Gender Change from Female to Male in
Classical Congenital Adrenal Hyperplasia
Meyer-Bahlburg HF, Gruen RS, New MI, Bell
JJ,
Morishima A, Shimshi M, Bueno Y, Vargas I, Baker SW.
Department of Plastic Surgery,
Eastern Virginia Medical School, Norfolk, Virginia, USA.
Abstract [Full Text] [PDF]
Abstract
The psychoendocrinology of the development of
normal gender identity and its variations is poorly understood. Studies of
gender development in individuals born with endocrinologically
well-characterized intersex conditions are heuristically valuable for the
disaggregation of factors that are acting in concert during normal
development. Four 46,XX individuals with classical congenital adrenal
hyperplasia (CAH) and atypical gender identity entered a comprehensive
research protocol including systematic interviews and self-report
inventories on gender role behavior and identity, sexual history, and
psychiatric history.
Some of the data on gender variables were
compared to data from 12 CAH women with the salt-wasting variant (CAH-SW)
with female gender identity. The four patients (ages 28, 35, 38, and 30
years) represented three different subtypes of classical early-onset CAH:
21-OH deficiency, simple virilizing (CAH-SV); 21-OH deficiency, salt-wasting
(CAH-SW); and 11--OH deficiency. Their medical histories were characterized
by delay beyond infancy or lack of surgical feminization of the external
genitalia and progressive virilization with inconsistent or absent
glucocorticoid replacement therapy.
Although three patients had undergone one
or more genital surgeries, all had retained at least some orgasmic capacity.
In regard to childhood gender-role behavior, the four gender-change patients
tended to be more masculine or less feminine than (behaviorally masculinized)
CAH-SW controls. All patients were sexually attracted to females only. The
process of gender change was gradual and extended well into adulthood.
The most plausible factors contributing to
cross-gender identity development in these patients to be neither a
particular genotype or endocrinotype nor a sex-typing bias on the part of
the parents but a combination of a genderatypical behavioral self-image, a
gender-atypical body image, and the development of erotic attraction to
women. Implications for psychosocial management are also discussed.
Citation: Hormones and
Behavior Dec 1996, 30(4), 319-332.
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