Dissertations, Theses, and Capstone Projects
Date of Degree
9-2025
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy
Program
Sociology
Advisor
Barbara Katz Rothman
Committee Members
Thomas DeGloma
Paisley Currah
stef shuster
Subject Categories
Disability Studies | Gender and Sexuality | Lesbian, Gay, Bisexual, and Transgender Studies | Medicine and Health | Science and Technology Studies
Keywords
transgender, autism, normativity, medicine, stigma
Abstract
Growing scholarship reveals significant co-occurrence between autistic and transgender experience. However, autistic transgender people have reported considerable struggles obtaining gender-affirming medical treatments (e.g. hormone replacement therapy and chest and genital surgeries). This study uses: 1) qualitative interviewing of autistic transgender people and providers and gatekeepers of gender-affirming care, 2) participant observation of a trans health conference, and 3) content analysis of scholarly literature on the intersection between autism and transgender identity to understand the micro and meso factors that contribute to inequitable access to gender-affirming care for autistic transgender people.
I argue that autistic transgender people are held accountable to neuronormativity, a normative framework that privileges and naturalizes “neurotypical” behavior while marginalizing and pathologizing “neurodivergent” behavior. When autistic transgender people deviate from neuronormativity, they are liable to be held to account through longer wait times, greater surveillance, stricter guidelines, and occasionally outright denial of care.
The dissertation begins with an overview of the medicalization of autism and trans experiences and synthesizes the literature on accountability, gender, and critical autism studies to develop the term neuronormative accountability, which provides the theoretical framework for the ensuing chapters. Chapter 2 analyzes how the intersection between autism and transgender identity is constructed by the scientific community. Chapter 3 delves more deeply into the concept of neuronormative accountability, using insights from interviews with autistic trans people. I show how patients who deviate from neuronormativity are liable to be held to account by providers and clinical staff. Chapter 4 centers insights from interviews with care providers and participant observation of a trans health conference. I examine the ways that providers construct themselves as patient-centered allies and facilitators of GAC, problematizing these practices in the context of autistic trans people’s experiences and perspectives. The final chapter discusses theoretical and empirical implications for the study of transgender and autistic people’s lived experiences.
This study builds on the scholarly understanding of transgender people’s experiences with the medical system by providing a framework for examining how neurotypicality is enforced as an underlying requisite for transnormativity. It builds on the scholarship on autistic people by unraveling the processes of medical and social regulation.
Recommended Citation
Rios, Nico, "Fragmented Access: The Role of Ableism in Shaping Gender-Affirming Care Experiences for Autistic Transgender Individuals" (2025). CUNY Academic Works.
https://academicworks.cuny.edu/gc_etds/6362
Included in
Disability Studies Commons, Gender and Sexuality Commons, Lesbian, Gay, Bisexual, and Transgender Studies Commons, Medicine and Health Commons, Science and Technology Studies Commons
