1
|
Del Can Sánchez DJ, Dueñas Disotuar S, Piñar Gutiérrez A, Japón Rodríguez MÁ, Olea Comas I, Déniz García A, Soto Moreno A, Mangas Cruz MÁ. Gender Incongruity in a Person with 46,XY and Complete Androgen Insensitivity Syndrome Raised as a Female. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2353-2357. [PMID: 34786658 DOI: 10.1007/s10508-021-02183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 05/22/2021] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
We present the case of a patient with female sex assignment at birth whose parents consulted with a pediatrician when the child was 12 years old, indicating that despite female sex assignment, she felt that she (henceforth "he") had a male gender identity and was gynephilic. Medical examination revealed a 46XY karyotype, a primary amenorrhea and an appropriate testosterone increase after HCG stimulation test. The patient was diagnosed then with a 46,XY disorder of sex development with androgen insensitivity syndrome, but then he missed subsequent appointments. At the age of 24, he resumed medical follow-up to reaffirm his male gender identity through sex reassignment surgery. His physical examination showed a Tanner stage III-IV breast development, vulva, clitoris, normal-sized vagina, absence of uterus and ovaries on transvaginal ultrasound, bilateral cryptorchidism on abdominal-pelvic MRI and osteoporosis on bone densitometry. The results of the blood tests were LH 24.5 mIU/mL [normal range, 1.7-8.6 mIU/mL for men] and testosterone 8.8 nmol/L [8.7-33 nmol/L]; conversely, FSH, estradiol, progesterone, and prolactin levels were normal. The molecular genetic analysis revealed an androgen receptor gene mutation associated with complete androgen insensitivity syndrome. At present, the patient has undergone bilateral orchiectomy and has initiated treatment with topical testosterone and bisphosphonates. We have yet to evaluate the effects and decide the best therapy taking into account that he has a male gender identity but complete androgen insensitivity syndrome.
Collapse
Affiliation(s)
- Diego Jesús Del Can Sánchez
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain.
| | - Suset Dueñas Disotuar
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Ana Piñar Gutiérrez
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | | | - Isabel Olea Comas
- Department of Diagnostic Imaging of the University Hospital Virgen del Rocío, Seville, Spain
| | - Alejandro Déniz García
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Alfonso Soto Moreno
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Miguel Ángel Mangas Cruz
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| |
Collapse
|
2
|
Abstract
Human gender-related behavior/psychology is shaped by a developmental system that involves numerous influences interacting over time. Understanding of the full range of elements in the system and how they interact is currently incomplete. The available evidence suggests, however, that early exposure to testosterone, postnatal socialization, e.g., by parents and peers, and self-socialization related to cognitive understanding of gender are important elements. This article focuses on prenatal and early neonatal influences of testosterone on gender-related psychological/behavioral outcomes, and contextualizes these hormonal influences within an understanding of socialization influences. There is consistent evidence that early testosterone exposure influences childhood gender role behavior, including sex-typical toy play, as well as gender identity and sexual orientation. Evidence for similar hormonal influences on spatial ability and on traits related to autism, or autistic spectrum disorder, is inconsistent. Evidence from girls exposed to elevated testosterone prenatally suggests that they experience alterations in processes of external socialization, as well as self-socialization, and that these, along with early testosterone exposure, shape gender-related outcomes.
Collapse
Affiliation(s)
- Melissa Hines
- Department of Psychology, University of Cambridge, Free School Lane, Cambridge, CB2 3RQ, UK.
| |
Collapse
|
3
|
Campo-Engelstein L, Chen D, Baratz AB, Johnson EK, Finlayson C. The Ethics of Fertility Preservation for Pediatric Patients With Differences (Disorders) of Sex Development. J Endocr Soc 2017; 1:638-645. [PMID: 28944319 PMCID: PMC5607629 DOI: 10.1210/js.2017-00110] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Differences (disorders) of sex development are diverse conditions with variations in chromosomal, gonadal, and/or genital development. Fertility potential in this population is variable. Recent investigations into fertility potential in those previously thought to be infertile suggest that the majority may have fertility potential through experimental protocols. Fertility preservation may be more successful if pursued in childhood. As fertility research and techniques advance, it is important to carefully consider pediatric ethical issues specific to this population, including gonadectomy, consent/assent, experimental treatment and false hope, cost and insurance coverage, genetic transmission to offspring, and gender dysphoria.
Collapse
Affiliation(s)
- Lisa Campo-Engelstein
- Alden March Bioethics Institute, Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York 12208
| | - Diane Chen
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611.,Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Arlene B Baratz
- Division of Breast Imaging, West Penn Allegheny Health System, Temple University School of Medicine, Pittsburgh, Pennsylvania 15212
| | - Emilie K Johnson
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611.,Department of Urology and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Courtney Finlayson
- Division of Pediatric Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois 60611.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| |
Collapse
|
4
|
Khorashad BS, Roshan GM, Reid AG, Aghili Z, Hiradfar M, Afkhamizadeh M, Talaei A, Aarabi A, Ghaemi N, Taghehchian N, Saberi H, Farahi N, Abbaszadegan MR. Sexual orientation and medical history among Iranian people with Complete Androgen Insensitivity Syndrome and Congenital Adrenal Hyperplasia. J Psychosom Res 2017; 92:55-62. [PMID: 27998513 DOI: 10.1016/j.jpsychores.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sexual orientation, relationship status and medical history of Iranian people with Differences of Sex Development (DSD) who were raised female. METHODS Our participants consisted of nineteen 46,XY individuals with Complete Androgen Insensitivity Syndrome (CAIS) and eighteen 46,XX individuals with Congenital Adrenal Hyperplasia (CAH) who were raised as females and older than 13years. As well as their relationship status and detailed medical history, an expert psychiatrist assessed their sexual orientation by a semi-structured psychiatric interview with them and, where applicable, their parents. RESULTS Five percent of CAH participants and 42% of CAIS participants were in a relationship, which was significantly different. All CAH individuals had been diagnosed at birth; 89% of CAIS had been diagnosed after puberty and due to primary amenorrhea and 11% were diagnosed in childhood due to inguinal hernia. Genital reconstructive surgery had been performed in 100% of CAH participants and 37% of CAIS. Regarding sexual contact experiences and sexual fantasies (androphilic, gynephilic or both), no significant differences were found. However, CAH females had significantly more gynephilic dreams (P=0.045). CONCLUSION This study, notable as one of the rare from a non-western culture, described sexual, medical and socioeconomic status of 46,XX CAH and 46,XY CAIS individuals living in Iran. Although broadly in line with previous findings from Western cultures, Iranian CAH individuals had fewer romantic relationships, but in contrast to previous studies their sexual orientation was only different from CAIS in the contents of sexual dreams.
Collapse
Affiliation(s)
- Behzad S Khorashad
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ghasem M Roshan
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alistair G Reid
- Molecular Pathology Unit, Liverpool Clinical Laboratories, Liverpool, UK.
| | - Zahra Aghili
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mehran Hiradfar
- Department of Pediatric Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mozhgan Afkhamizadeh
- Endocrine Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Talaei
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azadeh Aarabi
- Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nosrat Ghaemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
| | - Negin Taghehchian
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Hedieh Saberi
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nazanin Farahi
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Reza Abbaszadegan
- Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
5
|
Callens N, Van Kuyk M, van Kuppenveld JH, Drop SLS, Cohen-Kettenis PT, Dessens AB. Recalled and current gender role behavior, gender identity and sexual orientation in adults with Disorders/Differences of Sex Development. Horm Behav 2016; 86:8-20. [PMID: 27576114 DOI: 10.1016/j.yhbeh.2016.08.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 01/08/2023]
Abstract
The magnitude of sex differences in human brain and behavior and the respective contributions of biology versus socialization remain a topic of ongoing study in science. The preponderance of evidence attests to the notion that sexual differentiation processes are at least partially hormonally mediated, with high levels of prenatal androgens facilitating male-typed and inhibiting female-typed behaviors. In individuals with Disorders/Differences of Sex Development (DSD), hormonal profiles or sensitivities have been altered due to genetic influences, presumably affecting gender(ed) activity interests as well as gender identity development in a minority of the affected population. While continued postnatal androgen exposure in a number of DSD syndromes has been associated with higher rates of gender dysphoria and gender change, the role of a number of mediating and moderating factors, such as initial gender assignment, syndrome severity and clinical management remains largely unclear. Limited investigations of the associations between these identified influences and gendered development outcomes impede optimization of clinical care. Participants with DSD (n=123), recruited in the context of a Dutch multi-center follow-up audit, were divided in subgroups reflecting prenatal androgen exposure, genital appearance at birth and gender of rearing. Recalled childhood play and playmate preferences, gender identity and sexual orientation were measured with questionnaires and semi-structured interviews. Data were compared to those of control male (n=46) and female participants (n=79). The findings support that (a) prenatal androgen exposure has large effects on (gendered) activity interests, but to a much lesser extent on sexual orientation and that (b) initial gender of rearing remains a better predictor of gender identity contentedness than prenatal androgen exposure, beyond syndrome severity and medical treatment influences. Nonetheless, 3.3% of individuals with DSD in our sample self-reported gender dysphoria from an early age and changed gender, which further underlines the need for thorough long- term follow-up and specific clinical support.
Collapse
Affiliation(s)
- Nina Callens
- Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, Ghent, Belgium; Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maaike Van Kuyk
- Department of Medical Psychology, Radboud University Medical Center - Amalia Children's Hospital Nijmegen, The Netherlands
| | - Jet H van Kuppenveld
- Department of Medical Psychology, Radboud University Medical Center - Amalia Children's Hospital Nijmegen, The Netherlands
| | - Stenvert L S Drop
- Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology and Medical Social Work, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Arianne B Dessens
- Department of Pediatrics, Division of Pediatric Endocrinology, Sophia Children's Hospital and Erasmus Medical Center, Rotterdam, The Netherlands.
| | | |
Collapse
|
6
|
Brunner F, Fliegner M, Krupp K, Rall K, Brucker S, Richter-Appelt H. Gender Role, Gender Identity and Sexual Orientation in CAIS ("XY-Women") Compared With Subfertile and Infertile 46,XX Women. JOURNAL OF SEX RESEARCH 2015; 53:109-124. [PMID: 26133743 DOI: 10.1080/00224499.2014.1002124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The perception of gender development of individuals with complete androgen insensitivity syndrome (CAIS) as unambiguously female has recently been challenged in both qualitative data and case reports of male gender identity. The aim of the mixed-method study presented was to examine the self-perception of CAIS individuals regarding different aspects of gender and to identify commonalities and differences in comparison with subfertile and infertile XX-chromosomal women with diagnoses of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) and polycystic ovary syndrome (PCOS). The study sample comprised 11 participants with CAIS, 49 with MRKHS, and 55 with PCOS. Gender identity was assessed by means of a multidimensional instrument, which showed significant differences between the CAIS group and the XX-chromosomal women. Other-than-female gender roles and neither-female-nor-male sexes/genders were reported only by individuals with CAIS. The percentage with a not exclusively androphile sexual orientation was unexceptionally high in the CAIS group compared to the prevalence in "normative" women and the clinical groups. The findings support the assumption made by Meyer-Bahlburg ( 2010 ) that gender outcome in people with CAIS is more variable than generally stated. Parents and professionals should thus be open to courses of gender development other than typically female in individuals with CAIS.
Collapse
Affiliation(s)
- Franziska Brunner
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Maike Fliegner
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Kerstin Krupp
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| | - Katharina Rall
- b Department of Obstetrics and Gynaecology , Tübingen University Hospital
| | - Sara Brucker
- b Department of Obstetrics and Gynaecology , Tübingen University Hospital
| | - Hertha Richter-Appelt
- a Institute for Sex Research and Forensic Psychiatry , University Medical Center Hamburg-Eppendorf
| |
Collapse
|
7
|
Disorders of sex development: management of gender assignment in a preterm infant with intrauterine growth restriction. Case Rep Med 2012; 2012:587484. [PMID: 22489245 PMCID: PMC3318260 DOI: 10.1155/2012/587484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 12/01/2011] [Indexed: 11/18/2022] Open
Abstract
We describe how a gender specialist team managed the case of a disorder of sex development in a preterm infant where definitive diagnosis and gender assignment were delayed due to complications of prematurity, anemia, and severe intrauterine growth restriction.
Collapse
|
8
|
Cadet P. Androgen insensitivity syndrome with male sex-of-living. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:1101-1104. [PMID: 21809174 DOI: 10.1007/s10508-011-9823-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|