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Intersexuality - The Intersexual Spectrum
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Causes of Intersexuality - Hormones
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Congenital Adrenal Hyperplasia (CAH)
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Hormonal Imbalance
The three main hormones involved in CAH are:
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- Cortisol (works against stress, injury and infection; helps in controlling blood sugar levels),
- Aldosterone (needed for kidney functioning; helps in retaining salt), and
- Androgens, one of which is testosterone (needed for healthy body development).
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In a person with CAH, the mixture of these hormones is wrong: The levels of both cortisol and aldosterone are too low, and the androgen level is too high. This can result in a number of physical problems, some of them, like salt loss, very severe. Also: A girl born with CAH may have “ambiguous” external sex organs, such as an unusually large clitoris and fused vaginal lips. Boys with CAH may have poorly functioning testicles without proper sperm production, but otherwise may have no physical problems. Both girls and boys with CAH may develop pubic hair in early childhood, and their clitoris or penis may grow even before they enter school. Generally speaking, children with CAH are likely to grow very fast, but, as adults, tend to remain shorter than average. There are several forms of CAH, some less serious than others. Some forms are obvious or easily detected at birth (“classical CAH”), but a mild form of the condition does not become apparent until puberty (“non-classical CAH” or “late onset CAH”). Fortunately, in either case the condition is treatable. It affects approximately 1 in 15,000 newborns (ca. 0,007%).
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Adrenal Cortex
- Lack of cortisol
- Lack of aldosterone
- Excessive androgens
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A: Kidneys (white) and adrenal glands (orange). B: Enlarged longitudinal section of one adrenal gland. The malfunctioning cortex is here colored orange.
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