Fetal feminization and female gender identity in the testicular feminizing syndrome of androgen insensitivity

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Abstract
Interview data on aspects of sex and eroticism from a sample of 10 chromosomally male (XY) patients with the complete testicular feminization (androgen insensitivity) syndrome and from a sample of 23 patients with the late-treated adrenogenital syndrome showed marked differences. Homosexual experiences and/or dreams were lacking in the androgen-insensitive group as compared with the adrenogenital group (p⩽0.01).The androgen-insensitive group reported lower frequency of sexual arousal from visual stimuli than did the adrenogenital group (p⩽0.05).Findings on different aspects of sexual behavior suggest a tendency for the androgen-insensitive patients as a group to have a lower sex drive, to be less keenly aware of their sex drive, to be less assertive in heterosexual relations, and to be less versatile in coitus than the adrenogenital patients. No case of exclusive lesbianism, transsexualism, or transvestism was reported from either patient group. Although the two groups differed in sexual and erotic behavior, both were within the range of what in our culture is accepted as feminine. Nonetheless, the androgen-insensitive patients conformed more closely to the conventional feminine stereotype. Regarding explicit satisfaction with female sex role and with cosmetic and clothing interests, the androgen-insensitive group was characteristically feminine. Findings on the Draw-a-Person Test and the Guilford—Zimmerman Temperament Survey are compatible with the results of normal females, but are in sharp contrast with those of normal males. Interview and psychometric data thus concur in showing the androgen-insensitive patients to be unmistakably feminine in behavior and outlook. Their femininity is best conceived of as a product of hormonal nonandrogenization, prenatally and later, in combination with the social experiences of rearing and development, after initial assignment as a girl.