The relationship between gender and autism is an underexplored topic, and one in which the psychoanalytic literature on gender is relevant. The therapist examines her failing to have understood the importance of gender issues for an autistic male child and his family and the ramifications of this oversight to help in the development of “gender creativity” (Ehrensaft, 2016). The gender issues included an initial absence of gender (the meaning of which will be clarified),  a subsequently emerging wish to be a girl, and then a powerful, in part reactive wish to be a male. This case highlights the early sensory issues in the development of gender, dyadic work with parents in the treatment sessions, countertransference reactions related to gender, and the relevance of thinking psychoanalytically about neurodevelopmental disorders.