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Endocrine Abstracts (2014) 35 S14.2 | DOI: 10.1530/endoabs.35.S14.2

Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland.


Disorders of sex development (DSD) is the matter of controversy on what should be the methods of treatment. One of the main problem is preservation of underdeveloped gonads. The issue of concern are especially patients with gonadal dysgenesis and Y chromosome (with presence of potential testes) (GD) and patients with androgen insensitivity (46,XY and underdeveloped testes) (AIS). It was confirmed by many studies that the risk of germ cell neoplasia (GCN) is high in these gonads, thus prepubertal gonadectomy has been recommended for years. However, the number of studied patients was relatively low, etiology of DSD was diverse, growth of gonads and their hormonal function were quite good in some cases, so resection of gonads was not obvious in every patient. Moreover, there is currently observed a growing number of protests against gonadectomy organized by adult persons with DSD who underwent such surgery in childhood. They claim that because of gonadectomy they are deprived of fertility and convicted for the life-long hypogonadism treatment. Nevertheless, a study on adult patients with GD and AIS with preserved gonads until adulthood leads us to the conclusion that most of underdeveloped testes has poor hormonal function and need sex steroid supplementation. Only one out of 145 gonads revealed spermatogenesis advanced to spermatozoa, which gives prognosis of potential fertility. A lot of these gonads revealed overt germ cell tumours or preinvasive intratubular GCN and were removed because of it. Besides, the psychic condition was worse in persons with preserved one or both gonads in comparison to those after early gonadectomy. Further studies on the justification of underdeveloped testes preservation are still expected. Results of the dsd-LIFE European project with a large group of DSD patients may give the additional advice.

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