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EVALUATION OF BONE MASS IN MALE PSEUDOHERMAPHRODITES (MPH) RAISED AS FEMALES

Evaluation of bone mass in castrated MPH has not yet been reported in the literature. Our goal was to study bone mass after the onset of puberty in a group of 19 MPH raised as females, by measuring bone mineral density expressed as Z score with a Hologic QDR-1000 densitometer. Patients were divided into 2 groups: Group I - 7 patients with complete (4 cases) or partial (3 cases) androgen insensitivity, who had been castrated after puberty; Group II - 12 patients with MPH due to various causes, who had been castrated before puberty, and started on estrogens either before 12 years (Group II A) or after 16 years (Group II B) of age. Results are expressed as mean ± standard deviation.All patients in Group I (except for 2 cases with Z score of -2.16) and also in Group IIA had a bone mass within the normal limits. In Group IIB, all subjects had a bone mass below −2 standard deviations, (except for one case with a Z score of −0.49). We conclude that most patients with androgen insensitivity who were castrated after puberty, and all subjects with various causes of male pseudohermaphroditism who were castrated in childhood and started on estrogen before the age of 12, had normal bone mass. The presence of endogenous or exogenous estrogen at the time of puberty appears to be important for the maintenance of normal bone mass.