194 Chapter 10 Pérez-López, and Ly-Pen conducted describes that experiencedminority stress is one factor that justifies this association (2021). The interview and questionnaire study we conducted shows that several professionals share this view (Vrouenraets et al., 2015). They think that the negative impact of society can be a mediating factor, stating that society marginalizes minority groups. Indeed, various studies show that high rates of perceived stress and lack of support appear to be facilitators of psychopathology in the transgender population (Hoy-Ellis & Fredriksen-Goldsen, 2017; Witcomb et al., 2018). This perceived stress may lead to significant internalized transphobia, which appear to increase the depression and anxiety in the transgender population (Chodzen, Hidalgo, Chen, & Garofalo, 2019). Specifically, the suggested overlap between autism spectrum disorder and gender dysphoria/gender incongruence has been much disputed (Kallitsounaki & Williams, 2022). A recent review study shows that the prevalence of an autism spectrum disorder diagnosis in transgender individuals is 11%, compared to approximately one percent in the worldwide population (Kallitsounaki & Williams, 2022; Lai, Lombardo, & Baron-Cohen, 2014). Some suggest that a great part of the increased number of referrals to gender identity clinics involves transgender individuals who are on the autism spectrum, which may create additional challenges for clinicians regarding the assessment for GAMT and medical decision-making regarding the medical treatment (e.g. Lehmann, Rosato, McKenna, & Leavey, 2020). The aforementioned review study confirms a link between autism spectrum disorder and gender dysphoria/gender incongruence (Kallitsounaki & Williams, 2022). However, it does not provide tools regarding its consequences for care (Kallitsounaki & Williams, 2022). Several people claiming the risks of the use of early medical treatment for transgender minors, as well as people stressing the benefits of it, think that whether gender dysphoria and co-occuring psychopathology are merely interrelated or coexisting, depends on the individual and the co-occuring psychopathology (Vrouenraets et al., 2015). In our research, some stress that severe coexisting psychopathology should be addressed before GAMT in minors is started. Others state that, even though coexisting psychopathology may interact with gender dysphoria and related medical treatments, those two aspects may be the result of completely different underlying processes and should therefore have separate treatment plans, strategies, and goals (Vrouenraets et al., 2015). In line with this consideration, one could state that instead of focusing on only the transgender individuals, one should start ‘depathologizating’ gender dysphoria, and realise that these coexisting psychopathologies are not the result of gender variability in itself or that the gender variance is not a consequence of psychopathology (Littman, 2019; Paz-Otero et al., 2021). However, in order to gain more information about this association, further research is needed, while in clinical practice, co-occurring psychological difficulties may lead to ethical dilemmas when providing GAMT.
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