Signs and symptoms

Infants with complete androgen insensitivity syndrome appear to be female at birth, but do not have a uterus, fallopian tubes or ovaries. Their testicles are hidden inside the pelvis or abdomen. Breasts develop during puberty, but there is little or no pubic and armpit hair. Babies born with complete androgen insensitivity syndrome are typically raised as girls and have a female gender identity. In many cases, they aren’t diagnosed until adolescence or later, when they fail to menstruate or are unable to get pregnant.

Babies born with partial androgen insensitivity syndrome may have sexual characteristics that are typical of a male, a female, or both. They may have a partial closing of the outer vagina, an enlarged clitoris and a short vagina. They may be raised as males or as females and have a male or female gender identity.

Other symptoms of partial androgen insensitivity syndrome include failure of one or both of the testicles to descend into the scrotum after birth and an abnormal penis in which the urethra opens on the underside, instead of at the tip. In the least severe cases, the only sign of androgen insensitivity syndrome is male infertility.

Cause

Androgen insensitivity syndrome is an inherited condition passed down by the mother. A baby’s sex is determined at the moment of conception when the mother contributes an X chromosome and the father contributes either an X or a Y chromosome. Testosterone signals an XY fetus to develop male sex organs. In androgen insensitivity syndrome, a defect on the X chromosome fully or partially blocks testosterone’s effect on the body. This prevents the fetus from responding to the male hormone, interfering with the development of the sex organs.

Testing and diagnosis

Complete androgen insensitivity syndrome may be discovered in infancy when a testicle is felt as a mass in the groin or abdomen. However, in most cases, the syndrome isn’t diagnosed until adolescence or later.

Partial androgen insensitivity may be diagnosed at birth because of the presence of male and female sexual traits.

Tests used to confirm this condition include blood work to check hormone levels, genetic testing and pelvic ultrasound.

Treatment

Children with complete androgen insensitivity syndrome (CAIS) typically go through puberty naturally and develop breasts without hormone treatment if their testes remain in place. This is because their bodies convert testosterone into estrogen, so estrogen replacement therapy is usually not needed during puberty. 

As children with CAIS grow older, they and their families may consider a gonadectomy (surgery to remove the testes) after puberty is complete. While this surgery can reduce the risk of developing gonadal germ cell tumors, the risk of cancer is generally low before adulthood. After discussing the benefits, risks and personal preferences with their healthcare team, many choose to keep their gonads and undergo regular monitoring.

If a gonadectomy is performed, lifelong estrogen replacement therapy is recommended to support bone health, sexual health and overall well-being.

Outlook

Children with androgen insensitivity syndrome will become infertile as adults. However, with psychological support and hormone replacement therapy, they are able to otherwise lead a normal life.