Intersex
 What is Intersex?
 Examples of DSD
 History
 Examples of intersex condition
 Treatment /Hormonal induction of Puberty
 Surgery
 % Of Intersex Opting to Change Sex
 Support from medical professionals should include
 Conclusion
What is Intersex?
 Intersex is a group of conditions where there is
a discrepancy between the external genitals
and the internal genitals (the testes and
ovaries). The older term for this condition is
hermaphrodites.
 According to Bertelloni (2008) DSD are rare
conditions in total one person in about 5,500
is affected.
Examples of Disorders of Sexual
Development (DSD)
 Complete Androgen Insensitivity Syndrome (CIAS)
Has a female external appearance despite a 46XY karyotype and undecended testes; a condition
termed "testicular feminization" in the past.
 Partial Androgen Insensitivity Syndrome
Androgen insensitivity syndrome (AIS) is when a person who is genetically male (has one X and
one Y chromosome) is resistant to male hormones called androgens. As a result, the person has
some or all of the physical characteristics of a woman, despite having partial fusion of the outer
vaginal lips.
 5a-Reductase type 2 deficiency
5-alpha-reductase deficiency (5-ARD) is an autosomal recessive intersex condition caused by a
mutation of the 5-alpha reductase type 2 gene. Normal function 5-alpha-reductase is an enzyme
that converts testosterone...
 Ovotesticular DSD
The presence of Y chromosome confers a high risk of neoplastic transformation in dysgenetic
gonads. The neoplastic development in these patients is associated with the presence of Y
chromosome and intra abdominal location of the abnormal gonad.
(Dictionary.com)
Examples of Disorders of Sexual
Development (DSD)
 Mixed Gonadal Dysgenesis
(MGD) refers to individuals who usually have a differentiated gonad
on one side and a streak gonad or streak testis on the other side. A
differential diagnosis between the TH and MGD has important clinical
implications for gender assignment and the decision for early
gonadectomy.
 46,XY Complete Gonadal Dysgenesis
(46,XY CGD) is characterized by a 46,XY karyotype, normal female
external genitalia, completely undeveloped (”streak”) gonads, no sperm
production, and presence of normal Müllerian structures.
 17-hydroxysteroid dehydrogenase-3 (17B-HSD-3) Deficiency
(Dictionary.com)
History
1
It was first assumed that children are psychosexually neutral at
birth. Until a publication of a studied came out that suggested
prenatal brain exposure to sex hormones determines gender
development.
In the 1950s, the well known psychologist John Money and
his co-workers at the John Hopkins University Hospital in
Baltimore were the first to conduct follow up studies on intersex
patients. Because, in their work, gender largely seemed to follow
the gender of rearing, they concluded that gender assignment
and rearing, and not the chromosomal, gonadal or genital sex,
was the best predictor of adult gender identity. (Cohen-Kettenis,
P .2005 (1)
History 2
 As a consequence the “true sex policy “was replaced by the
so called “optimal gender policy”, according to witch gender
assignment was based on the expected optimal outcome in
terms of psychosexual, reproductive and over all
psychological functioning. Because gender appropriate
rearing was considered to be crucial for gender identity
development, early surgery was recommended to facilitate
this.
 As gender identity was assumed to depend entirely on the
environment, this female sex assignment in all 46,xy with
functionally inadequate penis. At this time, very little was
known about sexual differentiation of the brain. So, the
theory of ‘psychosexual neutrality’ at birth prevailed. Since
the 1950s, this paradigm was increasingly challenged by a
number of studies in the field of neuroscience. .
History
3
First sex-dimorphic brain nuclei were found in animals and
humans as a consequence, prenatal exposure of the brain to androgens
was increasingly put forward as a factor in gender identity development.
Second several studies on neuroendocrine effects on gender-atypical
behaviors, traits, preferences and activities. In these studies evidence
was found of an influence of sex steroids on a wide range of behaviors. .
(Cohen-Kettenis, P .2005 (3)
Third, studies were carried out on the long-term out-come of gender
identity in individuals with various intersex conditions. For example a
baby boy, one of a pair of twins, lost his penis during circumcision.
Along the lines of the optimal gender policy, the boy was reassigned as a
girl at 15 months. Regrettably, the child turned out to be increasingly
unhappy as a girl. At 14, she was informed that she had been born a boy.
From that moment on she resumed the male role. In this case, biology
seemed to clearly determine gender identity. This outcome seemed to be
in line with a number of follow –up studies among intersex patients, in
particular 5a-reductase-2 deficiency.
(Cohen-Kettenis, P .2005 (4)
The percentage of gender changes varies depending on the
Examples of intersex condition
True hermaphrodites have both male and female
organs, often because of abnormal chromosomes.
”Ferms”(female pseudoherma-phrodites) are genetic
females who’s sex organs were masculinizes through
prenatal exposure to testosterone. ”Merms ” are genetic
males who failed to produce the necessary hormones or
whose tissue failed to respond to them.
(Sillars, 1998 P 10-11)
Examples of intersex condition
The results are often bizarre and produce lives filled
with emotional upheaval depression and debilitating side
effects from years of drug treatment and surgeries,
according to the Intersex Society of North America (ISNA),
a group witch objects to surgical reassignment of infants.
At the age of 12, reports one member, ”My body began to go
haywire. My hips spread and my voice began to break. My
breasts grew, and so did my facial hair, "Some genetic
females have been raised as boys because of the presence of
male genitals, only to start menstruating at age 13.
(Sillars, 1998 P 10-11)
http://search.live.com/video/results.aspx?q=intersex+c
hildren&docid=417119273197&mid=856E9BA69F35ABE
34F92856E9BA69F35ABE34F92&FORM=VIVR35
Treatment and hormonal induction of puperty
usual occurs between 11 and 13 years of age

Testosterone
Gel
Patch
Oral
Injections
 Androgen
DHT gel
Oral
Injections
Implant
(Bertelloni, 2008)
Surgery
 Gives rise in feeling in loss of body ownership.
 May regret surgery after its performed
 Irreversible Surgical damage may accrue
 Constant surgery can be a constant reminder of their differences.
 A need for on going treatment (med. for infections)
 The need for additional surgeries when the first is unsuccessful
 Vaginal dilation witch at a young age leads to severe psychological problems.
(Nihoul-Fekete, 2005)
% Of Intersex Opting to Change
Sex
 Congenital Adrenal Hyperplasia (CAH)
A study took 250 patients raised as females. Out of the 250, 32 had
male assessment at birth, but 28 were reassigned within the first 19
months. At the follow up 9.2% experienced problems related to gender
identity. However, only 1.6% made gender changes.
 Androgen Insensitivity
Out of 99 cases (55 assigned females and 44 assigned males) 9 of
them decided to change gender later in life.6 Changed from male to
female. In 3 of the cases the child had female assignment at birth, but
were than reassigned and then raised as boys.3 other cases were female
to male changes.1 child had a male assignment at birth, but was
reassigned as female later.
% Of Intersex Opting to Change
Sex
 5a-RD-2 and 17B-HSD-3
 5a-RD-2 Out of 100 raised patients (56%) 62 changed gender from
female to male.
 17B-HSD-3 On patients with 17B-HSD-3 had a gender change of 39%
(19 of 49). In the case of adolescence raised as boys, no changes in
gender were reported.
 (Cohen-Kettenis, 2005)
Support from medical
professionals should include
 Open communication
 Attention to family/patients
 Management evaluations
 Providing accurate information
concerns
to the patient/family
 Respect
 Be aware and acknowledge
 Strict confidentiality
important biological
determinants
 To minimize psychological
(Cohen-Kettenis, P .2005)
distress, patients /family should
Be told exactly what will be
done and why.
Conclusion
From the beginning you’re reared according to your
anatomy and your genitals. The intersexes, the people
who don’t always speak out, have feelings and are
humans too.
We as people have lived life in accordance to labels,
but it isn’t fair to live life as being labeled some thing more
or less than you really are. If were all unique as individuals
wouldn’t that be consider normal anyway?
Living with (DSD), some Adolescence start to
experience side effects during puberty that normal
adolescence might not. They spend time in hospitals having
surgery, hormonal treatment, and suffer with depression.
They sometimes seem lost and confused.
Conclusion
 The percentage of gender changes depends, on the person’s
condition and personal preference. This may imply that
androgen exposure to the brain during fetal development
plays a role in gender identity.
However, rearing a child as middle sex may cause
psychological damage. It is best to raise a child with one sex
or the other, but not both.

Finding the support that Adolescence need is very
critical. Being sensitive to their condition, showing respect,
and concern will hopefully minimize any negative impact
.If we keep an open mind we might gain a better insight in
to the crucial factors of gender identity and how they effect
adolescence.
(Cohen-Kettenis, P .2005)