Journal of Pediatric Endocrinology and Metabolism · 2005 · 117 citations · 11 references
MedicineEndocrinologyPediatricsHuman GeneticsPediatric EndocrinologyReproductive EndocrinologyAndrogen DeficiencyCongenital Endocrine DisordersGender IdentitySex DifferentiationSexual DifferentiationSexual DysfunctionCongenital Androgen DeficiencyCraniofacial Developmental AnomaliesDisorders Of Sexual DifferentiationGenital Ambiguity AssessmentMixed Gonadal DysgenesisPartial Androgen Insensitivity SyndromeSex Chromosome AbnormalitiesSexual Differentiation Disruption
The study compares declared sexual identity with sex‑of‑rearing among individuals with disorders of sexual differentiation. The authors evaluated 84 patients aged ≥5 years, classifying them by conditions such as cloacal exstrophy, partial androgen insensitivity, mixed gonadal dysgenesis, hermaphroditism, craniofacial anomalies, and congenital adrenal hyperplasia, and documented their sex‑of‑rearing and declared sexual identity. The results show that among Y‑chromosome patients, 53 % declared male identity (especially those with active prenatal androgen effects), while among 46,XX CAH patients, 55 % declared female identity; overall, 69 were reared female but only 32 lived as female, 29 as male, and all 15 reared male lived as male, indicating that prenatal androgen activity strongly predicts male identity independent of sex‑of‑rearing.
To compare declared sexual identity to sex-of-rearing in individuals with disorders of sexual differentiation.All 84 patients > or =5 years old in a pediatric psychosexual development clinic were assessed for sex-of-rearing and sexual identity. Diagnoses included 1) male-typical prenatal androgen effects but an absent or severely inadequate penis - 45 patients with cloacal exstrophy or aphallia; 2) inadequate prenatal androgens and a Y-chromosome - 28 patients with partial androgen insensitivity (pAIS), mixed gonadal dysgenesis (MGD), hermaphroditism, or craniofacial anomalies with genital ambiguity; 3) inappropriate prenatal androgen effects and a 46,XX karyotype - 11 patients with congenital adrenal hyperplasia (CAH).Of 73 patients with disordered sexual differentiation and a Y-chromosome, 60 were reared female; 26 of the 60 (43%) declared female identity while 32 (53%) declared male identity including 18 (55%) with cloacal exstrophy, six (55%) with MGD, four (40%) with pAIS, one (50%) with aphallia, one (100%) with hermaphroditism, and two (67%) with craniofacial anomalies; two (3%) declined to discuss identity. Nine of 11 patients with CAH and a 46,XX karyotype were reared female and two reared male; six (55%) declared female identity and five (45%) declared male identity. Of 84 total patients, 69 were reared female, but only 32 lived as female, while 29 lived as male; four patients refused to discuss sex-of-living; parents of four patients rejected their declarations of male identity. All 15 patients reared male lived as male including two genetic females.Active prenatal androgen effects appeared to dramatically increase the likelihood of recognition of male sexual identity independent of sex-of-rearing. Genetic males with male-typical prenatal androgen effects should be reared male.
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