Review Article| Volume 127, P51-54, September 2019

Long-term consequences of androgen insensitivity syndrome

  • Konstantia Kosti
    Corresponding author at: Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Ring Road, 56403 Nea Efkarpia, Greece.
    Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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  • Loukas Athanasiadis
    Third Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, Greece
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  • Dimitrios G. Goulis
    Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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      • Individuals with androgen insensitivity syndrome are subject to long-term complications.
      • The increased risk of germ cell tumours implies the need for gonadectomy for the majority of patients.
      • Osteoporosis has been observed even before gonadectomy.
      • Surgical procedures may be indicated due to gynaecomastia, hypospadias or blind-ending vagina.
      • Besides infertility, increased risks of cardiovascular disease, obesity, diabetes and psychiatric disorders have been demonstrated.


      Androgen insensitivity syndrome (AIS) is one of the most common sexual developmental disorders. According to the grade of the remaining androgen receptor (AR) function, AIS is classified as complete (CAIS), partial (PAIS) or mild (MAIS). In CAIS, the prevalence of germ cell tumours is increased compared with the general population. Although patients with CAIS used to undergo gonadectomy before puberty, nowadays a gonadectomy is recommended after spontaneous puberty, and up to 15% of patients retain their gonads. Nevertheless, the risk of germ cell tumour increases gradually after puberty. Annual follow-up with ultrasound or magnetic resonance imaging (MRI) is recommended. Unfortunately, these imaging methods are not sensitive enough for the diagnosis of an in situ germ cell tumour. In PAIS, the risk of germ cell tumour is higher than in CAIS; therefore, an early gonadectomy or an orchidopexy is indicated. Optimal hormone replacement therapy (HRT) is necessary for long-term health. The risks of osteopenia and of regimen osteoporosis are higher, ESPECIALLY in patients with early gonadectomy. Infertility is the rule in CAIS and PAIS. A few mutations do not affect fertility detrimentally, and these are responsible for MAIS. In PAIS leading to a predominantly male phenotype or ambiguous genitalia, multiple surgical procedures for gynaecomastia and/or hypospadias are required. Some small studies have found a higher risk of obesity, hyperlipidaemia and impaired insulin sensitivity. Psychological support is essential, as the prevalence of psychiatric disorders is increased. In conclusion, the diagnosis of AIS has long-term consequences for which shared decision-making (physicians, patients, parents) is appropriate.


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