Episode 13: Working with Autistic Transgender and Non-Binary People with Isabelle Hénault

Dr Isabelle Hénault, is the Director of the Autism & Asperger's Clinic at Montreal. She is a sexologist and psychologist from the University of Québec at Montréal, Canada. Her practice and studies have focused on providing diagnosis, education and support to children,
adolescents, adults and couples living with Autism and Asperger's Syndrome. Dr. Hénault has developed a relationship and sex education program and works with individuals and groups to increase their understanding of sexuality and conducts relationship counseling. Asperger Syndrome and Sexuality was her first publication (with Jessica Kingsley Publisher in 2005). She is presently collaborating on numerous international research initiatives involving socio-sexual education, interpersonal relationships and gender identity. Dr. Hénault is the co-
author of The Autism Spectrum, Sexuality and the Law (Attwood, Hénault &
Dubin) published by Jessica Kingsley Publisher, London (2014). In 2020 she published a book
that was co-authored on the Female profile of Asperger syndrome (Hénault & Martin) at
Chenelière Education.

Contact Information:
Clinique Autisme et Asperger de Montréal
http://www.clinique-autisme-asperger-mtl.ca/
514 990-3373

Here are links to resources that Isabelle mentions during this episode:

Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents

“I Don't Feel Like a Gender, I Feel Like Myself”: Autistic Individuals Raised as Girls Exploring Gender Identity

Transcript

0:07  
Hello, and welcome to the autism in real life podcast. In each episode, you'll get practical strategies by taking a journey into the joys and challenges of life with autism. I'm your host, Ilia Walsh, and I'm an educator and the parent of two young adults, one of which is on the autism spectrum. Join me as I share my experience and the experiences of others. So that we may see the unique gifts and talents of individuals on the autism spectrum, fully recognized. Hello, everyone, and welcome. This is Ilia with the spectrum Strategy Group. And today, I'm very excited to have Isabelle Henault on here with me. We have worked together in the past. And, you know, I'm really happy that we're here for very specific topics. So that's exciting. And, Isabel, if you want to just introduce yourself, like I always say it's always better if people give their own backgrounds and they know it way better than I do.

1:04  
Okay, good. Thank you so much for the invitation. So I'm Isabella No, I work in Montreal, and I'm the director of the autism and Asperger's clinic. We run some assessment for children, teenagers and adults. We also provide some group sessions because I'm also a sexologist on the top of being a psychologist. So I'm very interested in sex education and counseling. And of course, today we will talk about gender identity. We also work with women's because we now have more information on the female profile of autism and Asperger's syndrome. And we also work with couples where there can be one member of the couple who's under the spectrum or sometimes both partners who may have traits of autism or Asperger's Syndrome. So it's a I would say, a wide variety of services. And we also collaborate with school boards, of course, and different organization that provides services for adults on the spectrum.

2:01  
Awesome. And yeah, I mean, I think it's always I know, when I first heard you speak, you know, the the whole eye topic of sexuality and autism and how that sort of overlaps was interesting, because we, I think we always get so caught up in the education and you know, all of the all of the other stuff, we forget that we're also talking about people I know, at the time, it was more like we were talking about adolescence and moving into adulthood. But, you know, during those conversations, I know, we would often you and I would talk about, you know, we're noticing that there's this overlap with gender identity and people on the autism spectrum, and it's like, well, well, what is that? And you know, having worked in adult services, I was hearing these conversations, parents were coming, you know, not knowing what do I do? How do I, what do I do as pretty much a lot of the questions. And I also know clinicians and educators same thing. And I think there's more, there's definitely more education out there. And there's definitely more information. But I also think sometimes I'm in a little bubble, because I get to work with people like yourself, and I work with other psychologists and other people who are doing this type of work. So for me, it seems, I don't know, it seems like a given like, it's, it's normal for me, but for other people who are, you know, just entering into this, I think this is a really important topic. So. So yeah, I really want to talk a little bit Emmanuel, you said you were working on a new book called working with autistic, transgender and non binary people. And as I say that to me that I totally understand what that means, I think. But I know that there are people listening in who are like, you know, I'm not really sure what that's about. And just like other sexuality topics, what you know, and again, sex, sexuality, gender, all different things. But they're all uncomfortable topics, right. And I think people are afraid to ask, I want this to be a safe space where people they don't have to ask, they can listen in. And, you know, get a little bit more than what they knew before. So can we talk a little bit, you know, step back a little bit about what you mean, just by the title of your new book coming out?

4:13  
Yes. So that's such an important topic. And I would say probably about 15 years ago, I started to work with teenagers and adults on the spectrum who were exploring their gender identity. So I've learned a lot from my work, clinical work. And eventually, I was very lucky to travel in Scandinavian countries where they are quite advanced when it comes to gender identity. So we worked in research programs together, we did some clinics. And then I was I was, in a way very relieved to conclude that we have the same observation so they're a higher correlation when it comes to autism and gender identity quest. So we receive teenagers and adults who may search about their identity in a different way because of course they have autism or Asperger's Syndrome. their profile and characteristics are different. And the way we address it also sometimes, maybe more, I would say, detail. So they ask us question about is this normal? For example, if I feel that I'm stuck in the wrong body? Is this okay? Do I have what we should count gender dysphoria. So we discover that there seems to be more flexibility when it comes to autism and gender identity, because social norms and pressure are not felt the same way by our students and adults on the spectrum. So they really go with how they feel inside. And there seems to be more flexibility when it comes to integrating male and female characteristics. And for some of them, it's not a conflict. So that's the important aspects. So I've started to work with this, I will say this very important topic, that it may not be something linked to a pathology, but mainly a different way of exploring gender identity. So that's how it started. And since then, I've seen lots and lots of clients come into our clinic, and also as I sit in other countries, as well. And I was approached by Marianne P. Corty, who's the editor of the book that will come up in October, and we've discussed previously together and other clinicians, and she wanted me to explore factors that may lead to this quest for identity. And later on today, we can talk about three different hypothesis, clinical hypothesis that I developed over the years. And that gives us a lot of information about how to support these teenagers and adults.

6:42  
Oh, awesome. Yeah. So let's, let's get to that, then. Yeah. So so? No, definitely. And I think I want to, I want to, again, look, let's look at the I know, you're talking to other colleagues about correlations. And again, the the glossary of terms and the language would be, I would say, would be, you know, a common for you, and maybe for myself. But for a lot of people listening in, it might not be or for, you know, I do have a lot of adults listening in as well, who are also beginning this quest, or on the quest, thinking about, well, I don't even I don't really even understand what all of the terms what all these terms mean. So can you help? Can you help us? Like, just give us sort of like that background? Schema? Yeah,

7:28  
yes. So when we come when we approach this topic of flexibility, many adults will call themselves non binary, because binary means male or female. So when they think about who they are as a person as a whole, not just in their body, but the way they feel, they may see that there is a combination of male and female traits. So non binary is usually a term that they may use. And also Marianne T Corty. I think she's very brilliant, she made up a word called all TGM for autism gender. So the autogen would be a very special unique way for many individuals on the spectrum to consider this flexibility, where it's not a conflict again, where they can, you know, dress in a neutral way. So gender neutral, that's another term that is used by many of our teenagers and adults. So they are more neutral, meaning that they will integrate both male and female, sometimes in the way they dress up, or they may use a neutral pronoun as well, like Alex is a very common one, where you don't define yourself to a name that would be male or female. And again, the integrate these characteristics that I think is fascinating, I think it's a color and rich color, that express that they may express to their personality. So the quest in itself, of being more flexible, we see it in a clinical way and research way in about 30 35% of our clients coming to the clinic. I'm a bit like you in your position where you work in the field. So people coming to us at the clinic, of course, they have we may be have this bias because they will search for information and in support, but out of all my clients. So that's a large number 335.

9:18  
Out of this, of this group, we may also have some sometimes students or adults who, eventually when we work together find, we find together that there may be underlying conflict, that may explain why they want to search or sometimes transition. An example is not necessarily accepting the diagnostic. So I work with some individuals who for many reasons, maybe the diagnostic was not explained in a proper way or in a positive way, and they want to become a new persona. I have some of them who say if I become let's say a girl or a boy, I will be a new persona so I won't have autism anymore. So if there's underlying conflict, we will work with the person, of course, to try to find some ways to deal with the conflict. For example, accepting the diagnostic and developing most of the time, a lot of social skills, because some of them the conflict, maybe due to difficult childhood, or going to school where they were teased or bullied. And they felt that's the word they use that they didn't fit in with their peer group. So not fitting in may lead to a quest of becoming a new person again. So that's why we focus on the assessment. This is something we can talk about. We have tools now and good questionnaires to fully assess, you know, their question. So if it's linked to bullying, teasing, lack of social skills, we will build these skills with them give them more confident, and if they become more sometimes popular, they may say, okay, so I will stay myself, this is not what I'm looking for anymore. And the other hypothesis, the third one is really, if I have to use the term gender dysphoria, but this is not the term I use at my clinic. But we from the DSM, this is what we need to call it gender dysphoria used to be called gender identity disorder, I think this term, and especially in our field of autism, so I usually call it more transitioning. So someone with autism or Asperger Syndrome who wish to transition, so there's different steps after the assessment and knowing the person very well, we will address if there are underlying issues or conflict. But sometimes really, their path is to have a transition that can be hormonal changes, partial surgery, up to full surgery. And if that's the case, we will work with the individual their family, we try to collaborate with parents as well, even if they are adults. In terms of getting right support, we will work with other professionals in the field doctors, surgeons, so they will have a better idea of the needs of our clients. So this is more or less the way we work at the clinic with this kind of tree hypothesis to make sure that if we follow someone to transitioning, it is the right decision, because we don't want to sometimes go to quickly not knowing the person and then make a decision that may not be the right decision. But if it turned out to be the good decision, we have a committee at the clinic with psychologists like myself sexologist and we have a special educators. And we will then support the individual to access services, because years ago, one of the problem that I found is that some of our clients were not accepted in transgender clinic, due to their profile of autism. So other professionals were not too keen to work with them due to lack of information, or they were unsure how to understand the request. And some of them were refused by clinics. And then as you can imagine, it will increase you know, anxiety, sometimes depression, we had also some clients who were suicidal, because that was really their project and their pap. And since they were refused, they were at risk of you know, being in distress. So that's why I'm I'm promoting a better understanding of this complex issue. But in our field, as you know, we have specialists in the world of autism, and then we have specialists in transgender care, that rarely both worlds joined together.

13:41  
Right. So what would be? So how is that how is it different because I know as it is, resources in both areas are limited, especially in the the gender, transgender, you know, arena that's super limited. So to cross them together to have that intersection with both is even more challenging to find. But what so So aside from talking about resources, let's talk about you know, the reasoning for overlapping the two I know, you talked a little bit about it, but how would that how would someone a clinician or you know, even a parent who's just starting to have these, you know, conversations? What, what a what a, what is the difference, I guess, between one or the other and the need for combining them together?

14:29  
And definitely, I think we have to take into account the social aspect that is linked with autism. I was talking earlier about sometimes social pressure to fit in, or to have partners boyfriend girlfriend, and some of our teenagers or adults may experience a delay in the development of their social skills or abilities, but also in terms of sexual development. So this is super important because when we work with a person with autism, I always take into account that there can be a gap or a delay in terms of the maturity. So this is why they may start to question themselves later on as a teenager, and even adults. And that's something we don't find outside of the field of autism. If we work in transgender care in general, usually, the questioning or the request will be before or around the age of puberty. As when we work with students on the spectrum, they may be 1718. And sometimes adult, as I said, because they start to think about sexuality, they start to think about themselves their own identity later on. And that's why many of them, unfortunately, were rejected from protocol and clinics, because the initial definition in the DSM is that it should happen prior or during puberty. So that's one aspect that we really need to focus on. So that this delay, and also the way the person may experience or express their quest about identity, they may not use the words that were thinking about because they expressed himself in a different way. And sometimes they can be very literal. So for example, I was working with him a teenager, and he, he, he came to the clinic, and he said Isabel, and feeling good in my body as a boy, I would like to become a girl. And I started to explore with him why the reasons. And he said, you should know you're the expert. So you know, I said, we need to discuss it. So we really need to follow them and explore this concept. So again, is to make sure that this is the right pathway for them. So the social impact is very important to Deeley as well. And for them to start to think about who they are as a person in terms of their gender identity, it is a very complex issue. So that's why in the field of autism, that we work with our clinic, is we take our time, and that may be something very different from other colleagues, and I'm more than okay to discuss it, some of our colleagues would be more critical and say, The moment someone mentioned that they want to transition, you should say yes, and then offer services. At our clinic, we take more time, because from experience, as a, as I was saying, previously, we want to make sure that this is the right decision. And it's gonna take time, it's a lifetime, you know, decision. And we really need to explore with our clients, also the aspect of transitioning, so to make sure that they fully understand what it means talking about hormonal changes, talking about surgery, sometimes, it's almost like they go on internet, and they read information, is this the right information? Sometimes, yes, sometimes no. And I want for them to make sure that they fully understand. And also including their parents, and sometimes partners, because I work with adults who wish to transition once they are in a relationship, some of them also have children. So it's a as you as you can think about it, it's quite an adaptation for everyone in the surroundings in the environment. So working closely with the person. And we're also using a very interesting document, maybe that's something we could share after the podcast. It's a document you can find online on initial guidelines when it comes to transitioning in autism. And the authors are also talking about a very important aspect linked to autism is executive function. So that's something that we find in some of our clients. And they may have difficulties in day to day organization, planning steps. And when you think about transitioning, you will have lots of appointments, you know, checkups, you need to go and see different professionals. And if you decide to transition after the surgery, you have to take care of yourself. So we also want to make sure that we address the executive function skills. So we are using some questionnaires and tests. And if we feel that one of our students or adults may need support, then we will work with a team, my special educators will be with them. Sometimes on a weekly basis to check if everything's fine if they're following, you know, all the steps required. Just an example taking the hormonal therapy, so you need to take your meds every day. So, so that's a complex issue that can be very practical in some way. But also, my work as a sexologist and psychologist is really to, to get in in a deeper way to fully understand this concept. Again, the flexibility is very common, and it may not lead to transitioning, but really living in a positive way. This non binary gender are, as we were called it autogen as well and being accepted, you know, by families, friends and eventually maybe co workers as well.

19:58  
Yeah, so it was funny you I was gonna mean you back to the flexibility piece that you mentioned before? Because I think, you know, when, if someone, you know, I'm thinking about other people who might not have the same background, right, they're looking at transgender, though that word seems like oh, it's very extreme, just like what you're saying is, you know, we there's a lot of steps in there, we need to really think about that process and what you know what it all means, if we go down that kind of path, and then non binary, that also has its own, you know, challenges and its own areas to think about, but also can be so liberating, and so freeing for so many people. I also think about, I think many people get confused about, you know, particularly we're talking about the non binary piece of this, people get that gender identity term confused with sexuality, or who people like to have sex with, you got to be really specific. But I think so. So if you can help people understand that I remember going to a training and someone explained it super well, they use these three continuums. But I'd like to hear how you kind of explain that I'm thinking like, you know, you, you probably have parents or educators that come in and say, Can you please help me understand, you know, all the different aspects of what we're talking about here?

21:23  
Yeah, so that's very important, what you just mentioned. So the first thing that we explore is the identity, the self identity concept, who are you as a person, and then we will explore the gender identity? Is it male, female, non binary, neutral, and then we will talk about sexual preference, because that's another layer. And most of the time, my experience, when I work with teenagers and adults on the spectrum, their sexual preference has nothing to do, or their sexual orientation has nothing to do with their gender identity. So some of us will confuse it. And sometimes I work with parents, and they say, oh, maybe it's because my son is almost sexual, or bisexual. So they kind of, you know, mix this concept that has, in fact, nothing to do. Because when we do the assessment, we ask a very specific question to, you know, to our clients. If you transition or you become, let's say, you know, the opposite sex, will it change your sexual orientation, and 99% of the time, they say, No, this has nothing to do it. So if I work, let's say, with a born female, was interested in women as well, transitioning will have nothing to do with the preference, the preference will stay the same. If there is a mixed up, or a change in your preference, that could lead us in the assessment to explore if there is a conflict them. Because most of the time, there are two separate things. So that's very, very important. So that's why when we work with the circles of identity, we will start with the, you know, the self identity, gender sexual preference. And we will include this in how do I see myself as a person with autism or Asperger's Syndrome, because again, as I sit there, that could be a delay in the maturity sometimes also, that's something I really need to share with you. Lately, we had some consultations, where some of our students were confused, they were just confused with the terms. And they thought that if they don't know yet, if they are interested in boys or girls, they may be trans. And this has nothing to do with it. So part of our work is also sex education to make sure they understand the words the meaning, and how does it reflect, you know, in terms of their own identity. So this is also what we work with parents, we have a group session for parents, where we explain the difference between orientation identity, and how everything is all connected with autism.

23:58  
I would say I think the other piece that goes into that is expression as well, gender expression, because I've also worked with people who say, Well, the way I feel inside and the way I want to express myself, for others might appear different and can also change. So there's a flexibility in that as well.

24:20  
Definitely, and I feel it's more common in autism and Asperger's Syndrome. So the self expression, this is something we truly encourage, when we work with teenagers and adults. So they find more control, you know, the more you express yourself, the more you're in control. So this is something we explain to parents because sometimes they're against some of our suggestion to say oh, don't you think you're encouraging my son or daughter. So, this is self expression, because many of them the experience high anxiety and we understand of course by nature, they tend to be more anxious. So if on the top of it, they cannot express who they are, you know, it can be to clothing accessories, being very open about this flexibility or combination, they will feel more anxious. So we encourage them to experience in fact, so we call it exploring and experiencing, and that reduce a lot of distress, less depression. And we try to initiate these exploration in safe zone. So most of the time we start at home. So when they're at home or in their bedroom, they can choose neutral clothing, or even opposite sex clothing, because that's an expression. And sometimes, I don't want to sound superficial, but it can be the color of clothing, just last weekend was a teenager, and he said, You know, I'd love to wear more purple, but purple at school, you know, I'll be teased and bullied. So let's start purple at home. And he felt so comfortable and happy. And he said, I can express myself, I feel I'm true to myself, if I wear this color, sometimes it can be again, changing pronouns at home, I was working with a family last weekend, mom said that after a few months of discussion, they, they're okay now to call him, let's say, Alex at home. So that reduces anxiety, you know, of their daughter, because she finds that she can be neutral and accepting these, you know, changes as slowly, gradually, and we encourage the person also to experience and then we come back at the clinic and we discuss how do you feel in this situation? You know, did you felt less anxious that you felt that you were more assertive, for example, and this is a positive progress. And, you know, years after it's been years now, and many, many of our students and adults said that they didn't know that they could have this permission. And they asked me sometimes do you give me permission is that LSA I'm not there to choose for you. But I give you permission to really explore who you are, and be assertive. And many of them with this smooth transition, that is just the starting point said to me, I'm okay for now. Because that's also a worry when it's too quick, maybe we're, you know, we're not following the right steps. So taking time to experience feel, you know, in different clothing, colors, whatever haircut, and some of them said, I'm okay, for now, I don't necessarily feel that I need to go for hormonal changes. In other cases, they come to us and they say I just want to have a neutral body neutral feature. So hormonal therapy, may be an option for them. So that's why when we assess, and we feel that this is really important for them, we will work with colleagues, for them also to accept because in the initial work, when we work in transgender care, the moment you go to a clinic, that the other professionals and colleagues, they have in mind that you will transition up to surgery. But in the field of autism, many they request in the wish for hormonal therapy, and that's it. So they have a neutral body, or more feminine, in some cases are more masculine traits. And they're happy, you know, with their body features. So they find themselves in clothing, wherever accessories, colors, but also within their body, and that defuse tension and problems, and they feel more happy. So this, I would say, new, I don't want to use the word category. But this is a new area where years ago, never, you would just go for hormonal therapy, you would go for the full surgery. And now we work with a very fine group of surgeons in Montreal and also doctors who accept to go with hormonal therapy, and then to wait and see how things go because we refer them with clients with autism and Asperger's Syndrome. So that's pretty new interview.

29:00  
Yeah, I'm just that's the first I've heard of that. You know, that step of that process where we kind of pause there, and kind of see how people are feeling in that area. And I, I don't feel like it's, it's I don't feel like it's new. I think I kind of knew people were doing that. But I guess to actually explore it as an option for like, sort of staying there that that's, that feels new to me that I have not heard that. So yeah.

29:30  
Yeah. And that's why we work closely with our clients on a weekly basis most of the time or every second week just to see their progress. We assess their mood all the time to make sure they're not too anxious or depressed, because that's a big, big issue for them. And the more they are assertive and feeling good within their own body, and then it usually increase their quality of life. And this pause is not force. We go with them. We go with the flow, but we don't necessarily promote you know, Making quick changes, because we've seen from research and clinical work that, and with clients with Autism and Asperger Syndrome, if you go too quick, there may be risk of regrets. And that's another issue. Because imagine you go to all the transitioning. And finally, let's say there was underlying conflict or misunderstanding or whatever, and the changes are there, and it doesn't solve the issue. So again, you find you find yourself in, you know, a situation that can be critical. So that's why we want to make sure that they make the right decision. And if yes, we will follow them as far as they want, of course.

30:38  
Yeah, so I think about, you know, parents who are educators, for clinicians who might be working with people who say, you know, all the things that you've just described, where does someone start with that, you know, I think, especially if you know, your, your child is on Spectrum, or a student is on spectrum or client. You know, it's, it's like, oh, well, first, I think many people might feel like, they're kind of Whoa, I don't know what to do. I don't know what to do with this. But what would you suggest would be the, you know, a first step where people can kind of go and say, okay, but also understanding this overlap. So I would say, well, so that's one question, I guess, where do people start? And then I also think about, you know, either late teens or adults thinking about, you know, wait, I think this might feel like this resonates with me, and I need to explore this further. I think because of lack of resources on both sides, you know, someone may not disclose to, you know, someone who has experience with transitioning, they might not disclose the autism. And so now from what you're telling me, I think that would be that's a huge component of that. So and again, I don't know, I haven't, I don't know the process, detailed enough for someone who's not on Spectrum, what that looks like. But I would think there would be a lot of investigation into all different things. But so I guess those are the two. I know, they're two big questions, but one is like,

32:13  
but it's interesting. So where to start? For parents, I would definitely recommend reading about it and getting some information. In the book that will be published by Marianne T Corty. There will be lots of resources, and also explaining the importance of knowing about autism, and also gender identity. So the book will be a good good one, there's also the initial guidelines that I will share with you that is really, really important as well. And I'm careful about the information we share with parents and our clients. Because I don't want to sound negative, but you know, if you go online, you can find everything. And sometimes information online, it may not be the right one, there can be sometimes promotion of becoming transgender with some people in different groups that we don't know about. So we made a list of very good information. It can be more clinical educational, but also for families. There are books now on how to work with your children, if and how to understand your children or as educators. So I will share with you the list of resources. So that's the first tip I say, the second one is really, I will say something that may sounds funny, but my clients, they tell me all the time, Isabel, maybe you're the first one really asked me. You're asking me, and you're listening to me. So I don't take anything for granted. So I will ask them, How can you explain to me why do you want to become a burger, so addressing the issue with the person and saying, Tell me, in your own words, sometimes they don't know how to express it. So that's why we'll take time and we will give them tools to help them understand and express, you know, their questioning. So we will guide them in the discussion. So I know that sounds weird, but I asked them, and I listened to them. And I'm very patient. That's why I can take time with some of my clients who are maybe confused, not sure that they feel that they are accepted, they are not judge, and that will give them opportunities to discuss. And I most of the time we invite parents in our session. And I know most of my colleagues say if you work with someone who's over 14 in Canada, in Quebec, parents don't have even to know about the process. I encourage my students to say maybe mom or dad can, you know, sit with us. So we discussed together because if there is transitioning in this, they are still living at home. We want harmony, we want support for everyone. So I will share information with my colleagues, to parents and also to our students. So that's the first thing I would recommend is to read about the dual. Okay, autism and gender identity NTT together. And the second question, you were asking because you are so huge questions, but you were talking about transition it. Can you just maybe give me more details about your second question?

35:15  
Yeah, sure, I'm thinking about a, you know, an elite teen or an adult that might be thinking that, you know, transition might be a way to go or looking to explore this journey a little, you know, a little more. And I like how you say, you know, like your quest. But then oftentimes, I think that in in the mainstream world, but everything we're talking about here is not mainstream, but let's just say in the mainstream world, you know, they might go to a specialist in transitioning, but they might not know that someone that that person has autism, so, so that I think that's a huge, important piece of disclosure. You know, in healthcare, I think,

36:00  
yeah. So just to answer your question, I'll tell you a short story, and then I'll answer your question. Years ago, I was traveling to Sweden, and I met the director of one of the largest transgender clinic, at the hospital, they're in they're in SoCal. And I was presenting the hypothesis and discussing my clinical cases. And at lunchtime, she came to me and say, Isabel, we need to talk. So I was like, whoo, super impressed. She wants to talk with me. And she said, you know, what? It's been three, four years. So that's about five years ago. So now, maybe eight or nine years ago, she said, every time we receive a new request at the gender clinic now, we also assess autism, because they also discovered that, you know, 30 40% of their new request, where individuals on the spectrum, so that's so coming back to your question, definitely, knowing about autism and Asperger's Syndrome, from my perspective, is super important, because it's going to change the course, of transitioning the course of exploring, thinking about the flexibility as well, because this is particular to autism. So we encourage colleagues to also think about autism, but not necessarily severe autism, think about Asperger's Syndrome, as well, because we work with some clients who, as you know, who can have, you know, different skills and different profile of autism. And they fall under the radar, because they adapt the camouflage a lot, some of their difficulties, especially females on the spectrum. So knowing and thinking about autism, I think is very important. Otherwise, there is a risk, I'm not saying that necessarily is going to be negative, but the risk is maybe to misunderstand the person go too quickly, and not, you know, supporting the aspects that are so important in our field of autism. So I'm giving a lot of training at the moment, discussing with the other colleagues, we do a lot of supervision to teach them about the artisan profile. So they learn more. So this is what we were saying at the beginning of our discussion. The two fields are coming along together slowly, slowly.

38:18  
No, and I think that's, that's super important. And I think, you know, not just from the clinician side, but also from an adult exploring, I think, in this situation, you know, we talked about disclosure, at other times that this would be an important place, I think, to to have that conversation about disclosure.

38:40  
Definitely. And that's why also working with many professionals in the field, since they come to our training, and that's a topic we discuss more and more people know more about autism and Asperger's Syndrome 10 years ago, and they're starting to make this connection. About two weeks ago, I was discussing with an educator in a school, and she contacted me because she said, you know, we have a student who's talking about maybe exploring, transitioning, and she said, we thought about referring her first for an assessment for autism or Asperger's Syndrome. She said, Is this the right you know, way to go? So you have nothing to lose everything to gain. If it's not autism or Asperger's Syndrome. Okay, we'll rule it out. But anyway, in our assessment, we also need to assess mental health issues because if we work with someone who may be to distress or someone who may have psychotic episode, that's something we need to consider because we want the person to feel as stable as possible before, you know transitioning. So thinking about autism is now something that we promote more and more definitely, and that's why we will publish the book. In fact, in the book, there are some specialists in the field of transgender care professionals in the field of autism. So we all joined together there. And in the book, there is also a chapter from an adult who transitioned in, in in, in our 50. Can you imagine, and talking about adult transitioning as years ago, never never, someone would say, that's impossible because you have to, you know, transition as a teenager or young adult. But now we know that with autism and Asperger's syndrome that can come later on in life.

40:26  
Yeah, and I think it's important to note that it's not just because I think people with autism might get concerned that that would add a stigma to, you know, help getting the help and the support that they need to make a decision like this. But I also think that, it there are some real, just some very, I think I'm thinking of it as adding it to the checklist of right, whatever the processes for working through this journey, it's, it's like an add on to the checklist. And it's, and it's for very real circumstances, just like with with mental illness, you know, the fact that we're doing some very biological changes with hormones, and and I hadn't even considered, you know, the executive functioning piece, like with the care, like, all of those pieces are very tangible, you know, things that we can actually hold on to why that connection is so important, I think,

41:25  
exactly. And it's a complex issue. That's why, you know, we take your time to explore. And in the guidelines, this is what the authors are also referring to making sure that you know, you take the right direction, because it can be a long process months and years when you think about it, and we haven't talked about after the surgery. So I'm working with adults as well, who've been through surgery, like genital surgery, hormonal therapy before, of course, and I work with them also to make sure that after the transitioning, first they are safe, because you know, as you can imagine, after huge surgery, there are always some risk, to make sure that they have a safe place to go, they have care that's very important and self care of their genitals as well. So we will explore in details, all these aspects and making sure that they're okay. And, in fact, you know, it's a new transition for them becoming a male or female, and some of them are in couples as well. So we also work with couples where there are lots of adjustments, not just physically speaking, but also in terms of their relationship and sexuality. One of the couples I've worked with a few years ago, it was super interesting. And the male became a female. And they were in couples. So they became two females together, and they had children on the spectrum. So a lot of the work we did also was preparing the children to the transitioning to make sure that they would feel okay, they would understand. And I was in a good way, super happy surprised to see that the children were very accepting. And they say, that is now mum, but it's a person before everything else. So it's still my parents, and they adjusted very well. Sometimes in other families that may be a bit more tricky or difficult. So we will do some work together, again, to understand accept the difference, and working with couples as a sexologist, also the sexual adjustment, when it comes to intimacy, I won't go in detail today, but very important, and accepting your new body, you know, pleasure as well, sexual desire, and how the couple can be intimate together. The good news that I also want to share with you is that when we took time to do the work in the right way, and there was full transition, so far, there hasn't been any regrets in our clients. That's something that I'm very happy to share. But again, it's because I take time, and I'm okay with sometimes criticism from other colleagues to say, if you work with Isabel and her team, it's gonna take time, and I am okay with that. I assume, as I said, I don't see how things could be different. Because our clients are complex. And I'm not saying this in a negative way, but they are different in complex. So we need to address everything around to make sure that this will be a success, and exactly what they wanted. And the adjustments to be more positive.

44:29  
Yeah, I mean, I would think a decision like this would would and should take time and I think just like all, you know, other types of self discovery and exploration, it takes time and I would, I would hope that someone you know, and those listening will find someone who will take the time to listen to all the different pieces and educate on all the different aspects because it's not, you know, it's sort of like rediscovering, like you said yourself and rediscover covering how you move through the world, and how you relate to people who are in your family, and friends, and then how that changes, and then meeting new people and how that kind of fits into the paradigm. So I would hope someone would take time to help.

45:18  
And we have we talked briefly about, you know, sexual orientation that if they wish to have a boyfriend, girlfriend, during transition, or after transitioning, we talked about this as well relationship and disclosing yourself to your new boyfriend, girlfriend. So these are important aspects. Another thing is, when I work with younger students, and they're still going to school, I go to school with them. If they asked me, of course, they make decisions, I'm just there to support. And we've done some, I think, very positive experience of talking to a classroom, one of my student was transitioning during summer. So at the end of the year before summer, and I went to school with him, and she would he would become a she in September, okay. And I explained gender identity, we talked about autism, we talked about the transition, and how it was positive for this person to transition. And we did the presentation together. And that was one of the probably most positive experience I had in school. And we choose carefully what we would disclose to, of course, respect confidentiality. But you know, my client said, you know, if you come with me, I'll feel better in case they have tricky questions. So I gave him her time to discuss and disclose. And after maybe half an hour, 40 minutes, there was a big sound and no sound sorry, in the classroom, like big silence. So we looked at everyone and I said, are you okay? And all the students lift up, and they started to clap, and say, congratulation, while your break. And I had goosebumps everywhere. And, you know, my client looked at me and I said, this folks. A few years, and I'm still like, so touched by the start. And the students came around in the circle him and say, What will be your pronouns? How can we call you back in September, so that was super positive, and then the teachers were there, and professionals the direction of the school, you know, and they were more like concern. So after this, very good vibe, positive will coming from students, I left them together in I went and talked to the direction of the school and other pressure, and they are the one who had lots of issues and misunderstanding. So they were less accepting in a way, then the student. So that was very interesting. So since then, we've decided to work with teachers, educators, that's why today, I was very happy to collaborate with you. To explain the, I would say, yes, the party clarity, but also, if someone will wish to transition, this is all the steps that we have done together to make the decision. And this is the next step coming. So that was a very fine and positive experience. So going back to the issue we're discussing just before taking time, so that can be part of the work I do. So I won't do this in a week. So we needed to prepare, you know, the students with me to, you know, to feel assertive enough and to share this very personal information as well. So that's part of the kind of protocol that we use.

48:30  
Yeah, and I think you know, all of this, you know, that that story sort of emphasizes, you know, why having this conversation is so important, because ultimately, we want individuals to feel accepted and, and celebrated for who they are, who they truly are, and to build that authenticity. And this is yet another piece of and a huge piece for many people of how they can feel authentic and be who they really are.

49:00  
Definitely, and this is why this process is important. And I am that's why I'm always really willing to work with them. The moment we have a request at the clinic, we work as a as a group, that's something maybe I forgot to say, I'm not working alone. So we have all the team aside, to make sure that we really cover all the important aspect. And again, it can be at home at work at school. And this being assertive and being happy with who you are, will bring quality of life and this is my main goal as well. So no matter the transitioning, honestly, I'm working with a person, I'm not working with someone who transition. So even we don't really use the term when we work together trans whatever. I'm working with Alex with Eric, I don't mind. I'm with you, and I'm going to follow you and we will work all together so you will be happy. And we see some very good outcomes and positive outcomes of students and adults who finally they say it's a huge relief, I can be who I am, I can celebrate this difference. And remember, some of them are in this flexibility zone. And they can be gender neutral, agender autogen, how, no matter that we call it, I'm fine with that. And just being happy with that and say, again, you know, I know I talked about this before, but they say I didn't know, I could choose to me just flexible non binary without going through the full transitioning. And you see that comes from education in discussing with them, that we explained that we have some of our students who are in different, you know, zones, or different steps in the course of exploring their identity. And this is not something you find online, when you go online on internet and you search, gender identity teachers, whatever, it's very rare that they may say, Oh, you can be a flexible person. If that's the case, that's why I want to discuss it and explore. If not, of course, I'll follow the person. But just having this new concept that we talked about, and that's my chapter in the book that will be published is this is the reality we seen in many of them. And parents also do need to worry about.

51:16  
Yeah, no, absolutely. And I think that's a great way to kind of, you know, hold on to that and help understanding that we're working with a whole person, and no matter what areas and I think that that's a theme that keeps coming up over and over again, regardless of what topic I'm talking with, is like we're working with a whole person, we're not working with a label, and we're not working with a diagnosis. And so I appreciate you bringing that to this work as well as super important. So if people want to find more information about all the things we've talked about today, where can they where can they go?

51:57  
The book, I think contains most of the information because we've we've been working for more than a year and a half with this group of professionals and adults on the spectrum, I will share some resources with you as well, that you could maybe put online with the podcast, and also at the autism and Asperger's clinic at Montreal, we're on Facebook, and we have a website. And we have the list of services professionals working and we also share most of the information is on our Facebook, of course account. And then there will be more and more publication I think in the future because that's a topic that is so important and very interesting. This morning, I was discussing with a French editor who's interested in translating the book that will be published in English. And the editor said a few years ago, we were starting to publish on autism now where we publish sexualities, sexuality in the law, now it's going to be gender identity. So I was super happy because I said this is such an important part, you know of the quest of many of our students in an orphan. This is a topic that now we talk in the society, not just in the field of autism, we talk about neuro diversity, gender identity, everywhere. So we need to have more, I say information, especially a better understanding and better support, giving access to the services and the right protocol. We also work with them a questionnaire that was adapted for clients with autism exploring gender. It's called the gender questionnaire. And it's very interesting because we have questions linked to autism and flexibility and sexual identity and sexual preference. So we really go in detail to make sure that we cover all the aspects. So we don't use a general protocol. We use one that is adapted to autism and Asperger's syndrome. And this is something that in the next year, I wish that I'll be able to publish. We call it the protocol of services. And then I would share the questionnaire that guidelines, the type of work we do in a very practical way. So to support parents and educators, if ever they need someone who's questioning which direction to take.

54:13  
Okay, excellent. So we I will post all that information in the description of the podcast and if whatever resources you send me, I will put all the links in there. So thank you so much for sharing all that with me and I look forward to working with you again in the future.

54:31  
Yeah, thank you very much.

54:32  
Thank you Take care thanks for listening to autism in real life. This is Ilia Walsh. And if you like the show, please hit subscribe so you can get notified each time a new episode is released. You can also join my email list to get more information on the podcast, receive blog posts and my newsletter. If you have suggested topics for the podcast or would like to be A guest please reach me on social media or through my contact page talk to you next time

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