Androgen insensitivity syndrome
Androgen insensitivity syndrome (AIS) is when a person who is genetically male (who has one X and one Y chromosome) is resistant to male hormones (called androgens). As a result, the person has some or all of the physical traits of a woman, but the genetic makeup of a man.
AIS is caused by genetic defects on the X chromosome. These defects make the body unable to respond to the hormones that produce a male appearance.
The syndrome is divided into two main categories:
Complete androgen insensitivity prevents the penis and other male body parts from developing. At birth, the child looks like a girl. The complete form of the syndrome occurs in as many as 1 in 20,000 live births.
In incomplete AIS, people have different numbers of male traits.
Incomplete AIS can include other disorders, such as:
Infertile male syndrome is also considered to be part of incomplete AIS.
A person with complete AIS appears to be female but has no uterus, and has very little armpit and pubic hair. At puberty, female sex characteristics (such as breasts) develop. However, the person does not menstruate and become fertile.
People with incomplete AIS may have both male and female physical characteristics. Many have partial closing of the outer vagina, an enlarged clitoris, and a short vagina.
There may be:
Exams and Tests
Complete AIS is rarely discovered during childhood. Sometimes, a growth is felt in the abdomen or groin that turns out to be a testicle when it is explored with surgery. Most people with this condition are not diagnosed until they DO NOT get a menstrual period or they have trouble getting pregnant.
Incomplete AIS is often discovered during childhood because the person may have both male and female physical traits.
Tests used to diagnose this condition may include:
Other blood tests may be done to help tell the difference between AIS and androgen deficiency.
Testicles that are in the wrong place may not be removed until a child finishes growing and goes through puberty. At this time, the testes may be removed because they can develop cancer, just like any undescended testicle.
Estrogen replacement is prescribed after puberty.
Treatment and gender assignment can be a very complex issue, and must be targeted to each individual person.
The outlook for complete AIS is good if the testicle tissue is removed at the right time. The outlook for incomplete AIS depends on the appearance of the genitals.
When to Contact a Medical Professional
Call your health care provider if you or your child has signs or symptoms of the syndrome.
Achermann JC, Hughes IA. Pediatric disorders of sex development. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 23.
Donohuoe PA. Disorders of sex development. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 588.
Review Date: 8/16/2016
Reviewed By: Anna C. Edens Hurst, MD, MS, Assistant Professor in Medical Genetics at the University of Alabama, Birmingham, AL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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