5 Androgen Insensitivity

What If the Androgen Receptor Doesn’t Work? Estrogen Brain organization Aromatase Adpated from Ganong, William F. REVIEW OF MEDICAL PHYSIOLOGY 22 nd ed. Lange Medical Books/McGraw-Hill (2005)

Androgen Insensitivity Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complete AIS (CAIS) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Complete Androgen Insensitivity Syndrome Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons, 1987. Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)

Partial Androgen Insensitivity Syndrome (PAIS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AIS Grading Scheme ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Numbered I through 7 in order of increasing severity (more defective masculinization ) Adapted from Quigley CA, DeBellis A, Marschke KB, El-Awady MK, Wilson EM, French FS. Androgen Receptor Defects: Historical, Clinical, And Molecular Perspectives. ENDOCRINE REV, 1 6:282; (1995) with permission. In: Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004)

Complete AIS & Gender Identity ,[object Object],[object Object],[object Object],* Indicates to me that androgen receptor is required for “alteration” of human gender identity brain region(s). Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004) published statements from ALIAS, an AIS newsletter. Agree Disagree “ I don’t think I am any different in feeling than if I were born XX, feel very female.” 82%* 18% “ All my efforts over the years in presenting a female persona have left me completely exhausted. I might just as well have had a mastectomy, cut my hair short and lived as a celibate man. It would actually have been easier I think.” 10% 90% I have to “work at being a woman” 56% (dressing in a feminine way or using cosmetics or hair styles in a way to signal “female” unambiguously, altering selection of clothes; 30% did above much of the time) 44% Considered suicide 62% 38% Attempted suicide 23% 77%

Partial AIS & Gender Identity ,[object Object],[object Object],[object Object],[object Object],* Now angry about castration, vaginal reconstruction surgery, and somatic feminization by estrogen treatment since puberty **Attempted before switching Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004) PARTIAL AIS 8 raised as boys 4 live as women 10 raised as girls 2 live as men* Considered suicide 61% **Attempted suicide 17%

Milton Diamond Admonished Germaine Greer for Ignoring Brain/Mind ,[object Object],[object Object],[object Object],[object Object]

5 Androgen Insensitivity

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5 Androgen Insensitivity