Despite the identification of over 3700 distinct ABCD1 variants cataloged in the X‐ALD Mutation Database (Liu et al. 2022), a fundamental gap persists in understanding the mechanistic relationship between the spectrum of ABCD1 mutations, particularly those disrupting transmembrane and ATP‐binding domains critical for transporter function (Jia et al. 2022; Schleker et al. 2022), and the extreme clinical heterogeneity observed in X‐ALD. Here, ABCD1 is linked to adrenoleukodystrophy.