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We describe a patient who was assigned female at birth because of genital ambiguity without performing further diagnostic procedures and presented at the age of 13-1/2 years because of her strong desire to change her legal sex. Karyotype was 46,XY; clinical, endocrinological, radiological and surgical work-up revealed hypergonadotropic hypogonadism and mixed gonadal dysgenesis. Gender identity reversal was performed after extensive psychological testing and adaptation of living circumstances resulting in a successful integration as a male with normal psychological and social functioning. In several surgical procedures, the streak gonad, the nonfunctional testis, and the rudimentary uterus were removed, and a penis was reconstructed from a penisoid with chorda and hypospadias. Our patient supports the idea that gender identity is imprinted prenatally by hitherto poorly understood mechanisms and that sex assignment in infants with ambiguous genitalia needs careful consideration of not solely endocrinological and anatomical data.

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A new method of hormone administration was tested in the human male. PDS (silastic) capsules filled with dry, milled steroid and implanted subcutaneously, release the hormone at a relatively constant rate over a longer period of time. A standard capsule of 20 mm length, a membrane thickness of ∼0.8 mm and a surface area of about 150 mm² was used. Capsules filled with 22–23 mg ethinyl estradiol and implanted in patients with carcinoma of the prostate had a releasing factor of approximately 45 µg/24 h/capsule, and a therapeutic effect of about 17 months. Capsules filled with 21–23 mg testosterone and implanted in castrates, hypogonadal and subfertile men had a releasing factor of approximately 55 µg/24 h/capsule and a therapeutic effect of about 13 months. The clinical results of testosterone substitution in castrates and hypogonadal men were good as judged by clinical observation and regular determinations of plasma testosterone levels. There was a definite improvement of the sperm qualities of subfertile men with moderate forms of Leydig’s cell insufficiency. The observation period of the cases of prostatic carcinoma treated with ethinyl estradiol capsules still is too short for exact clinical evaluation, but the results seem to be encouraging.