INTRODUCTION: Few studies exist on the psychosexual outcome of homogeneous 
groups of individuals with 5α-reductase deficiency type 2 (5α-RD-2) and the 
relation between gender changes and parental hostile and benevolent sexism, 
which are two components of ambivalent sexism that assume a stereotypical 
approach toward women in an overtly negative way or a chivalrous, seemingly 
positive way.
AIM: To report on the psychosexual outcome of individuals with 5α-RD-2 and to 
investigate its relation to the level of parental sexism in a relatively large 
sample of Iranians with 5α-RD-2.
METHODS: Twenty participants (mean age = 19.5 years, SD = 6.345) with a 
molecularly confirmed diagnosis of 5α-RD-2 who were assigned the female gender 
at birth and raised as female were included in the study. Participants and their 
parents were interviewed and their medical records were assessed. Parents also 
completed the Ambivalent Sexism Inventory (ASI), which includes hostile and 
benevolent sexism subscales.
MAIN OUTCOME MEASURES: Psychosexual outcome and parental hostile and benevolent 
sexism measurements.
RESULTS: Twelve of 20 participants (60%) were diagnosed with gender identity 
disorder not otherwise specified (Diagnostic and Statistical Manual of Mental 
Disorders, Fourth Edition, Text Revision). Ten of these transitioned to the male 
gender. The other 10 participants (50%), including the two diagnosed with gender 
identity disorder not otherwise specified, continued living in a female gender 
role. When comparing the ASI subscale scores between families of participants 
who changed their gender and those who did not, no significant difference was 
found for ASI total and hostile sexism scores, but there was a difference for 
benevolent sexism (P = .049): those whose daughters had changed their gender had 
higher benevolent sexism scores.
CONCLUSION: The high prevalence of gender change and gender dysphoria reported 
in the literature was confirmed in this relatively large and homogeneous sample 
of Iranians with 5-α-RD-2 raised as female. Prenatal exposure to testosterone is 
hypothesized to play a role in the development of gender identity and 
sexual orientation, but parental attitudes also might be important. Although 
gender change in individuals with 5-α-RD-2 is often attributed to high levels of 
hostile sexism in some cultures, our findings show this to be associated with 
benevolent sexism.