The International Journal of Romanian Society of Endocrinology / Registered in 1938

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July - September 2021, Volume 17, Issue 3
Endocrine Care

Doktur H, Tanidir C, Gunes H, Aytemiz T, Durcan G, Onal H, Kutlu E

Gender Dsyphoria and Psychiatric Disorders in Children and Adolescents with Congenital Adrenal Hyperplasia

Acta Endo (Buc) 2021, 17 (3): 365-371
doi: 10.4183/aeb.2021.365

Context. Gender identity, psychosexual function, psychiatric adjustment and quality of life have been investigated in congenital adrenal hyperplasia(CAH) patients. Objective. We aimed to investigate gender identity problems and the psychiatric disorders and associated factors in children and adolescents with CAH patients. Subjects and methods. Forty-five children and adolescents with CAH were included in the study. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children – Present and Lifetime Version. Gender identity problems were investigated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Results. The mean age of the sample was 11.02 years (SD: 3.25, range: 6–18). 51.1% of the patients had at least one lifetime comorbid psychiatric disorder. The most common diagnoses were anxiety disorders, attention deficit hyperactivity disorder(ADHD), tic disorders and enuresis nocturna. Tic disorders and ADHD were higher in males but they were not statistically significant. Two female patients were diagnosed with gender dysphoria and 18.5% of females showed variably masculinized behaviors. The girls with gender identity problems expressed lower satisfaction with their sex than other girls and boys. Conclusions. Children and adolescents with CAH had many psychiatric disorders, especially neurodevelopmental disorders. ADHD and tic disorders should be kept in mind during assessment especially in male patients. Gender dysphoria and masculine behaviors seem to be common in female patients with CAH so they should be carefully investigated.

Keywords: adolescent, child, congenital adrenal hyperplasia, gender dysphoria, psycopathology

Correspondence: Hilal Doktur MD, Bakirkoy Training and Research Hospital for Mental Health and Neurological Disorders, Department of Child and Adolescent Psychiatry, Istanbul, Turkey, E-mail: