Research Topic

Management of Females with Congenital Adrenal Hyperplasia

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Congenital adrenal hyperplasia (CAH) in girls is usually classified as a disorder of sex development (DSD).This has given rise to controversies including but not limited to gender assignment of virilized individuals at birth, gender of rearing and timing of corrective surgery despite the fact that these girls ...

Congenital adrenal hyperplasia (CAH) in girls is usually classified as a disorder of sex development (DSD).This has given rise to controversies including but not limited to gender assignment of virilized individuals at birth, gender of rearing and timing of corrective surgery despite the fact that these girls with good hormonal management have potential for normal sexual and reproductive functions seldom exhibit gender dysphoria and in a way are not very different from boys with corrected severe hypospadias.
Those who propose to rear severely virilized XX individuals with CAH as males seem to ignore the need for steroid replacement in the majority of these children since they are salt losers. In addition individuals with poor steroid therapy tend to develop precocious puberty, short stature and at risk for cardiac disease. Raised as males they will be infertile and likely need numerous surgical procedures in the genitalia.

Those who propose a moratorium for all “gender” surgery in children tend to include CAH in their recommendation; a trend we feel can lead to inappropriate government regulations that will be a disservice to girls with CAH. Also inclusion of CAH among DSD has led to confusion among the lay public that composes patient advocacy groups.

The objective of this Research Topic is to assemble a collection of papers by recognized authorities in the field addressing current thoughts on all aspects of the treatment of CAH and on the advisability of including it among DSD instead of addressing it in a manner more like male hypospadias which has not given rise to similar controversies and is not considered by most as a DSD.


Keywords: CAH, DSD, Feminizing genitoplasty, clitoral hypertrophy, Urogenital sinus, gender identity, gender dysphoria


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