Gender Identity and Gender Role in DSD Patients Raised as Females: A Preliminary Outcome Study

Abstract

Gender identity and gender role are expected to be consistent with gender assignment for optimal DSD management outcome. To our knowledge, our study is the first to attempt evaluation of gender related outcomes in Turkish DSD patients. After receiving institutional ethical board approval and subject (or parent) informed consent, subjects with DSD raised as girls (22 patients 46 XX DSD, 11 patients 46 XY DSD) answered 566 questions of the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire including 60-item Masculinity-Femininity (MF) subscale which was the focus in this study. Controls (n: 50) were females similar to the probands in age, level of education, relationship status, and having a job or not also answered all questions. The answers were evaluated by a trained psychologist (Derya Inceoglu) on MMPI. For statistical purposes, seven findings were obtained from the data related to the MF subscale from the patients and controls. Of these seven findings (S1–S7), two were associated with masculinity (S3–S4) and another two were associated with femininity (S5–S6). In DSD patients, the percentages of masculinity findings were significantly higher when compared to controls (p < 0.001 and p < 0.001 for S3 and S4, respectively). In controls, the percentages of femininity findings were significantly higher when compared to DSD females (p < 0.001 and p < 0.001 for S5 and S6 respectively). There was no significant difference between 46 XX DSD patients and 46 XY DSD patients with respect to the percentage of any of the seven findings. Two patients requested gender change to male; only these two patients had the finding stating that sexual impulses could come to existence as actions (S7). In conclusion efforts to identify modifiable factors with negative impact and thus modifying them, and professional guidance may be important in minimizing the encountered gender related problems in DSD patients.

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

“…It can result in the individual being ostracized from all socio-familial events. One-third of 46 XX patients with disorders of sexual differentiation (DSD) tend to experience gender dissonance [3] with their biological sex.…”

Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma

“…According to many authors, the primary goal in DSD was for gender identity to be consistent with the gender assigned and to avoid a gender assignment that would increase the risk of GD [25,35]. In fact, although there is no clear manifestation of GD, it has been reported that both individuals with 46,XX (27.3 %) and 46,XY (45.5 %) may show a discomfort with their gender identity [63]. For many years, according to the "optimal gender policy" developed by Money [11,64], it was believed that gender identity should have been concordant with assigned sex, assuring that the child is raised unambiguously and that appropriate surgical "corrections" and hormone therapies are instituted in line with the gender chosen.…”

“…Defective conversion of 17-hydroxyprogesterone to 11-deoxycortisol (CYP21 deficiency) accounts for more than 90 % of cases of CAH [110]. Psychosocial assessments have demonstrated that CAH women, when compared to controls, report more cross-gender typical role behavior and patterns during childhood [25, 63,111,112], with a preference for typically male toys [24, [111][112][113][114][115][116] and playmates [25,114]. Moreover, it has been reported that they are less interested in maternal rehearsal play, feminine makeup, and accessories [115,117,118].…”

“…In fact, even if there is a strong evidence (40.9 %) of behaviors considered more typical of male gender identity [63], the majority (95 %) of 46,XX patients with CAH raised as females develop a female gender identity later on [24]. Although this rate far exceeds GD in the general population, the absolute proportion is quite low [129,133], and it cannot be predicted from genital virilization [22,23,128,134].…”

Advances in diagnosis and care of persons with DSD over the last decade

“…Furthermore, recent studies include reports by people with DSD who identify neither as male nor female, or who identify as both male and female at different times in their lives. This inability of binary (male/female) gender categories to adequately describe gender identity is more common in people with DSD who possess a Y chromosome [54,57].…”