ESPE Abstracts

Background: The commonest cause of 46, XX disorders of sex development (DSD) is congenital adrenal hyperplasia (CAH). We report two female virilised siblings with uncontrolled CAH who were reared as boys since birth. Different team members were involved in management. We discuss here gender reassignment and the psychosocial implications from Islamic perspectives.

Case reports: An eight and 11 years old severely virilised CAH Yemeni girls were raised as boys since birth. They were referred to Saudi Arabia for further management. Parents are consanguineous and there is a family history of neonatal death. The gender was first assigned when parents were under social and cultural pressures. They were unsatisfied of the assignment and, therefore, have kept a balance in counseling their children and the way they brought them up, in order to help easier gender reassignment in the future. The dilemma has reached a peak when children started to menstruate at the age of 7.5 years. They will now be reassigned as girls.

Discussion: Similar to western societies, gender assignment in Muslim communities, as per Islamic guidance, follows the best available evidence and parents should be well informed. The dominant role of male gender in a Muslim community shouldn’t over rule Islamic laws. Management shouldn’t be influenced only by how easy to reconstruct the genitalia, but sexual function and better chance of fertility should also be considered. Should gender-reassignment is required; the Islamic recommendation is to perform surgery as early in life as possible to avoid serious psychosocial implications. Gender transfer is totally prohibited, and even considered criminal in Islam.

Conclusion: Management of patients with DSD requires a multidisciplinary team approach, owing to make the best decision to help patients entertaining more or less usual gender role, sexual life, fertility and psychosocial wellbeing. Cultural and religious perspectives should not be overlooked.