title: A 7-year experience of genetic males with severe phallic inadequacy assigned female.
abstract: OBJECTIVE
  We examine the hypotheses underlying the clinical decision to assign female gender at birth in male neonates with severe phallic inadequacy.
  
  
  METHODS
  A total of 18 genetic males with severe phallic inadequacy were assessed longitudinally for physical, social, psychological and sexual identity development. Diagnoses included cloacal (11) and classic (1) exstrophy, partial androgen resistance (3), mixed gonadal dysgenesis (2) and penile agenesis (1). Neonatal sex assignment was female in 15 and male in 3 patients.
  
  
  RESULTS
  All patients demonstrated marked male typical behaviors and interests. Of the 15 female assigned patients 1 died, 1 refused to declare sexual identity or orientation, 1 converted to male before initial evaluation, 1 was reassigned male by the parents and 5 others declared male sexual identity. Thus, of 17 living patients 10 live as males and 6 as females. Of patients 17 years or older only those living as male lived independently. The 4 oldest patients living as male but only 1 patient living as female would discuss sexual orientation-all 5 declared orientation toward females, and 3 of these 4 males had girlfriends or were married. The sexually undeclared patient lived in a residential treatment center because of major behavioral difficulties since age 15. Only patients living as male had dated.
  
  
  CONCLUSIONS
  This longitudinal study implies that males with severe phallic inadequacy reared male and those reared female but converting to male can have functional psychosocial developmental trajectories. Those reared female have a realistic likelihood of recognizing male sexual identity and converting to male. Those not converting to male appear to have less successful psychosocial developmental trajectories.
authors.affiliation: Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. william-reiner@ouhsc.edu
authors.forename: William G
authors.initials: WG
authors.lastname: Reiner
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Kropp
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D012734:Disorders of Sex Development / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D005260:Female; D005783:Gender Identity; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010413:Penis / Q000002:abnormalities*; D012720:Severity of Illness Index; D013997:Time Factors