Archives of Sexual Behavior

, Volume 20, Issue 5, pp 459–470 | Cite as

Development of male gender identity/role and a sexual orientation towards women in a 46,XY subject with an incomplete form of the androgen insensitivity syndrome

  • Louis Gooren
  • Peggy T. Cohen-Kettenis


Transsexualism and homosexuality have been theorized to originate in the male from insufficient androgenization of the brain. For verification of this hypothesis clinical science must rely on subjects with an abnormal prenatal/perinatal endocrine history. A case of a 33-year-old 46,XY subject with an incomplete form of androgen insensitivity syndrome (AIS) is presented. In adulthood the only genital sign of masculinization is a clitoris of 4 cm; the vagina is normal size. The diagnosis AIS was verified by androgen receptor studies. At birth there was confusion as to the sex of the newborn. Originally, the subject was assigned to the male sex, but this decision was reversed 5 days after birth and the subject was reared as a girl. At age 30 the subject applied for gender reassignment treatment to the male sex. Upon psychological evaluation the gender identity was unambiguously male and the sexual orientation was exclusively towards women. The estrogen feedback effect on LH, regarded by some as a marker of the sexual differentiation of the neuroendocrinium was negative before orchiectomy but positive after orchiectomy. Our observation demonstrates that in 46,XY subjects a male gender identity and a sexual orientation towards women can develop with a strikingly lower-than-normal level of biological action of androgens.

Key words

gender identity sexual orientation androgens 


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Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Louis Gooren
    • 1
  • Peggy T. Cohen-Kettenis
    • 2
  1. 1.Division of Andrology/EndocrinologyFree University HospitalAmsterdamthe Netherlands
  2. 2.Department of Child and Adolescent PsychiatryUniversity of UtrechtUtrechtthe Netherlands

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