Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 17;110(7):1906-1914.
doi: 10.1210/clinem/dgae720.

Psychiatric Comorbidities in Women With Complete Androgen Insensitivity Syndrome or Müllerian Duct Aplasia/Agenesis

Behzad Sorouri Khorashad  1   2   3 , Oumaima Kaabi  4 , Melissa D Gardner  1 , Darios Getahun  5   6 , Michael Goodman  4 , Timothy L Lash  4 , Peter A Lee  7 , Courtney McCracken  8 , Joshua May  5 , Maria Muzik  2 , Suma Vupputuri  9 , Rami Yacoub  4 , David E Sandberg  1
Affiliations

Psychiatric Comorbidities in Women With Complete Androgen Insensitivity Syndrome or Müllerian Duct Aplasia/Agenesis

Behzad Sorouri Khorashad et al. J Clin Endocrinol Metab. .

Abstract

Context: Understanding mental health issues facing individuals with disorders/differences of sex development (DSD) is crucial for optimizing evidence-based practices in this population.

Objectives: This work aimed to compare the prevalence of psychiatric diagnoses among patients diagnosed with complete androgen insensitivity syndrome (CAIS) or müllerian duct aplasia/agenesis (MA) to male and female reference groups.

Methods: A retrospective cohort study was conducted among 3 large integrated health systems. Participants included all individuals with confirmed CAIS or MA enrolled in 1 of 3 Kaiser Permanente health-care systems between January 1, 1988, and January 31, 2017. For each DSD patient, age-, race/ethnicity- and health system-matched male and female referents with typical sex development were randomly selected. Outcome measurements were mental health diagnoses and use of psychiatric medications.

Results: The prevalence of anxiety and depressive disorders in the CAIS and MA cohorts was approximately twice as high as in male referents without DSD, but the corresponding differences relative to female referents were less evident. A subgroup of MA patients with uterine agenesis had a higher prevalence of bipolar disorder than either reference group, but these results were accompanied by wide CIs. Women with CAIS and MA more frequently filled psychiatric medications compared to male but not female referents.

Conclusion: On balance, these findings are reassuring, albeit requiring confirmation in other settings. Future studies using longitudinal designs and patient-reported outcomes are needed to evaluate changes in mental health status of CAIS and MA patients at different ages and different intervals following initial diagnosis.

Keywords: MRKH; complete androgen insensitivity syndrome; differences of sex development; disorders of sex development; müllerian duct agenesis; psychiatric morbidity; vaginal agenesis.

PubMed Disclaimer

Comment in

References

    1. Lee PA, Houk CP, Ahmed SF, Hughes IA, International Consensus Conference on Intersex organized by the Lawson Wilkins Pediatric Endocrine Society, the European Society for Paediatric Endocrinology . Consensus statement on management of intersex disorders. International consensus conference on intersex. Pediatrics. 2006;118(2):e488‐e500. - PubMed
    1. Hines M. Gonadal hormones and sexual differentiation of human brain and behavior. In: Pfaff DW, Joëls M, eds. Hormones, Brain and Behavior. Vol 5. 3rd ed. Academic Press; 2017:247‐278.
    1. Berenbaum SA, Beltz AM. Evidence and implications from a natural experiment of prenatal androgen effects on gendered behavior. Curr Dir Psychol Sci. 2021;30(3):202‐210. - PMC - PubMed
    1. de Vries ALC, Roehle R, Marshall L, et al. Mental health of a large group of adults with disorders of sex development in six European countries. Psychosom Med. 2019;81(7):629‐640. - PMC - PubMed
    1. Sandberg DE, Gardner M. Differences/disorders of sex development: medical conditions at the intersection of sex and gender. Annu Rev Clin Psychol. 2022;18(1):201‐231. - PMC - PubMed

MeSH terms

Supplementary concepts