Health-related Quality of Life and Psychological Wellbeing in Adults with Differences of Sex Development (DSD)

Abstract

Objective

Rare congenital conditions with incongruence of chromosomal, gonadal, and phenotypic sex have been classified as Differences/ Disorders of Sex Development (DSD). Included in DSD are conditions with diverse genetic aetiology, varying levels of prenatal androgen effects, phenotypes, and subsequently, different medical treatments. Quality of life (QoL) and psychological wellbeing are indicators of successful psychosocial adaptation to the conditions. We sought to investigate the HRQOL and psychological wellbeing in this population.

Design

This multicentre clinical evaluation study was part of a German network related to DSD funded by the German Ministry of Science and Education (BMBF 2003 to 2007).

Methods

To assess health-related quality of life (HRQoL), we used the Short Form Health Survey (SF-36) and for psychological wellbeing, the Brief Symptom Inventory (BSI). Participants were classified into five groups: females with CAH, females with XY DSD conditions where there is a partial androgen effect (partial androgen insensitivity, mixed/ partial gonadal dysgenesis, disorders of androgen biosynthesis), females with XY DSD without androgen effect (complete androgen insensitivity, complete gonadal dysgenesis), males with XY DSD, and individuals with DSD conditions and other gender.

Results

Participants included 110 adults with DSD (age range 17-62). We found a trend of lowered mental HRQoL and significant higher physical HRQoL for participants as compared to the norm. The high physical HRQoL especially applied to females with androgen effect and XY karyotype. Participants reported significant higher psychological distress compared to the norm. Forty-seven participants (42.7%) reported distress in a clinically relevant range on the BSI.

Conclusions

Although we did not find significant impairments in overall HRQoL, participants reported significant impaired psychological wellbeing. Specialised interdisciplinary care should focus in particular on psychological issues to ensure good overall health and wellbeing.

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