Gender Role, Gender Identity and Sexual Orientation in CAIS (“XY-Women”) Compared With Subfertile and Infertile 46,XX Women

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.

Health‐related quality of life and psychological well‐being in adults with differences/disorders of sex development

“…Our result is in agreement with the findings of Brunner et al ., in which five of 11 participants with cAIS chose the gender/sex category of ‘other’. However, an overlap of participants might be possible as they are both German studies . These results are different to previous studies, in which female gender identity and role were established and maintained in all individuals diagnosed with cAIS .…”

“…The term ‘disorders of sex development’ is controversial within interdisciplinary teams and affected individuals as it is perceived as pathologizing and might be confused with aberrant sexuality or gender identity . The authors therefore prefer ‘differences of sex development’, which was introduced by other researchers . Depending on the impact of androgens, the functional impairment of the gonads and the reproductive system, DSD can have different effects on the individual's body and health.…”

Effects of chromosomal sex and hormonal influences on shaping sex differences in brain and behavior: Lessons from cases of disorders of sex development

“…In contrast, recent literature has begun to challenge this strongly established view of nearly exclusive heterosexual behaviors in women with CAIS. A recent report by Brunner and colleagues () indicated that 46,XY women compared with other females with infertility conditions showed increased tendencies of nonheterosexual preference and behavior, evidence that is out of line with previously established views of fully heterosexual outcomes in women with CAIS. These findings, although limited to a small sample size (n = 11 CAIS), raise an interesting topic for further investigation that could identify additional influences guiding sexual preference and perhaps identity in 46,XY women, aside from their inability to respond to male‐sex hormone.…”

“…Once again however, recent reports have begun to suggest that this theory is not as concrete as previously thought. A growing body of literature and case reports has identified gender dysphoria and cross‐gender feelings in CAIS individuals at rates higher than have been established (Kulshreshtha et al, ; T'Sjoen et al, ; Brunner et al, ). The role of social and initial medical decisions associated with CAIS cases may be a contributing factor in these results because, as stated by Tom Mazur, “the best predictor of adult gender identity in CAIS, PAIS (partial androgen insensitivity syndrome) and micropenis is initial gender assignment” (Mazur, ).…”

Brain Sex Differences Related to Gender Identity Development: Genes or Hormones?

“…In fact, in CAIS patients, with complete lacking function of the androgen receptor, female gender identity is usually reported indicating that masculinization of gender identity depends of androgen exposure during foetal period [90]. However, two cases of male gender identity in CAIS individuals have been reported in literature [91][92][93], questioning the role of androgen receptor in brain masculinization. Observations from other intersex conditions-such as 5-alpha-reductase-2 deficiency-lead to assume a potential role of pubertal hormones in the development of gender identity.…”