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J Sex Med. 2013 Nov;10(11):2703-14. doi: 10.1111/j.1743-6109.2012.02751.x. Epub 2012 Apr 30.

Psychosexual development in adolescents and adults with disorders of sex development--results from the German Clinical Evaluation Study.

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Institute for Social Medicine, University Lübeck, Germany Department for Paediatric and Adolescent Medicine, University Lübeck, Germany Institute for Biometry and Medical Informatics, University Otto-von-Guericke, Magdeburg, Germany Gender Clinic, VU University Medical Centre, Amsterdam, The Netherlands Department of Paediatric Endocrinology, University Children's Hospital, Charité, Humboldt University, Berlin.



Both biological and psychosocial factors influence psychosexual development. High levels of pre- and postnatal androgens lead to more male-typical behavior. So far, the influence of androgens on gender identity and sexual orientation is unclear. Disorders of sex development (DSDs) are heterogeneous genetic conditions with different levels of prenatal androgens resulting in variations of genital development. Through DSD, the role of the different factors, especially androgen exposure, on psychosexual development can be evaluated.


The purpose of the study was to assess psychosexual development in adolescents and adults with different forms of DSD.


For the examination of psychosexual development of 66 adolescents and 110 adults with DSD, the authors used the Utrecht Gender Dysphoria Scale for adolescents, the Questionnaire of Gender Identity for adults, and a condition-specific DSD study questionnaire. Individuals were analyzed in four subgroups reflecting the karyotype, absence/presence of androgen effects, and gender of rearing.


Main outcome measures used were gender identity, friendships, love and sexual relationships, and sexual orientation in adolescents and adults with DSD.


Individuals with DSD did not show increased gender dysphoria. However, partnership and sexuality were identified to be difficult areas of life. Both adolescents and adults with DSD reported fewer experiences regarding love or sexual relationships compared with unaffected individuals. Especially men with DSD and undervirilization and women with DSD and androgen effects less often had a love relationship. Adult women with DSD and androgen effects more frequently engaged in love and sexual relationships with individuals of the same gender compared with women without DSD.


Individuals with DSD experience atypical hormonal influences (higher levels of androgens in girls/women and lower levels in androgens in boys/men); however, they did not show increased gender dysphoria in this study. However, partnership and sexual relationships are difficult areas of life for adolescents and adults with DSD. We recommend that individuals with DSD should get support from a multiprofessional team with competency in assessing and counseling issues regarding relationships and sexuality. Contact to other individuals with DSD can be helpful for nonprofessional support and exchange of experiences.


Androgens; Disorders of Sex Development; Gender Identity; Psychosexual Development

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