Rodents, on which most of Diamond’s (1) animal research was conducted, are not a good neuroendocrine model for nonhuman primates.
Similar observations were reported by Rösler and Kohn (20) on the syndrome of 17β-HSD deficiency.
Critics ( questioned, however, whether direct sex-hormone effects on the brain could be the sole or even the major mechanism underlying this late gender change; it seemed likely that other psychosocial and psychological mechanisms also contributed.
In the late1960s, Ehrhardt (15–17) reported gender-role behavior shifts in the direction of masculinization in prenatally androgen-exposed 46, XX girls and women and demonstrated thereby that the pre-/perinatal sex hormone theory applied to the human species, at least to some extent.
It is important to note, however, that also in the presence of markedly masculinized gender role behavior, gender identity usually remained female, even in the extreme situation of late-treated women with congenital adrenal hyperplasia who, in addition to prenatal masculinization, also showed massive postnatal virilization (16).
Human research has made it likely that prenatal sex hormones influence, but do not by themselves fully determine, the development of gender-role behavior (22), and there is a large body of evidence in support of marked effects of social and psychological factors on normal human gender development (23).
It is the evidence from long-term follow-up of intersex patients themselves, however, that will be the final arbiter of the adequacy of a given management policy, and this evidence is extremely limited, especially in the case of male pseudohermaphroditism.In 1952 a 27-year-old, former WWII-era GI from New York named George Jorgensen traveled to Denmark, and returned to the U. In time, she became a trailblazer in seeking those gender reassignment surgeries as these procedures, now known as gender realignment (reconstruction, affirmation or confirmation) surgeries, wouldn't begin in the U. A person living with this an internal conflict may develop anxiety and depression, and go on to be diagnosed with gender dysphoria, formally known as gender identity disorder (GID). Jorgensen, who had described herself as a woman trapped in a man's body, was one of the first to transition from the male to female gender through a process involving hormone therapy and surgical procedures [source: Hadjimatheou]. Gender identity struggles usually begin in early childhood but descriptions of feeling like a man trapped inside a woman's body, or vice versa, have been identified in and reported by people of all ages.Apparently, a given gender identity can accommodate wide variations in gender role behavior, a conclusion that should resolve at least some of the interpretive discrepancies between gender-role-behavior-based criticisms of the optimal-gender policy by biological determinists and gender-identity-focused statements by the policy’s defenders.In 1974, Imperato-Mc Ginley (18) reported on a newly identified syndrome of 46, XY patients with 5α-RD; their external genitalia looked female at birth and they were so assigned, but they markedly virilized in adolescence.A few years ago, Diamond (1) began collecting scattered reports of cases of 46, XY patients who had been raised female and who later, on their own initiative, changed gender to male.Unfortunately, those cases were often not documented in sufficient psychological detail so that it is difficult to evaluate with at least some plausibility to what extent biological and/or social factors may have contributed to the gender change.A circumcision accident at 7 months of age led to loss of the penis, a decision to reassign the child to the female gender (“Joan”) at 17 months, and to perform feminizing surgery on her external genitalia at 21 months.Interview-based follow-up studies during childhood by Money and Ehrhardt (13, 25, 26) showed a reasonably well adjusted, although somewhat tomboyish, girl; but in adolescence, years after the family had stopped coming to Johns Hopkins Hospital, Joan had herself re-reassigned as John (who is reported to live now, in his mid-30s, as a married man with his wife and adopted children) (24).THE current intense debate of the management of patients with intersexuality and related conditions focuses on three major issues: 1) the assignment of gender; 2) the indication for genital surgery; and 3) the disclosure of medical information to the patient.For instance, in recently published guidelines for intersex management, Diamond and Sigmundson (1, 2) emphasized the growing evidence of prenatal androgen effects on the sexual differentiation of the brain and made strong recommendations for assigning to the male gender all 46, XY patients of the following categories: genital trauma (leading to loss of the penis), micropenis, androgen insensitivity (AIS) of Quigley (3) stages 2 and 3, hypospadias, 5α-reductase deficiency (5α-RD), and 17β-hydroxysteroid dehydrogenase (HSD) deficiency.