Medical symptoms and conditions in autistic women

Abstract

The sex bias in autism diagnosis suggests the involvement of sex-specific endocrine mechanisms during prenatal development, but these hormones affect health throughout life. Therefore, the current study examined the association of autism and autistic traits with conditions and symptoms related to the sex-steroid system in adult women. In total, 1230 women (361 autistic), aged 15–77 years, reported on autistic traits and medical history. Medical diagnoses and symptoms were grouped by unsupervised factor analysis, and associations with autism diagnosis and autistic traits were explored. Higher rates of reproductive system diagnoses (odds ratio = 1.035, p = 0.024), prediabetes symptoms (odds ratio = 1.319, p = 0.001), irregular puberty onset (odds ratio = 1.458, p = 0.009), and menstrual length (odds ratio = 1.368, p = 0.034) and lower rates of metabolic and vascular conditions (odds ratio = 0.654, p = 0.013) were associated with diagnosis. Reproductive system diagnoses (β = 0.114, p = 0.000), prediabetes symptoms (β = 0.188, p = 0.000), menstrual length (β = 0.071, p = 0.014), irregular puberty onset (β = 0.149, p = 0.000), excessive menstruation symptoms (β = 0.097, p = 0.003), and hyperandrogenism symptoms (β = 0.062, p = 0.040) were also associated with autistic traits. Many of the conditions and symptoms found to be associated with autism or autistic traits are also related to conditions of steroid hormones and, specifically, the sex-steroid system. The study suggests an important role for steroids in autistic women, beyond prenatal development. Clinical implications are discussed. Lay abstract Sex-steroids, such as testosterone, are thought to be one of the biological factors implicated in autism. This relies on the sex bias in the diagnosis of autism (boys are approximately four times more likely to be diagnosed than girls) and findings of associations with fetal testosterone levels in traits and abilities related to autism. The current study aimed to examine the association between medical conditions and physical symptoms, which tend to manifest in adulthood, and autism in females. Moreover, we examined their association with autistic traits throughout the spectrum. We focused on autistic women because there is little research focusing on the healthcare needs of autistic women, but those that exist suggest heightened vulnerability, and lower access to medical care. We find that conditions related to steroid hormones function are more frequent in autistic women and that they correlate with autistic traits. Specifically, we found that body mass index, reproductive system diagnoses, prediabetes symptoms, irregular puberty onset, and menstrual irregularities were significantly more frequent in autistic women and were significantly correlated with autistic traits in neurotypical women. The findings have important implications for raising awareness in autistic women of the possibility of medical conditions which might need medical attention. In addition, healthcare providers should consider these associations when performing healthcare maintenance checks and/or screening for autism.

Sex-Related Neurocircuitry Supporting Camouflaging in Adults with Autism: Female Protection Insights

“…Intriguingly, higher FC between the hypothalamus and limbic reward circuits predicted more camouflaging, better cognitive control/emotion recognition, and showed no association with depression/anxiety in ASD-F, suggesting this "male-typical" FC pattern may be particularly adaptive. The observed "male-typical" patterns supporting camouflaging in ASD-F are consistent with the fetal steroidogenic hypothesis, [81][82][83][84][85] given that such exposure in females would result in "male-typical" brain features. 12 However, the growing literature on sex differences in the brain suggests that both masculine and feminine processes interact with individual genetics and environment across development in a time-sensitive manner to produce an individual's brain "mosaic."…”

“…Various lines of evidence have linked elevated prenatal sex steroid exposure [81][82][83][84][85] to ASD.…”

Sex differences in placental markers and later autistic traits

“…Similar maletype patterns have been noted in autistic females' personality traits, facial structure, and brain structure (37)(38)(39). Autistic females also have higher prevalence in steroid-related symptoms and conditions (including PCOS and metabolic dysfunction) (13,40,41). In tun, these conditions have been variably linked to the effects of the placenta, which is hypothesised to 'programme' the developing endocrine and nervous system of the fetus (7,42).…”

The link between autism and sex-specific neuroanatomy, and associated cognition and gene expression

“…This is in line with clinical findings indicating that autistic females may be characterised by a relative imbalance between androgens and estrogens, rather than high steroid levels across all pathways (83, 84). Conditions related to androgen/estrogen imbalances in females (e.g., polycystic ovary syndrome) have previously been linked to autism likelihood in both mothers and their children (85–88). Further, estrogen-regulated signalling can influence region-specific neurodevelopmental male-shifts and affect neuronal excitation(89–91), but more studies are needed to demonstrate this in human-derived cell-models.…”