Background: 47XXY males and other cases of hypogonadism are usually treated with testosterone at adolescence or on diagnosis, often with surgery for gynaecomastia. These procedures are usually found helpful in affirming a male gender identity.
Aims: To describe four such patients who in adulthood presented with Gender Dysphoria, asking for oestrogen. Two of them regretted having had mastectomy and wanted breast reconstruction.
Results: Two of the patients identified as Transsexual, changing their names and taking a female identity. The other two saw themselves as frankly Intersex, professing pride in the characteristics of both sexes.
Conclusion: These cases give food for speculation as to the relation of body to body image and as to possible antenatal hormonal influence on gender identity. They might also illustrate academic notions of gender fluidity. However, the main purpose of this paper is clinical – a plea for careful assessment of gender identity before launching on physical treatments. This would call for great sensitivity as the majority of 47XXY adolescent males benefit from affirmation of their masculinity rather than questioning it!
