ESPE Abstracts

Background: Patients with 46, XY DSD present conflicts and issues related to gender identity (GI) and change to male social sex in patients registered in the female social sex is not rare. The HTP test is a projective psychological test, which assesses aspects related to sexual identification. GI in this test is defined as female (F), male (M) or ambiguous.

Objective and hypotheses: To evaluate GI in patients with 46, XY DSD by the HTP test and compare the results among individuals who maintained the social sex with those who changed the social sex.

Method: We used the HTP test in 96 subjects with 46, XY DSD before and after treatment (psychological, surgical and clinical). The first HTP test (HTP1) was performed on 90/96 patients. The second HTP (HTP2 – after treatment) was applied in 81/96 patients (all>16 years old)

Results: 20 patients changed social sex in adulthood and 76 kept the social sex (56/76=73.68% in F social sex and 20/76=26,31% in M social sex). In the group that changed the social sex in adulthood, all patients (18 F to M and two M to F) showed inappropriate HTP results before treatment. In these cases, the HTP2 was consistent with the final social sex in all of them. Among those who maintained the F social sex in adulthood, the HTP1 was adequate in 67.8% (38/56) and inadequate in 32.2%. After treatment, the HTP2 showed 81.1% of agreement with F social sex. In male social sex, HTP1 was discordant in 50% of cases (10/20), After treatment, the HTP2 was adequated in 80% (16/20) and inadequated in 20%.

Conclusion: In 46, XY DSD who changed social sex in adulthood the HTP test was able to identify a discordant GI before treatment in 100% of the cases. Among the patients who kept the social sex, inadequate GI was found in 1/3 of F social sex and in 1/2 of M social sex. After multidisciplinary approach the social sex adequacy had a marked improvement. The HTP test proved to be a useful tool for diagnosis and treatment of patients with 46,XY DSD.