Kula Krzysztof, Słowikowska-Hilczer Jolanta
Zakładu Andrologii i Endokrynologii Płodności, Instytut Endokrynologii, Uniwersytet Medyczny w Łodzi.
Neurol Neurochir Pol. 2003;37 Suppl 3:19-38.
Experimental studies revealed that transient action of sex steroids during perinatal period is crucial for the development of male sexual behavior and sexually dimorphic brain anatomy. Meanwhile, the lack of gonadal steroids in female foetus and estrogen effects at puberty determine female behavior together with female type of anatomical brain structures and of endocrine functions. In men psychic sex consists of gender identity (self-estimation), gender role (objective estimation of sex behavior). In addition, a sexual psycho-orientation (hetero-, bi- or homosexual) has been distinguished. Although it is believed that gender depends on the socio-environmental influences such as rearing, learning and individual choice, the biological factors are considered to be most important. This concept arises from recent study on patients with gender dysphoria syndrome (transsexualism). In intersexualism, in genetic men with disturbances of sexual differentiation of external genitalia because of the lack of testoterone production or action in peripheral tissues (male pseudohermaphroditism) or in genetic women with ambiguous genitalia because of the presence and action of androgens (female pseudohermaphroditism), a discordance between the formal sex (assigned after the birth) and the psychic gender may appear. In these individuals the legal sex established according to somatic and/or genetic sex at birth may be incompatible with their actual gender identity and role. The knowledge about gender identity is necessary at the decision of eventual (!) surgical correction of sex organs in patients with ambiguous genitalia. This decision should depend not on the expected, but on the actual gender identity of the individual patient. Meantime, early bilateral gonadectomy in patients with gonadal dysgenesis and male pseudohermaphroditism is an indication for life because of the highest risk of germ cell carcinoma.
实验研究表明，围产期性类固醇的短暂作用对于男性性行为和两性异形的脑解剖结构的发育至关重要。同时，雌性胎儿缺乏性腺类固醇以及青春期的雌激素作用，与女性类型的脑解剖结构和内分泌功能共同决定了女性的行为。在男性中，心理性别包括性别认同（自我评估）、性别角色（对性行为的客观评估）。此外，还区分了性心理取向（异性恋、双性恋或同性恋）。尽管人们认为性别取决于社会环境影响，如养育、学习和个人选择，但生物因素被认为是最重要的。这一概念源于最近对性别焦虑症（易性癖）患者的研究。在两性畸形中，由于外周组织缺乏睾酮产生或作用，导致外生殖器性分化紊乱的遗传男性（男性假两性畸形），或由于雄激素的存在和作用，导致生殖器模糊的遗传女性（女性假两性畸形），可能会出现形式上的性别（出生后指定）与心理性别之间的不一致。在这些个体中，根据出生时的躯体和/或遗传性别确定的法定性别可能与他们实际的性别认同和角色不相符。在决定对生殖器模糊的患者最终（！）进行性器官手术矫正时，了解性别认同是必要的。这一决定不应取决于预期的，而应取决于个体患者实际的性别认同。同时，对于性腺发育不全和男性假两性畸形患者，早期双侧性腺切除术是必要的，因为患生殖细胞癌的风险最高。
