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Noroozi Asl S, Ibrahimi R, Bagheri S, Lotfi M. 5-Alpha reductase deficiency; an important cause of 46, XY DSD: Report of three cases within a family. Clin Case Rep 2023; 11:e7269. [PMID: 37180321 PMCID: PMC10172458 DOI: 10.1002/ccr3.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Key clinical message 5-Alpha reductase deficiency is an important cause of 46, XY disorder of sex development. Timely diagnosis and proper management by a multidisciplinary team can lead to a favorable outcome. Sex assignment should be deferred until puberty because spontaneous virilization occurs and the patient can engage in the decision-making process. Abstract 5-Alpha reductase deficiency is a genetic disorder causing 46, XY disorder of sex development (DSD). Typical clinical feature is a male with ambiguous genitalia or undervirilization at birth. Here we report three cases of this disorder within a family.
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Affiliation(s)
- Samaneh Noroozi Asl
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Reza Ibrahimi
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Sepideh Bagheri
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mojtaba Lotfi
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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2
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Nascimento RLP, de Andrade Mesquita IM, Gondim R, Dos Apóstolos RAAC, Toralles MB, de Oliveira LB, Canguçu-Campinho AK, Barroso U. Gender identity in patients with 5-alpha reductase deficiency raised as females. J Pediatr Urol 2018; 14:419.e1-419.e6. [PMID: 30297225 DOI: 10.1016/j.jpurol.2018.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 08/27/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE 5-Alpha reductase type 2 deficiency (5-ARD) is a rare disorder of sex development. The lack of 5-alpha reductase, an enzyme that converts testosterone into dihydrotestosterone, results in external genitalia that may appear female, or predominantly male, albeit undervirilized, or, more often, ambiguous. METHODS This study describes a series of patients with 5-ARD raised as female, focusing on aspects related to gender identity. Following a retrospective chart review, patients with 5-ARD were invited to return to the clinic to enable their gender identity to be assessed using an 11-item structured in-house questionnaire. The Golombok-Rust Inventory of Sexual Satisfaction was applied to patients who had initiated their sexual life. RESULTS Six patients aged >15 years with 5-ARD and raised as female were included. Most patients were diagnosed late: two before and four after puberty. The mean length of the phallus was 2.8 cm (0.5-5.0). Reasons for seeing a doctor included genital appearance (n = 3), amenorrhea/absence of breast development (n = 2), and changes in gender role attitudes (n = 1). According to the gender identity assessment, 4 patients identified as female, 1 as male, and 1 as both genders. Only the patient identified as male requested gender re-assignment. Of the two patients who had initiated their sexual life, sexual satisfaction was found to be good in one and poor in the other due to vaginal discomfort during intercourse. CONCLUSION In the present series, the majority of undervirilized patients with a diagnosis of 5-ARD raised as female were in complete conformation with being female and described themselves as heterosexual. The more virilized patients were those least in conformity with their female-assigned gender.
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Affiliation(s)
- R L P Nascimento
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - I M de Andrade Mesquita
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - R Gondim
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - R A A C Dos Apóstolos
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - M B Toralles
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - L B de Oliveira
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - A K Canguçu-Campinho
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil
| | - U Barroso
- Disorders of Sexual Development Multidisciplinary Clinic, Federal University of Bahia, Salvador, Bahia, Brazil.
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Al-Juraibah FN, Lucas-Herald AK, Alimussina M, Ahmed SF. The evaluation and management of the boy with DSD. Best Pract Res Clin Endocrinol Metab 2018; 32:445-453. [PMID: 30086868 DOI: 10.1016/j.beem.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Atypical genitalia in a boy may have a very wide and diverse aetiology and a definitive diagnosis is often challenging to reach. Detailed clinical evaluation integrated with extensive biochemical and genetic studies play an important role in this process. Such care should be undertaken in highly specialized centres that can also provide access to a multidisciplinary team for optimal long-term care.
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Affiliation(s)
- F N Al-Juraibah
- Developmental Endocrinology Research Group, University of Glasgow, UK; Department of Paediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - A K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, UK
| | - M Alimussina
- Developmental Endocrinology Research Group, University of Glasgow, UK
| | - S F Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, UK.
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Chen MJ, McCann-Crosby B, Gunn S, Georgiadis P, Placencia F, Mann D, Axelrad M, Karaviti L, McCullough LB. Fluidity models in ancient Greece and current practices of sex assignment. Semin Perinatol 2017; 41:206-213. [PMID: 28478088 PMCID: PMC5950726 DOI: 10.1053/j.semperi.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Disorders of sexual differentiation such as androgen insensitivity and gonadal dysgenesis can involve an intrinsic fluidity at different levels, from the anatomical and biological to the social (gender) that must be considered in the context of social constraints. Sex assignment models based on George Engel's biopsychosocial aspects model of biology accept fluidity of gender as a central concept and therefore help establish expectations within the uncertainty of sex assignment and anticipate potential changes. The biology underlying the fluidity inherent to these disorders should be presented to parents at diagnosis, an approach that the gender medicine field should embrace as good practice. Greek mythology provides many accepted archetypes of change, and the ancient Greek appreciation of metamorphosis can be used as context with these patients. Our goal is to inform expertise and optimal approaches, knowing that this fluidity may eventually necessitate sex reassignment. Physicians should provide sex assignment education based on different components of sexual differentiation, prepare parents for future hormone-triggered changes in their children, and establish a sex-assignment algorithm.
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Affiliation(s)
- Min-Jye Chen
- Divison of Pediatric Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1020, Houston, TX 77030
| | - Bonnie McCann-Crosby
- Divison of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1020, Houston, TX 77030.
| | - Sheila Gunn
- Divison of Pediatric Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1020, Houston, TX 77030
| | - Paraskevi Georgiadis
- Section of Neonatology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Frank Placencia
- Section of Neonatology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - David Mann
- Department of Anesthesiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Marni Axelrad
- Section of Psychology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - L.P Karaviti
- Divison of Pediatric Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1020, Houston, TX 77030
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Byers HM, Mohnach LH, Fechner PY, Chen M, Thomas IH, Ramsdell LA, Shnorhavorian M, McCauley EA, Amies Oelschlager AME, Park JM, Sandberg DE, Adam MP, Keegan CE. Unexpected ethical dilemmas in sex assignment in 46,XY DSD due to 5-alpha reductase type 2 deficiency. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:260-267. [PMID: 28544750 DOI: 10.1002/ajmg.c.31560] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 11/10/2022]
Abstract
Sex assignment at birth remains one of the most clinically challenging and controversial topics in 46,XY disorders of sexual development (DSD). This is particularly challenging in deficiency of 5-alpha reductase type 2 given that external genitalia are typically undervirilized at birth but typically virilize at puberty to a variable degree. Historically, most individuals with 5-alpha reductase deficiency were raised females. However, reports that over half of patients who underwent a virilizing puberty adopted an adult male gender identity have challenged this practice. Consensus guidelines on assignment of sex of rearing at birth are equivocal or favor male assignment in the most virilized cases. While a male sex of rearing assignment may avoid lifelong hormonal therapy and/or allow the potential for fertility, female sex assignment may be more consistent with external anatomy in the most severely undervirilized cases. Herein, we describe five patients with 46,XY DSD due 5-alpha-reductase type 2 deficiency, all with a severe phenotype. An inter-disciplinary DSD medical team at one of two academic centers evaluated each patient. This case series illustrates the complicated decision-making process of assignment of sex of rearing at birth in 5-alpha reductase type 2 deficiency and the challenges that arise when the interests of the child, parental wishes, recommendations of the medical team, and state law collide.
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Affiliation(s)
- Heather M Byers
- Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Lauren H Mohnach
- DSD Program, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Patricia Y Fechner
- Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington.,Division of Pediatric Psychology, Seattle Children's Hospital, Seattle, Washington
| | - Ming Chen
- Division of Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Inas H Thomas
- Division of Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Linda A Ramsdell
- Division of Genetic Medicine, Seattle Children's Hospital, Seattle, Washington
| | | | - Elizabeth A McCauley
- Department of Psychiatry and Behavior Medicine, University of Washington, Seattle, Washington
| | | | - John M Park
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David E Sandberg
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Margaret P Adam
- Division of Medical Genetics, University of Washington, Seattle, Washington.,Division of Genetic Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Catherine E Keegan
- Division of Genetics, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Khorashad BS, Aghili Z, Kreukels BP, Hiradfar M, Roshan GM, Afkhamizadeh M, Abbaszadegan MR, Ghaemi N, Khazai B, Cohen-Kettenis P. Psychosexual Outcome Among Iranian Individuals With 5α-Reductase Deficiency Type 2 and Its Relationship With Parental Sexism. J Sex Med 2016; 13:1629-1641. [DOI: 10.1016/j.jsxm.2016.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 01/22/2023]
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Gangaher A, Chauhan V, Jyotsna VP, Mehta M. Gender identity and gender of rearing in 46 XY disorders of sexual development. Indian J Endocrinol Metab 2016; 20:536-41. [PMID: 27366722 PMCID: PMC4911845 DOI: 10.4103/2230-8210.183471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Disorders of sexual development (DSD) may pose a challenge to live as a fully-functioning male or female. In this study, we prospectively assessed eleven 46 XY DSD patients who were being treated at our center over the last 8 months for gender dysphoria. MATERIALS AND METHODS To determine gender dysphoria, age-appropriate gender identity (GI) questionnaires were used. For patients, 12 years and below, parent report GI questionnaire for children was used and for those above 12 years of age, GI/gender dysphoria questionnaire for adolescents and adults was administered. RESULTS Of 11 patients with 46 XY DSD, three were diagnosed with 5 alpha reductase deficiency (5aRD), two with partial gonadal dysgenesis, three with partial androgen insensitivity syndrome, one each with ovotesticular, complete gonadal dysgenesis, and complete androgen insensitivity. Gender assigned at birth was female in eight and male in three patients. Among the eight reared as female, gender had been reassigned as male in three patients well before the present study was conducted. None of the eleven patients had gender dysphoria at the time of this study. CONCLUSION Early gender of rearing was seen to be a critical indicator of present GI in our patients except in cases of 5aRD.
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Affiliation(s)
- Arushi Gangaher
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Vasundhera Chauhan
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Shabir I, Khurana ML, Joseph AA, Eunice M, Mehta M, Ammini AC. Phenotype, genotype and gender identity in a large cohort of patients from India with 5α-reductase 2 deficiency. Andrology 2015; 3:1132-9. [PMID: 26453174 DOI: 10.1111/andr.12108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/27/2015] [Accepted: 08/19/2015] [Indexed: 11/30/2022]
Abstract
Deficiency of the 5α-reductase 2 enzyme impairs the conversion of testosterone to dihydrotestosterone (DHT) and differentiation of external genitalia, seminal vesicles and prostate in males. The present study describes the phenotype, genotype and gender identity in a large cohort of patients with 5αRD2. All patients underwent detailed clinical evaluation, hormonal profile, karyotyping and molecular analysis of the SRD5A2 gene. The molecular analysis of the SRD5A2 gene showed the presence of mutant alleles in 24 patients. We found 6 novel mutations IVS(1-2) T>C, p.A52T, 188-189insTA, 904-905ins A, p.A12T and p.E57X in our patients. All patients had ambiguous genitalia and the degrees of under-virilization ranged from penoscrotal hypospadias and microphallus to clitoromegaly. The position of gonads was variable in patients with same mutation. All the patients with mutations in the SRD5A2 gene had male gender identity. Those reared as female had gender dysphoria and underwent gender reassignment. Though a specific genotype-phenotype correlation could not be established in our patient but confirming the diagnosis of 5αRD2 with assessment of the SRD5A2 gene may help in appropriate gender assignment.
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Affiliation(s)
- I Shabir
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - M L Khurana
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A A Joseph
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - M Eunice
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - M Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - A C Ammini
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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9
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Cheng J, Lin R, Zhang W, Liu G, Sheng H, Li X, Zhou Z, Mao X, Liu L. Phenotype and molecular characteristics in 45 Chinese children with 5α-reductase type 2 deficiency from South China. Clin Endocrinol (Oxf) 2015; 83:518-26. [PMID: 25899528 DOI: 10.1111/cen.12799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/26/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Affected by steroid 5α-reductase type 2 deficiency (5α-RD2), 46, XY individuals present divergent phenotypes characterized by undervirilization of male external genitalia. To identify the disorder, mutational analysis of 5α-reductase type 2 gene (SRD5A2) is a reliable approach. The genotype-phenotype relationship has not been elucidated. OBJECTIVE To improve the diagnosis and expand the knowledge of the disease, we collected and analysed relevant data of clinical diagnosis, biological investigation and molecular determination in 45 children with the SRD5A2 gene mutations from South China in our centre. SUBJECTS AND METHODS We studied a cohort of 45 Chinese children with SRD5A2 gene mutations. RESULTS Isolated microphallus (35·6%) and microphallus associated with various degrees of hypospadias (55·6%) were frequent phenotype. Female external genitalia with clitoromegaly (8·9%) were rare. 16 of 18 (88·9%) cases had hCG-stimulated T/DHT ratio above 10. In 45 patients, we identified 15 different mutations. Five have never been described: p.His90ThrfsX31, p.Gly21Arg, p.Gly149Asp, p.Arg145Leu and p.Gly66Arg. The p.Arg227Gln mutation was detected in 41 (91·1%) patients. The p.Leu89Val polymorphism was found in 38 (84·4%) patients. Homozygous mutations were presented in 16 (35·6%) patients, compound heterozygous mutations in 20 (44·4%) patients, compound heterozygous mutations alone with the p.Leu89Val polymorphism in nine (20·0%) patients. Exons 1 and 4 were most affected, and the number of mutant alleles per exon was 78·1% and 12·2%, respectively. CONCLUSIONS The study demonstrated a wide spectrum of phenotypes, biological profiles and genotypes in the children with 5α-RD2 from South China. The heterozygous mutation p.Arg227Gln is presumably a hot spot mutation and suggests a founder effect in the population of South China that may explain a moderate phenotype among our patients. Our report provides new insights into the molecular mechanism of 5α-RD2 and help to the diagnosis and treatment of this disease.
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Affiliation(s)
- Jing Cheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Ruizhu Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Wen Zhang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Guochang Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Huiying Sheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiuzhen Li
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Zhihong Zhou
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiaojian Mao
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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Long-term evaluation of patients undergoing genitoplasty due to disorders of sex development: results from a 14-year follow-up. ScientificWorldJournal 2013; 2013:298015. [PMID: 24376381 PMCID: PMC3858889 DOI: 10.1155/2013/298015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/06/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To summarize the experience in treating patients with genitoplasty due to disorders of sex development in China. METHODS The operative procedures, gender of rearing, surgical outcome, and psychosocial and family adjustments of 262 patients were reviewed retrospectively. RESULTS At initial diagnosis, the mean age was 14.3 ± 2.8 years (range: 2-38 years). There were 96 children, 133 adolescents, and 33 adults. Follow-up was done every 6 months. Patients with female sex assignment had no urinary incontinence or voiding difficulty. Five patients underwent the second surgery (3%); vaginal dilation was performed in 35 patients with postoperative vaginal stenosis; 12 patients (7.4%) were unsatisfactory with the outcome. For patients with male sex assignment, the median length of penis was 2.2 cm in prepubertal patients, 4.2 cm in pubertal patients, and 5.0 cm in adults; 39 patients developed postvoid dribbling (39%); 21 patients underwent a second surgery (21%); urethral dilation was done in 28 patients (28%) due to urethral stricture; 38 patients were unsatisfactory with the outcome (38%). In addition, 136 patients (83%) with female sex assignment and 54 (54%) with male sex assignment had favorable psychosocial adjustment. CONCLUSIONS Patients with male sex assignment have more surgical complications and difficulties in psychosocial adjustment as compared to those with female sex assignment.
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Fénichel P, Paris F, Philibert P, Hiéronimus S, Gaspari L, Kurzenne JY, Chevallier P, Bermon S, Chevalier N, Sultan C. Molecular diagnosis of 5α-reductase deficiency in 4 elite young female athletes through hormonal screening for hyperandrogenism. J Clin Endocrinol Metab 2013; 98:E1055-9. [PMID: 23633205 DOI: 10.1210/jc.2012-3893] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although a rare occurrence, previously undiagnosed disorders of sex development (DSD) with hyperandrogenism are sometimes detected by hormonal screening during the international sports competitions. Identifying the cause of XY,DSD raises medical and ethical concerns, especially with regard to issues of the eligibility to compete. OBJECTIVE The aim of this study was to determine whether the detection of high plasma T in young elite female athletes during hormonal screening would reveal an unsuspected XY DSD. SETTING The study was performed in the Nice and Montpellier University Hospitals (France), which collaborate as reference centers for DSD in elite athletes on behalf of sports governing bodies. PATIENTS Four cases of elite young athletes with female phenotypes but high plasma T detected during hormonal screening were investigated for undiagnosed XY DSD. MAIN OUTCOME MEASURES Evaluation of clinical, biological, radiological (magnetic resonance imaging and dual-energy x-ray absorptiometry) and genetic characteristics was conducted. RESULTS The 4 athletes presented as tall, slim, muscular women with a male bone morphotype, no breast development, clitoromegaly, partial or complete labial fusion, and inguinal/intralabial testes. All reported primary amenorrhea. The hormonal analysis evidenced plasma T within the male range, the karyotype was 46, XY, and molecular analysis of the 5α-reductase type 2 (srd5A2) gene identified a homozygotic mutation in 2 cases, a heterozygotic compound in 1 case, and a deletion in 1 case. CONCLUSION 5α-Reductase deficiency should be investigated in elite young female athletes with primary amenorrhea and high male T levels detected during antidoping programs to identify undiagnosed XY DSD.
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Affiliation(s)
- Patrick Fénichel
- Department of Reproductive Endocrinology and Institut National de la Santé et de la Recherche Médicale Unité 1065, Hospital of L'Archet, 06200 Nice, France.
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Annamalai AK, Cluroe AD, Sala E, Park SM, MacDougall J, Hughes IA, Simpson HL. Puberty reveals a familial disorder of sex development. Endocrine 2012; 42:453-5. [PMID: 22362597 DOI: 10.1007/s12020-012-9635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Wood RI, Stanton SJ. Testosterone and sport: current perspectives. Horm Behav 2012; 61:147-55. [PMID: 21983229 PMCID: PMC3264812 DOI: 10.1016/j.yhbeh.2011.09.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/06/2011] [Accepted: 09/11/2011] [Indexed: 02/07/2023]
Abstract
Testosterone and other anabolic-androgenic steroids enhance athletic performance in men and women. As a result, exogenous androgen is banned from most competitive sports. However, due to variability in endogenous secretion, and similarities with exogenous testosterone, it has been challenging to establish allowable limits for testosterone in competition. Endogenous androgen production is dynamically regulated by both exercise and winning in competition. Furthermore, testosterone may promote athletic performance, not only through its long-term anabolic actions, but also through rapid effects on behavior. In women, excess production of endogenous testosterone due to inborn disorders of sexual development (DSD) may convey a competitive advantage. For many years, female competitors have been subject to tests of sexual genotype and phenotype known as gender verification. Although gender verification has not identified any normal man competing as a woman, this process has identified women athletes with DSD. As understanding of DSD has expanded in recent years, women with DSD are increasingly able to continue athletic competition.
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Affiliation(s)
- Ruth I Wood
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA.
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Maimoun L, Philibert P, Cammas B, Audran F, Pienkowski C, Kurtz F, Heinrich C, Cartigny M, Sultan C. Undervirilization in XY newborns may hide a 5α-reductase deficiency: report of three new SRD5A2 gene mutations. ACTA ACUST UNITED AC 2010; 33:841-7. [DOI: 10.1111/j.1365-2605.2009.01036.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Potential determinant factors of sexual identity in ambiguous genitalia. J Pediatr Urol 2005; 1:383-8. [PMID: 18947576 DOI: 10.1016/j.jpurol.2005.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/06/2005] [Indexed: 01/13/2023]
Abstract
This is a review of literature scanning the potential factors which may affect Sexual Identity (S.I.) and Gender Identity (G.I.) in patients with ambiguous genitalia. Definitions of these concepts are outlined. Genetic, gonadal, hormonal, social and cultural pressures are reviewed as well as lessons to learn from clinical experiences and outcomes. Current criteriae used to assign gender in a child with ambiguous genitalia are discussed including medical and surgical criteriae as well as cultural disruptors. At the dawn of the third millennium, it is remarkable how little we know about the establishment of our individual and social identities.
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