Archives of Sexual Behavior

, Volume 47, Issue 4, pp 931–942 | Cite as

Mental Health and Disorders of Sex Development/Intersex Conditions in Iranian Culture: Congenital Adrenal Hyperplasia, 5-α Reductase Deficiency-Type 2, and Complete Androgen Insensitivity Syndrome

  • Behzad S. Khorashad
  • Zahra Aghili
  • Baudewijntje P. C. Kreukels
  • Alistair G. Reid
  • Ghasem M. Roshan
  • Mehran Hiradfar
  • Ali Talaei
  • Peggy T. Cohen Kettenis
Original Paper


Sixty-one patients (22 patients with congenital adrenal hyperplasia [CAH] with a mean age of 14.86 years [range, 5–23], 20 patients with 5-α reductase deficiency type 2 [5α-RD-2] with a mean age of 19.5 years [range, 5–29], and 19 patients with complete androgen insensitivity syndrome [CAIS] with a mean age of 18.26 years [range, 5–28]) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia, the Structured Clinical Interview for DSM-IV Axis I, Axis II, and the Global Assessment Functioning Scale. All participants were female-assigned at birth. Ten patients (16.4%) transitioned to the male gender. Overall, 68% of patients had one or more lifetime Axis I disorders, including 63.6% of the CAH participants, 90% of 5α-RD-2 participants, and 52.6% of the CAIS participants. The most commonly observed were affective disorders (27.9%), gender identity disorder (27.9%), and anxiety (16.4%). Our study demonstrates that mental health of Iranian patients with DSD is at risk. This might be due to the fact that patients with DSD conditions are mostly treated medically and their mental health is often superficially addressed in developing countries such as Iran, at least in the past. We argue that it is important to pay attention to the mental health issues of patients with DSD and focus on specific issues, which may vary cross-culturally.


Disorders of sex development Congenital adrenal hyperplasia 5-α reductase deficiency-2 Complete androgen insensitivity syndrome Mental health Gender dysphoria 



We thank our participants and their parents for their time and willingness to be involved in this research.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Behzad S. Khorashad
    • 1
    • 2
  • Zahra Aghili
    • 1
    • 2
  • Baudewijntje P. C. Kreukels
    • 3
  • Alistair G. Reid
    • 4
  • Ghasem M. Roshan
    • 2
  • Mehran Hiradfar
    • 5
  • Ali Talaei
    • 1
    • 2
  • Peggy T. Cohen Kettenis
    • 3
  1. 1.Transgender Studies CenterMashhad University of Medical SciencesMashhadIran
  2. 2.Psychiatry and Behavioral Sciences Research CenterMashhad University of Medical Sciences, Ibn-e-Sina HospitalMashhadIran
  3. 3.Department of Medical Psychology and Center of Expertise on Gender DysphoriaVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Molecular Pathology UnitLiverpool Clinical LaboratoriesLiverpoolUK
  5. 5.Department of Pediatric Surgery, School of MedicineMashhad University of Medical SciencesMashhadIran

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