5α-Reductase 2 deficiency: Difference between revisions
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'''5α-Reductase deficiency''' is an [[autosomal recessive]] [[intersexuality|intersex]] [[medical condition|condition]] caused by a [[genetic mutation|mutation]] in ''[[SRD5A2]]'', a [[gene]] encoding the [[enzyme]] [[5α-reductase type 2]].<ref name="Gpnotebook">{{Cite GPnotebook|852492298|5-alpha reductase deficiency}}</ref> |
'''5α-Reductase deficiency''' is an [[autosomal recessive]] [[intersexuality|intersex]] [[medical condition|condition]] caused by a [[genetic mutation|mutation]] in ''[[SRD5A2]]'', a [[gene]] encoding the [[enzyme]] [[5α-reductase type 2]].<ref name="Gpnotebook">{{Cite GPnotebook|852492298|5-alpha reductase deficiency}}</ref> The phenotype this usually causes is '''pseudovaginal perineoscrotal hypospadias''', a configuration of the external [[genitalia]] of an infant.<ref name="pmid16098368">{{cite journal |vauthors=Bahceci M, Ersay AR, Tuzcu A, Hiort O, Richter-Unruh A, Gokalp D |title=A novel missense mutation of 5-alpha reductase type 2 gene (SRD5A2) leads to severe male pseudohermaphroditism in a Turkish family |journal=Urology |volume=66 |issue=2 |pages=407–10 |year=2005 |pmid=16098368 |doi=10.1016/j.urology.2005.02.021}}</ref><ref name="NieschlagBehre2009">{{cite book|author1=Eberhard Nieschlag|author2=Hermann M. Behre|author3=Susan Nieschlag|title=Andrology: Male Reproductive Health and Dysfunction|url=https://books.google.com/books?id=mEgckDNkonUC&pg=PA328|access-date=2 January 2011|date=July 2009|publisher=Springer|isbn=978-3-540-78354-1|pages=328–}}</ref> In a sense, this configuration is roughly midway between [[phenotypical]] human male genitalia, and phenotypical human female genitalia, in structure and appearance. It is a relatively common form of [[ambiguous genitalia|genital ambiguity]] caused by [[undervirilization]] of genetic males due to several different [[intersex]] conditions. |
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==Signs and symptoms== |
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Individuals with 5-ARD are born with [[male]] [[gonad]]s, including [[testicles]] and [[Wolffian structures]]. They can have normal male external genitalia, [[ambiguous genitalia]], or external female appearing genitalia, but usually tend towards a female appearance.{{citation needed|date=August 2020}} |
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The development of the [[genital tubercle]] tissue (which by week 9 of a [[fetus]]' gestation becomes either a [[clitoris]] or a [[penis]]) tends towards a size qualifying it as an ambiguous [[clitoromegaly|macroclitoris]]/[[micropenis]] (large clitoris/small penis), and the [[urethra]] may attach to the phallus.{{citation needed|date=August 2020}} |
The development of the [[genital tubercle]] tissue (which by week 9 of a [[fetus]]' gestation becomes either a [[clitoris]] or a [[penis]]) tends towards a size qualifying it as an ambiguous [[clitoromegaly|macroclitoris]]/[[micropenis]] (large clitoris/small penis), and the [[urethra]] may attach to the phallus.{{citation needed|date=August 2020}} |
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5-ARD is associated with an increased risk of [[cryptorchidism]] and [[testicular cancer]].{{Citation needed|date=June 2018}} |
5-ARD is associated with an increased risk of [[cryptorchidism]] and [[testicular cancer]].{{Citation needed|date=June 2018}} |
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===Fertility=== |
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Male fertility can still be possible if viable sperm is present in the testes and is able to be extracted. In general, individuals with 5-ARD are capable of producing viable [[sperm]].{{citation needed|date=August 2020}} |
Since the [[gonad]] tissue develops into testes rather than ovaries, they are thus unable to create ova but may be able to create sperm. Male fertility can still be possible if viable sperm is present in the testes and is able to be extracted. In general, individuals with 5-ARD are capable of producing viable [[sperm]].{{citation needed|date=August 2020}} |
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Although the external genitalia can sometimes be completely female, the vagina consists of only the lower two-thirds of a normal vagina, creating a blind-ending vaginal pouch. Because of normal action of [[Anti-müllerian hormone|Müllerian inhibiting factor]] produced by the [[testes]] in utero, individuals with 5-ARD lack a [[uterus]] and [[Fallopian tube]]s. Thus, they would not physically be able to carry a pregnancy in any event. Even with treatments such as surrogate motherhood, female infertility is caused by the lack of any ova to implant in a surrogate mother.{{citation needed|date=August 2020}} |
Although the external genitalia can sometimes be completely female, the vagina consists of only the lower two-thirds of a normal vagina, creating a blind-ending vaginal pouch. Because of normal action of [[Anti-müllerian hormone|Müllerian inhibiting factor]] produced by the [[testes]] in utero, individuals with 5-ARD lack a [[uterus]] and [[Fallopian tube]]s. Thus, they would not physically be able to carry a pregnancy in any event. Even with treatments such as surrogate motherhood, female infertility is caused by the lack of any ova to implant in a surrogate mother.{{citation needed|date=August 2020}} |
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Fertility is further compromised by the underdevelopment of seminal vesicles and prostate.{{citation needed|date=August 2020}} |
Fertility is further compromised by the underdevelopment of seminal vesicles and prostate.{{citation needed|date=August 2020}} |
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==Cause== |
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The condition affects only those with a [[Y chromosome|Y-chromosome]] because DHT has no known role in development of XX fetuses.<ref>{{Cite journal|url=https://emedicine.medscape.com/article/924291-overview|title=5-Alpha-Reductase Deficiency: Background, Pathophysiology, Epidemiology|date=May 3, 2020|via=eMedicine}}</ref> |
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5-ARD has been observed in females. Case studies indicate that it is associated with delayed puberty and menarche and suggest that DHT plays a role in hirsutism and/or menstrual disorders in females.<ref>{{cite journal |last1=Katz |first1=M D |last2=Cai |first2=L Q |last3=Zhu |first3=Y S |last4=Herrera |first4=C |last5=DeFillo-Ricart |first5=M |last6=Shackleton |first6=C H |last7=Imperato-McGinley |first7=J |title=The biochemical and phenotypic characterization of females homozygous for 5 alpha-reductase-2 deficiency. |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 1995 |volume=80 |issue=11 |pages=3160–3167 |doi=10.1210/jcem.80.11.7593420}}</ref> |
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==Mechanism== |
==Mechanism== |
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==Society and culture== |
==Society and culture== |
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===Sport=== |
===Sport=== |
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In April 2014, the [[BMJ]] reported that four elite women athletes with 5-ARD were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that "partial clitoridectomy" was "not medically indicated, does not relate to real or perceived athletic “advantage,"" relating to elevated androgen levels. The athletes were all from developing countries where lifetime access to hormone replacement may prove elusive.<ref>{{cite journal |author=Rebecca Jordan-Young |author-link=Rebecca Jordan-Young |author2=Peter Sonksen |author3=Katrina Karkazis |author3-link=Katrina Karkazis|title= Sex, health, and athletes |journal=[[BMJ]]|volume=348|pages=g2926|year=2014 |doi=10.1136/bmj.g2926|url=http://www.bmj.com/content/348/bmj.g2926 |pmid=24776640|s2cid=2198650 }}</ref> Intersex advocates regard this intervention as "a clearly coercive process".<ref>{{cite web|url=https://ihra.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|title=UN Human Rights Council: resolution, statement and side event, "The time has come"|publisher=[[Organisation Intersex International Australia]]|access-date=2 February 2021|date=2014-09-11}}</ref> |
In April 2014, the [[BMJ]] reported that four elite women athletes with 5-ARD were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that "partial clitoridectomy" was "not medically indicated, does not relate to real or perceived athletic “advantage,"" relating to elevated androgen levels. The athletes were all from developing countries where lifetime access to hormone replacement may prove elusive.<ref>{{cite journal |author=Rebecca Jordan-Young |author-link=Rebecca Jordan-Young |author2=Peter Sonksen |author3=Katrina Karkazis |author3-link=Katrina Karkazis|title= Sex, health, and athletes |journal=[[BMJ]]|volume=348|pages=g2926|year=2014 |doi=10.1136/bmj.g2926|url=http://www.bmj.com/content/348/bmj.g2926 |pmid=24776640|s2cid=2198650 }}</ref> Intersex advocates regard this intervention as "a clearly coercive process".<ref>{{cite web|url=https://ihra.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|title=UN Human Rights Council: resolution, statement and side event, "The time has come"|publisher=[[Organisation Intersex International Australia]]|access-date=2 February 2021|date=2014-09-11}}</ref> |
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[[Jeffrey Eugenides]]' Pulitzer Prize-winning 2002 novel ''[[Middlesex (novel)|Middlesex]]'' is about a young man with 5-ARD. The character was originally born Calliope and raised as a girl, but upon realizing his genetic sex, he transitions into Cal. |
[[Jeffrey Eugenides]]' Pulitzer Prize-winning 2002 novel ''[[Middlesex (novel)|Middlesex]]'' is about a young man with 5-ARD. The character was originally born Calliope and raised as a girl, but upon realizing his genetic sex, he transitions into Cal. |
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==Notable people with 5α- |
==Notable people with 5α-Reductase deficiency== |
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*[[Caster Semenya]]<ref>{{Cite news |first=Sean |last=Ingle |url=http://www.theguardian.com/sport/2019/jun/18/caster-semenya-iaaf-athletics-guinea-pig|title=Caster Semenya accuses IAAF of using her as a ‘guinea pig experiment’ |date=June 18, 2019 |newspaper=[[The Guardian]] }}</ref> |
*[[Caster Semenya]]<ref>{{Cite news |first=Sean |last=Ingle |url=http://www.theguardian.com/sport/2019/jun/18/caster-semenya-iaaf-athletics-guinea-pig|title=Caster Semenya accuses IAAF of using her as a ‘guinea pig experiment’ |date=June 18, 2019 |newspaper=[[The Guardian]] }}</ref> |
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Revision as of 09:27, 13 July 2021
| 5α-Reductase deficiency | |
|---|---|
| Other names | 5-ARD |
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| Pseudovaginal perineoscrotal hypospadias is inherited in an autosomal recessive manner | |
| Specialty | Medical genetics  |
5α-Reductase deficiency is an autosomal recessive intersex condition caused by a mutation in SRD5A2, a gene encoding the enzyme 5α-reductase type 2.[1] The phenotype this usually causes is pseudovaginal perineoscrotal hypospadias, a configuration of the external genitalia of an infant.[2][3] In a sense, this configuration is roughly midway between phenotypical human male genitalia, and phenotypical human female genitalia, in structure and appearance. It is a relatively common form of genital ambiguity caused by undervirilization of genetic males due to several different intersex conditions.
Signs and symptoms
Individuals with 5-ARD are born with male gonads, including testicles and Wolffian structures. They can have normal male external genitalia, ambiguous genitalia, or external female appearing genitalia, but usually tend towards a female appearance.[citation needed]
The development of the genital tubercle tissue (which by week 9 of a fetus' gestation becomes either a clitoris or a penis) tends towards a size qualifying it as an ambiguous macroclitoris/micropenis (large clitoris/small penis), and the urethra may attach to the phallus.[citation needed]
If the condition has not already been diagnosed, it usually becomes apparent at puberty around age twelve with primary amenorrhoea and virilization. This may include descending of the testes, hirsutism (facial/body hair considered normal in males – not to be confused with hypertrichosis), deepening of the voice, and enlargement of the clitoris into what would then be classed as a penis.[citation needed]
In adulthood, individuals do not experience male-pattern baldness.[1] As dihydrotestosterone (DHT) is a far more potent androgen than testosterone alone, virilization in those lacking DHT may be absent or reduced compared to males with functional 5-AR. It is hypothesized that rising testosterone levels at the start of puberty are able to generate sufficient levels of DHT either by the action of 5α-reductase type I (active in the adult liver, non-genital skin and some brain areas) or through the expression of low levels of 5α-reductase type II in the testes.
5-ARD is associated with an increased risk of cryptorchidism and testicular cancer.[citation needed]
Fertility
Since the gonad tissue develops into testes rather than ovaries, they are thus unable to create ova but may be able to create sperm. Male fertility can still be possible if viable sperm is present in the testes and is able to be extracted. In general, individuals with 5-ARD are capable of producing viable sperm.[citation needed]
Although the external genitalia can sometimes be completely female, the vagina consists of only the lower two-thirds of a normal vagina, creating a blind-ending vaginal pouch. Because of normal action of Müllerian inhibiting factor produced by the testes in utero, individuals with 5-ARD lack a uterus and Fallopian tubes. Thus, they would not physically be able to carry a pregnancy in any event. Even with treatments such as surrogate motherhood, female infertility is caused by the lack of any ova to implant in a surrogate mother.[citation needed]
In individuals with an ambiguous genital resulting in a macroclitoris/micropenis, the genital may be capable of ejaculations as well as erections, but may be of insufficient size for penetrative sexual intercourse.[citation needed]
Fertility is further compromised by the underdevelopment of seminal vesicles and prostate.[citation needed]
Cause
The condition affects only those with a Y-chromosome because DHT has no known role in development of XX fetuses.[4]
Mechanism
5α-Reductase is an enzyme that converts testosterone to 5α-dihydrotestosterone (DHT) in peripheral tissues. These enzymes also participate in the creation of such neurosteroids as allopregnanolone and THDOC, convert progesterone into dihydroprogesterone (DHP), and convert deoxycorticosterone (DOC) into dihydrodeoxycorticosterone (DHDOC). 5-ARD is biochemically characterized by low to low-normal levels of testosterone and decreased levels of DHT, creating a higher testosterone/DHT ratio.[citation needed]
DHT is a potent androgen, and is necessary for the development of male external genitalia in utero.
Diagnosis
![[icon]](http://upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png){kind=small} | This section is empty. You can help by adding to it. (January 2019) |
Management
Until recently, reconstruction of children's genitals was often undertaken to "normalize" their appearance in accordance with a binary model of anatomical sex. Parents often request and/or authorize the reconstructive surgery with the hope of sparing their child the shame and embarrassment which is often associated with being visibly "different" than the child's peers in situations such as school locker rooms, etc. The practice is being met with increasing resistance from the medical community, since an actual medical need for such interventions is often not given. Furthermore, social advocates are working to increase awareness, understanding and acceptance of non-binary sexual anatomy, which is reducing the potential for stigma and shame for people born with intersex or indeterminate anatomy.[citation needed]
Epidemiology
The condition is rare, with areas of greater incidence known in regions of the Dominican Republic (where people with the condition are called güevedoces - "penis at twelve"), Papua New Guinea (where it's known as kwolu-aatmwol - suggesting a person's transformation "into a male thing"),[5] and Turkey.[6]
The cases of the condition reported in the Dominican Republic are of greatest interest due to its prevalence in the small remote village of Las Salinas, where 12 out of 13 families had one or more male family members that carried the genetic mutation, though not all the carriers of the mutation were affected. The overall incidence for the village was 1 in every 90 males were affected carriers, the remainder of the village genetic males were either non-carriers or non-affected carriers.[7]
It is thought that either a founder effect or a bottleneck effect (the villagers are interrelated and may have inherited the mutation from the same individual), in conjunction with a lack of geneflow (genes from outsiders) in the isolated geographic location of Las Salinas allowed the mutation to become amplified in the village. In the Dominican Republic, the colloquial Spanish term for a person with the condition is güevedoce, a contraction in the local dialect of the phrase "huevos a los doce", meaning "eggs at twelve".[8] Huevo or güevo literally means egg, but is also slang for testicle, so the meaning is "testicles at age twelve".[citation needed]
In the Dominican Republic, güevedoces are regarded as a third gender and experience ambivalent gender socialisation. In adulthood, they most commonly self-identify as men (perhaps because of the positions of freedom and power that men hold in their culture), but are not necessarily completely treated as such by society.[5] In the cases in Papua New Guinea, it has been said that the "girl" is shunned when he begins his natural transformation into a male body and socially assumes a male gender role.[9]
Society and culture
Sport
In April 2014, the BMJ reported that four elite women athletes with 5-ARD were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that "partial clitoridectomy" was "not medically indicated, does not relate to real or perceived athletic “advantage,"" relating to elevated androgen levels. The athletes were all from developing countries where lifetime access to hormone replacement may prove elusive.[10] Intersex advocates regard this intervention as "a clearly coercive process".[11]
Popular culture
In the Nip/Tuck season three episode "Quentin Costa", it is revealed that Quentin Costa had 5-ARD.
Jeffrey Eugenides' Pulitzer Prize-winning 2002 novel Middlesex is about a young man with 5-ARD. The character was originally born Calliope and raised as a girl, but upon realizing his genetic sex, he transitions into Cal.
Notable people with 5α-Reductase deficiency
See also
- Intersex
- Disorders of sexual development, pseudohermaphroditism, and ambiguous genitalia
- Inborn errors of steroid metabolism
- 5α-Reductase (I, II)
- Androgen (testosterone and dihydrotestosterone)
- Ambiguous genitalia
- Intersex surgery
- Androgen insensitivity syndrome
References
- ^ a b "5-alpha reductase deficiency". GPnotebook.
- ^ Bahceci M, Ersay AR, Tuzcu A, Hiort O, Richter-Unruh A, Gokalp D (2005). "A novel missense mutation of 5-alpha reductase type 2 gene (SRD5A2) leads to severe male pseudohermaphroditism in a Turkish family". Urology. 66 (2): 407–10. doi:10.1016/j.urology.2005.02.021. PMID 16098368.
- ^ Eberhard Nieschlag; Hermann M. Behre; Susan Nieschlag (July 2009). Andrology: Male Reproductive Health and Dysfunction. Springer. pp. 328–. ISBN 978-3-540-78354-1. Retrieved 2 January 2011.
- ^ "5-Alpha-Reductase Deficiency: Background, Pathophysiology, Epidemiology". May 3, 2020 – via eMedicine.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b Fausto-Sterling, Anne (2000). Sexing the Body: Gender politics and the construction of sexuality (1st ed.). New York, NY: Basic Books. p. 109. ISBN 0465077145.
- ^ Jong, Diana Mettadewi (2016). "5-alpha-reductase deficiency: a case report". Indonesian Pediatric Society. 43 (6): 234-240. doi:10.14238/pi43.6.2003.234-40. Retrieved 24 October 2020.
- ^ Imperato-McGinley, Julianne; Guerrero, Luis; Gautier, Teofilo; Peterson, Ralph Edward (December 1974). "Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism". Science. 186 (4170): 1213–1215. Bibcode:1974Sci...186.1213I. doi:10.1126/science.186.4170.1213. PMID 4432067. S2CID 36427689.
- ^ AlMomento.net. "BARAHONA: Enfermedad genética hace que niños RD nazcan sin pene". AlMomento.net (in European Spanish). Retrieved 2017-03-08.
- ^ Imperato-McGinley J, Miller M, Wilson JD, Peterson RE, Shackleton C, Gajdusek DC (Apr 1991). "A cluster of male pseudohermaphrodites with 5 alpha-reductase deficiency in Papua New Guinea". Clin Endocrinol. 34 (4): 293–8. doi:10.1111/j.1365-2265.1991.tb03769.x. PMID 1831738. S2CID 84664559.
- ^ Rebecca Jordan-Young; Peter Sonksen; Katrina Karkazis (2014). "Sex, health, and athletes". BMJ. 348: g2926. doi:10.1136/bmj.g2926. PMID 24776640. S2CID 2198650.
- ^ "UN Human Rights Council: resolution, statement and side event, "The time has come"". Organisation Intersex International Australia. 2014-09-11. Retrieved 2 February 2021.
- ^ Ingle, Sean (June 18, 2019). "Caster Semenya accuses IAAF of using her as a 'guinea pig experiment'". The Guardian.