Gender assignment in female congenital adrenal hyperplasia:: a difficult experience

被引:23
|
作者
Özbey, H
Darendeliler, F
Kayserili, H
Korkmazlar, Ü
Salman, T
机构
[1] Istanbul Univ, Istanbul Fac Med, Dept Paediat Surg, TR-34390 Istanbul, Turkey
[2] Istanbul Univ, Istanbul Fac Med, Dept Paediat Endocrinol, TR-34390 Istanbul, Turkey
[3] Istanbul Univ, Istanbul Fac Med, Dept Paediat Genet, TR-34390 Istanbul, Turkey
[4] Istanbul Univ, Istanbul Fac Med, Dept Paediat Psychiat, TR-34390 Istanbul, Turkey
关键词
congenital adrenal hyperplasia; gender (re)assignment; choice; culture;
D O I
10.1111/j.1464-410X.2004.04967.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To report experience of gender (re)assignment in genotypic female (46XX) patients with congenital adrenal hyperplasia (f-CAH), a difficult and stressful experience if complicated with delayed presentation and inadvertent assignment. PATIENTS AND METHODS Between 1983 and 2002, 70 patients with f-CAH were counselled for gender assignment. The age at diagnosis and operation, the degree of virilization, parental consanguinity, the gender preference of the families, and the factors governing the decision-making process were determined. RESULTS Forty-one (59%) patients presented after the neonatal period. All parents had already assumed or were advised of a gender for their children, based on the suggestive appearance of the external genitalia. Consequently, 49 patients were reared as female and 21 as 'male'. Only nine of these 'males' could be reassigned as females (mean age at presentation 7.87 months, sd 10.42). Twelve children had to be reared as 'male' (mean age at presentation 55.8 months, sd 32.42) in compliance with the parents' and the study group's decision, and appropriate masculinizing reconstructive surgery was undertaken. The difference in the mean age of those reassigned as female and those who remained 'male' was significant (P < 0.001). The parental consanguinity rate among the families was especially high in the 'male' patients. CONCLUSIONS It is extremely difficult to correct the gender of patients with f-CAH when they present at >2.5 years old. Furthermore, the delay in diagnosis and the male bias in choice of gender in our population might be a result of strong social pressures on families, influenced by cultural, traditional and economic factors.
引用
收藏
页码:388 / 391
页数:4
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