for cisgender men to as high as 85% for trans men (Reuben et al., 2021).

With such adverse effects, the common justification ‘more difficult to diagnose’ doesn’t feel right. These traumatic events, occurring when there is a lack of support, result in lifelong scarring. Healthcare practitioners are not able to properly accompany autistics to heal from trauma unless there has been an autism diagnosis.

When it has been established that autistics all share the same core characteristics (Wells, N. & White, S., 2013) one should ask why the gender binary is still playing a defining role in autism care?

Most autistics are actually far from typical masculine and feminine representations. Autistics have a genetic profile tending to androgyny according to Bejerot et al (2012). Female autistics have higher total and bioactive testosterone levels, less feminine facial features and a larger head circumference compared to non-autistics. Autistic males tend to have less masculine facial features, higher voices as well as less masculine physical proportions (Bejerot et al., 2012)

It isn’t surprising then to to know that gender diverse individuals are 3 to 6 times more likely to be autistic than cis-gendered people (Dattaro, L., 2020) .

In light of these characteristics, it appears that the gender binary and gender bias really do not have their place in autism care and research. There is no such thing as masculine or feminine autism, or gendered intelligence, as the ‘extreme male brain theory’ suggests with its empathising-systematising model.