Chapter 5

Lecture Notes

Hormonal imbalances may cause males or females to develop physical characteristics associated with the opposite sex. When a person who is genetically male is resistant to male hormones or androgens, he is said to have androgen insensitivity syndrome. The male has female genitals but no female internal organs. At puberty the male develops hips and breasts and other secondary sex characteristics, but no public hair and no menstruation. <br /><br />The testes also remain in the abdomen and are sterile. He is assigned a female gender status at birth and many experience female gender identity. They develop as a female; then the physical anomaly is discovered at puberty. Treatments include removal of the undescended testes and estrogen replacement therapy. <br /><br />Another hormonal disorder is congenital adrenal hyperplasia. This is when a genetic female with ovaries and a vagina who develops externally as a male. This is due to the malfunctioning of the adrenal gland, which produces androgen instead of androgen-inhibiting cortisone.

At birth the child has ambiguous genitalia, a penis with an empty scrotum or an enlarged clitoris with or without a vaginal opening. In the past doctors and families choose to assign female gender at birth and treatment is given to promote female development. However, the gender role behavior is masculine, and there is a higher likelihood of the female experiencing homoerotic dreams and sexual attraction. 

Of unknown origin, but in some cases passed down through families, is a condition called hypospadias. This is when the opening of the penis is located somewhere on the underside of the glans, the shaft or at the junction of the scrotum. Infants with hypospadias should not be circumcised. Surgery, which consists of straightening the penis and correcting the hypospadias, is usually done before the child is 18 months old.