Skip to main content

46,XX maleness (XX male syndrome) is a rare disorder occurring in about 1 in 20,000–25,000 newborn males (De la Chapelle 1972; Rajender et al. 2006). Three clinical categories of sex-reversed 46,XX individuals have been identified: (1) XX males with normal external or internal genitalia; (2) XX males with ambiguity, usually detected at birth by external genital ambiguities such as hypospadias, micropenis, or clitoromegaly; and (3) XX true hermaphrodites, who carry internal or external genital ambiguities detected at birth (Valetto et al. 2005). Recently, the term “46,XX testicular DSD (disorder of sex development)” has been proposed for XX male or XX sex reversal (Lee et al. 2006; Hughes et al. 2006; Hughes 2008).

Synonyms and Related Disorders

46,XX disorder of sex development; 46,XX sex reversal syndrome

Genetics/Basic Defects

  1. 1.

    Sex differentiation: Please see the chapter on XY Female Syndrome (Vilain 2009).

  2. 2.

    The SRY gene (Valetto et al. 2005)

    1. a....

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Abusheikha, N., Lass, A., & Brinsden, P. (2001). XX males without SRY gene and with infertility. Human Reproduction, 16, 717–718.

    Article  PubMed  CAS  Google Scholar 

  • Boucekkine, C., Toublanc, J. E., Abbas, N., et al. (1994). Clinical and anatomical spectrum in XX sex reversed patients. Relationship to the presence of Y specific DNA-sequences. Clin Endocrinology (Oxford), 40, 733–742.

    Article  CAS  Google Scholar 

  • De la Chapelle, A. (1972). Analytic review: Nature and origin of males with XX sex chromosomes. American Journal of Human Genetics, 24, 71–105.

    PubMed  Google Scholar 

  • De la Chapelle, A. (1981). The etiology of maleness in XX men. Human Genetics, 58, 105–116.

    Article  PubMed  Google Scholar 

  • Ergun-Longmire, B., Vinci, G., Alonso, L., New, M. I., et al. (2005). Clinical, hormonal and cytogenetic evaluation of 46, XX males and review of the literature. Journal of Pediatric Endocrinology & Metabolism, 18, 739–748.

    Article  CAS  Google Scholar 

  • Fechner, P. Y., Marcantonio, S. M., Jaswaney, V., et al. (1993). The role of sex determining region Y gene (SRY) in the etiology of 46, XX maleness. Journal of Clinical Endocrinology and Metabolism, 76, 690–696.

    Article  PubMed  CAS  Google Scholar 

  • Ferguson-Smith, M. A., Cooke, A., Affara, N. A., et al. (1990). Genotype-phenotype correlations in XX males and their bearing on current theories of sex determination. Human Genetics, 84, 198–202.

    Article  PubMed  CAS  Google Scholar 

  • Grigorescu-Sido, A., Heinrich, U., Grigorescu-Sido, P., et al. (2005). Three new 46, XX male patients: A clinical, cytogenetic and molecular analysis. Journal of Pediatric Endocrinology & Metabolism, 18, 197–203.

    Article  CAS  Google Scholar 

  • Hawkins, J. R., Taylor, A., Berta, P., et al. (1992). Mutational analysis of SRY: Nonsense and missense mutations in XY sex reversal. Human Genetics, 88, 471–474.

    Article  PubMed  CAS  Google Scholar 

  • Hughes, I. A. (2008). Disorders of sex development: A new definition and classification. Best Practice & Research. Clinical Endocrinology & Metabolism, 22, 119–134.

    Article  Google Scholar 

  • Hughes, I. A., Houk, C., Ahmed, S. F., et al. (2006). Consensus statement on management of intersex disorders. Journal of Pediatric Urology, 2, 148–162.

    Article  PubMed  CAS  Google Scholar 

  • Jager, R. J., Anvret, M., Hall, K., et al. (1990). A human XY female with a frame shift mutation in the candidate testis-determining gene SRY. Nature, 348, 452–454.

    Article  PubMed  CAS  Google Scholar 

  • Kojima, Y., Mizuno, K., Nakane, A., et al. (2009). Long-term physical, hormonal, and sexual outcome of males with disorders of sex development. Journal of Pediatric Surgery, 44, 1491–1496.

    Article  PubMed  Google Scholar 

  • Kolon, T. F., Ferrer, F. A., & McKenna, P. H. (1998). Clinical and molecular analysis of XX sex reversed patients. Journal of Urology, 160, 1169–1172.

    Article  PubMed  CAS  Google Scholar 

  • Koopman, P., Gubbay, J., Vivian, N., et al. (1991). Male development of chromosomally female mice transgenic for SRY. Nature, 351, 117–121.

    Article  PubMed  CAS  Google Scholar 

  • Kurita, M., Aiba, E., Matsumoto, D., et al. (2006). Feminizing genitoplasty for treatment of XX male with masculine genitalia. Plastic and Reconstructive Surgery, 117, 107e–111e.

    Article  PubMed  Google Scholar 

  • Kusz, K., Kotecki, M., Wojda, A., et al. (1999). Incomplete masculinisation of XX subjects carrying the SRY gene on an inactive X chromosome. Journal of Medical Genetics, 36, 452–456.

    PubMed  CAS  Google Scholar 

  • Lee, P. A., Houk, C. P., Ahmed, S. F., et al. (2006). Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics, 118, e488–e500.

    Article  PubMed  Google Scholar 

  • Liu, L., Feng, L. N., & Yang, L. L. (2005). The phenotype and genetics of 46,XX male syndrome. Endocrinol Foreign Medical Sciences, 25, 283–285.

    Google Scholar 

  • Margarit, E., Soler, A., & Carrio, A. (1998). Molecular, cytogenetic, and clinical characterisation of six XX males including one prenatal diagnosis. Journal of Medical Genetics, 35, 727–730.

    Article  PubMed  CAS  Google Scholar 

  • Pérez-Palacios, G., Medina, M., Ullao-Aguirre, A., et al. (1981). Gonadotropin dynamics in XX males. Journal of Clinical Endocrinology and Metabolism, 53, 254–257.

    Article  PubMed  Google Scholar 

  • Queipo, G., Zenteno, J. C., Peña, R., et al. (2002). Molecular analysis in true hermaphroditism: Demonstration of low-level hidden mosaicism for Y-derived sequences in 46,XX cases. Human Genetics, 111, 278–283.

    Article  PubMed  CAS  Google Scholar 

  • Rajender, S., Rajani, V., Gupta, N. J., et al. (2006). SRY-negative 46,XX male with normal genitals, complete masculinization and infertility. Molecular Human Reproduction, 12, 341–346.

    Article  PubMed  CAS  Google Scholar 

  • Rego, A., Margarit, E., Estivill, X., et al. (1996). Development in a 46,XX boy with positive SRY gene. Journal of Pediatric Endocrinology & Metabolism, 9, 623–626.

    Article  CAS  Google Scholar 

  • Rigola, M. A., Carrera, M., Ribas, I., et al. (2002). A comparative genomic hybridization study in a 46,XX male. Fertility and Sterility, 78, 186–187.

    Article  PubMed  Google Scholar 

  • Rizvi, A. A. (2008). 46,XX man with SRY gene translocation: Cytogenetic characteristics, clinical features and management. The American Journal of the Medical Sciences, 335, 307–309.

    Article  PubMed  Google Scholar 

  • Sarafoglou, K., & Ostrer, H. (2000). Familial sex reversal: A review. Journal of Clinical Endocrinology and Metabolism, 85, 483–493.

    Article  PubMed  CAS  Google Scholar 

  • Sinclair, A. H., Berta, P., Palmer, M. S., et al. (1990). A gene from the human sex-determining region encodes a protein with homology to a conserved DNA binding motif. Nature, 346, 240–244.

    Article  PubMed  CAS  Google Scholar 

  • Trujillo-Tiebas, M. J., Gonzalez-Gonzalez, C., et al. (2006). Prenatal diagnosis of 46,XX male fetus. Journal of Assisted Reproduction and Genetics, 23, 253–254.

    Article  PubMed  CAS  Google Scholar 

  • Valetto, A., Bertini, V., Rapalini, E., et al. (2005). A 46,XX SRY-negative man with complete virilization and infertility as the main anomaly. Fertility and Sterility, 83, 216–219.

    Article  PubMed  Google Scholar 

  • Vernole, P., Terrinoni, A., Didona, B., et al. (2000). An SRY-negative XX male with Huriez syndrome. Clinical Genetics, 57, 61–66.

    Article  PubMed  CAS  Google Scholar 

  • Vilain, E. J. (2009). 46,XX testicular disorder of sex development (Overview). GeneReviews. Updated May 26, 2009. Available at http://www.ncbi.nlm.nih.gov/books/NBK1416/

  • Vilain, E., Le Fiblec, B., Morichon-Delvallez, N., et al. (1994). SRY-negative XX fetus with complete male phenotype. Lancet, 343, 240–241.

    Article  PubMed  CAS  Google Scholar 

  • Wang, T., Liu, J. S., Yang, L. J., et al. (2009). 46,XX male sex reversal syndrome: A case report and review of the genetic basis. Andrologia, 41, 59–62.

    Article  PubMed  CAS  Google Scholar 

  • Zenteno, J. C., López, M., Vera, C., et al. (1997). Two SRY-negative XX male brothers without genital ambiguity. Human Genetics, 100, 606–610.

    Article  PubMed  CAS  Google Scholar 

  • Zenteno-Ruiz, J. C., Kofman-Alfaro, S., & Méndez, J. P. (2001). 46,XX sex reversal. Archives of Medical Research, 32, 559–566.

    Article  PubMed  CAS  Google Scholar 

Download references

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this entry

Cite this entry

(2012). XX Male. In: Chen, H. (eds) Atlas of Genetic Diagnosis and Counseling. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1037-9_250

Download citation

Publish with us

Policies and ethics