Gender identity in testicular feminisation Phenotypically, anatomically, legally, and socially female

Abstract

EDITOR, - The personal view on testicular feminisation expresses poignantly the difficulties facing someone who has to come to terms with the condition.1 The author was clearly distressed to learn that she was “chromosomally male, a pseudohermaphrodite,” and highlights the essence of the problem in asking “What makes a person female?” Doctors make a fundamental mistake in cases of testicular feminisation if they concentrate on the chromosomal definition of sex - a definition that is unhelpful to the patient. There are many definitions of a person's gender: genotypic (chromosomal pattern); gonadal (testis or ovary); phenotypic (including body habitus and genital anatomy); hormonal (oestrogen or androgen effects in the target tissues); legal (birth certificate, passport, etc); and, most importantly, social, which includes how we see ourselves, how others see us, the approach to sexual relationships, and everyday matters such as which changing room to use and which schools we may go to. Discordance among these definitions of gender may lead to problems in sexual identity. But patients with testicular feminisation have a high degree of concordance in their sexual …