Psychosexual outcomes in three siblings with partial androgen insensitivity syndrome: impact of nature versus nurture

Background:In congenital adrenal hyperplasia (CAH) with ambiguous genitalia, assigning gender of rearing can be complex, especially If genitalia is highly virilized. Apart from karyotype, prenatal androgen exposure, patient's gender orientation, sociocultural, and parental influences play a role. The aim of this study was to assess gender dysphoria and psychosocial issues in patients of CAH raised as males and females.Materials and Methods:This is a cross-sectional study that includes patients (old and new) with CAH who were treated by us in the last 6 months. A semi-structured interview proforma was used to elicit history and psychosocial background of the patients. The clinical and biochemical details were noted. For psychological analysis, patients were screened for gender dysphoria using Parent Report Gender Identity Questionnaire for children <12 years and Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults.Results:We analyzed 22 46 XX CAH patients among which, 3 were reared as males and 19 as females. Among the 19 patients reared as females, 17 patients showed no gender dysphoria. Two patients revealed gender dysphoria as indicated by their marginally low scores on the gender dysphoria assessment. However, in view of current literature and the age groups of the patients, behavior of the 6-year-old patient can be best understood as being tomboyish. Gender dysphoria in the 22-year-old can be explained by the dominance of psychosocial factors and not hormones alone. Among the three patients reared as males, two prepubertal were satisfied with their male gender identity. The third patient, aged 32 years, had gender dysphoria when reared as a male that resolved when gender was reassigned as female and feminizing surgery was done.Conclusion:Gender assignment in 46 XX CAH is guided by factors such as degree of virilization of genitalia, gender orientation, patient involvement, sociocultural, and parental influences.

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“…Hence, gender dysphoria and confusion cannot be solely attributed to psychosocial variables. [202122]…”

Section: Discussionmentioning

confidence: 99%

“…[21] Long-term exposure to negative conditions can compromise the coping mechanisms of these individuals that can take the form of mental illness and/or complete loss of self-confidence. Unacceptability, hostility, teasing, and discrimination from others can severely hamper an individual in academia, intimate relations, and occupation.…”

Section: Discussionmentioning

confidence: 99%

Gender of rearing and psychosocial aspect in 46 XX congenital adrenal hyperplasia

Gangaher

Jyotsna

Chauhan

et al. 2016

Indian J Endocr Metab

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“…[ 14 ] Initial gender assignment and subsequent gender of rearing were seen to be good predictors of their adult gender identities. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Gender identity and gender of rearing in 46 XY disorders of sexual development

Gangaher

Chauhan

Jyotsna

et al. 2016

Indian J Endocr Metab

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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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“…Punjab, with nearly 88,000 people who inject drugs (PWID), has the second-largest drug-using population. 1 Injection drug use (IDU) can cause a wide array of infective and non-infective pulmonary complications: pneumonia, cardiogenic edema, acute lung injury, pulmonary hemorrhage, and aspiration pneumonia. 2,3 We report a rare pulmonary complication of injection drug use: septic emboli caused by an unusual agent, Burkholderia cepacia, which resulted in pleural effusion.…”

Section: Pleural Effusion In a Patient With Injection Heroin Use: An Unusual Presentation With An Unusual Pathogenmentioning

confidence: 99%

Profile of Siblings with Disorders of Sexual Differentiation and Gender Dysphoria

Jiwanmall

Kattula

2020

Indian Journal of Psychological Medicine

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Psychosexual outcomes in three siblings with partial androgen insensitivity syndrome: impact of nature versus nurture

Cited by 6 publications

References 4 publications

Gender of rearing and psychosocial aspect in 46 XX congenital adrenal hyperplasia

Gender of rearing and psychosocial aspect in 46 XX congenital adrenal hyperplasia

Gender identity and gender of rearing in 46 XY disorders of sexual development

Profile of Siblings with Disorders of Sexual Differentiation and Gender Dysphoria

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