Psychological Aspects of Androgen Insensitivity Syndrome- A Case Report

Abstract

Introduction: Androgen insensitivity syndrome (AIS) is a condition that results in the partial or complete inability of the cell to respond to androgens. A person with androgen insensitivity syndrome can experience significant psychological distress secondary to the ambiguity concerning their sexual anatomy. Psychological evaluation and management of a case of Androgen insensitivity syndrome brought up as a female experiencing such distress is reported here. Case history: A 25 years aged female patient working as a police constable, was referred for psychiatric evaluation for repeated attempts to commit suicide secondary to depression and anxiety arising out of her sexual ambiguity. She had consulted a gynaecologist for not having attained menarche. Ultrasonography of abdomen showed aplastic uterus with streak ovaries. According to chromosome analysis, she was a phenotypic female with male karyotype-46, XY (sex reversal). Her testosterone levels were increased. She had undergone prophylactic laparoscopic gonadectomy. The impact of test results made her anxious and sad. Her sexual ambiguity resulted in worry about getting transformed into a hijda (Eunuch) which led to repeated attempts to commit suicide. Psychiatric intervention consisted of antidepressants and counselling sessions aimed at coming to terms with ambiguity about her gender. Conclusion: Androgen insensitivity syndrome, although very rare, can result in considerable psychiatric morbidity. Apart from gynaecological and endocrinal aspects, addressing associated psychological issues is essential to reduce psychiatric morbidity and increase quality of life.