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Persons with "CAIS:"
"Complete Androgen
Insensitivity Syndrome"

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Part 3 of a nine part section on transgender people.
This topic is continued from the previous essay.

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Woman with AIS

A group of 14 women with CAIS and male (XY) sex chromosomes 1,6

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Overview of people with Complete Androgen Insensitivity Syndrome (CAIS):

This section of the web site deals with transgender persons.

  • Many transgender people were identified by physicians as male at birth, and recorded as male on their birth certificate. However, often as children from 3 to 5 years-of-age, they will personally identify as female. Many will say that they have female brain trapped in a male body.

  • A large minority of transgender people were identified as female at birth, were observed as having "lady parts," but now identify as male.

  • Small percentages of transgender persons will identify themselves as both male and female, or neither male nor female gender.

People with CAIS have many similarities to transgender persons. CAIS causes them to appear female at birth, be identified as female on their birth certificate, and self-identify as female during their childhood. They are typically raised as girls by their parents. However, later in life, a medical concern will usually surface. Their menstruation cycles may not begin as expected, or they may find it impossible to become pregnant. About one in three persons with CAIS do not develop armpit hair. A doctor may order a DNA test and find that the patient's sex chromosomes are not the expected XX (female) pattern. Their chromosomes are XY, or some other pattern that contains a Y chromosome. That is, the person is a genetic or biological male!

Needless to say, this is a very difficult finding for a physician to communicate to their patient. It almost always will be a serious shock to the patient with CAIS. It takes time for them to accept and understand their situation.

For a youth to be diagnosed as having CAIS is a profoundly disturbing and life-altering experience.

Webmaster's comment:

We hesitated to discuss this topic on this website, because it may distress many young female readers whose menstruation cycles have not have begun when expected. But we decided to include it for the sake of completeness. We apologize for any distress that the article might cause.

By the age of 15, about 98% of female teens have started their periods. 7 Checking ones genetic gender by having a DNA test and receiving the results is not something that can be completed in a few hours. However, it might reassure you to know that CAIS is a very rare phenomenon. It only happens to about 3 out of every 100,000 genetic males.

There are a lot of other reasons why a young women will have a delayed onset of menstruation, such as: "hormonal disorders, radiation therapy, chemotherapy, disordered eating, excessive exercise, certain infections," etc. 7 CAIS is probably the least likely cause of the delay. WebMD lists it as the very last of many causes.

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More information on CAIS:

People with CAIS are not considered to be transgender. However, we will describe it here because the syndrome creates an emotional conflict that is very similar to being transgender. People with CAIS don't usually go through a gender identity transition after they find out that they are genetic males. They continue their female gender identity, gender presentation, and female appearance, after their diagnosis.

The presence of one (or rarely more than one) "Y" chromosome in an individual's DNA indicates that their biological sex is male. However, a very small percentage of genetic males with "XY" chromosome are born with CAIS. This causes their body's cells to be unable to respond to androgens. The result is that these biological males typically look female, act female, have a female body, are brought up as female, and identify themselves as female throughout their life. Their main deviations from a "standard" female body is that they have no uterus, ovaries or fallopian tubes. However, they do have a pair of undescended testicles in their body. These are internal organs and thus are not obvious at birth. Thus, a person with CAIS is usually assumed to be female, are registered as such on their birth certificate, and raised as a girl.

Their genitals appear female. That is because the genitals of all embryos start off as female. It is only when embryos with male sex chromosomes in their DNA start producing testosterone that the embryo normally begins to develop male genital structures. Since genetic males who have CAIS cannot respond to male hormones, they continue developing with a female body. Usually, none of the medical professionals attending their birth will suspect that the newborn is a genetic male.

Babies with CAIS are generally raised as girls. As they go through puberty, female secondary sexual characteristics, including breasts, lack of an Adam's Apple (laryngeal prominence), etc. develop normally. Often, the first indication of CAIS occurs when their periods do not start when expected. They might go to a doctor, have their DNA checked, and be totally shocked to find out that they are biologically male.

During the year 2000, a small scale study of 20 children and 10 adult women with CAIS found that:

"The short-term reaction upon the clinical diagnosis was, in the majority of both parents and adult patients, associated with shock, grief, anger, and shame and in the mothers and adult patients with guilt. Emotional reactions were more long-lasting in mothers and adult patients than in fathers. The confirmation by DNA analysis did not alter the actual feelings of both parents. Adolescents with AIS should be informed completely -- but in a step-by-step way -- about their condition, since adult patients indicated that they had suffered from being not at all [informed] or misinformed about AIS in their adolescence. 2

Because of the incidence of malignancy in the undescended testicles after puberty, they are often removed in a gonadectomy surgical procedure.

The prevalence of CAIS is on the order of 1 to 5 per 100,000 births. However a partial AIS syndrome (PAIS) is at least as common as CAIS. Finally, there is a mild AIS (MAIS) which is rare. 2,3

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An article in the Christianity forum of the Stack Overflow web site asked the question how should Christians view people who "don't fit into the [gender] box." The anonymous person who posted the question mentioned that hormonal upsets during pregnancy can result in a newborn being:

  • A genetic male with XY chromosomes who develops as a female, and

  • A genetic female with XX chromosomes who develops as a male because one of its X chromosomes contains a SRY gene from the father's spermatozoon. They have "XX male syndrome," a.k.a. de la Chapelle syndrome. It is also quite rare. 4

The question received four responses. They mostly discussed how every human can be saved by holding the right beliefs and that they should be accepted as within the church. Unfortunately, the discussion was terminated prematurely because it was considered off topic. 5

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This section continues with a discussion of transgender matters in the next essay

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References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. The Asexual Visibility & Education Network (AVEN)," at:
  2. P.G. Slijper, et al., "Androgen insensitivity syndrome (AIS): emotional reactions of parents and adult patients to the clinical diagnosis of AIS and its confirmation by androgen receptor gene mutation analysis," U.S. National Library of Medicine, at:
  3. , "Androgen Insensitivity Syndrome," U.S. National Library of Medicine, at:
  4. "XX male syndrome," Wikipedia, as on 2016-SEP-16, at:
  5. "God created male and female… What about those who do not fit in the box?," Stack Exchange, 2011-OCT-02, at:
  6. Image by Ksaviano (Own work) [CC BY 3.0 (], via Wikimedia Commons. See:
  7. "Why no period by age 15?," WebMD, 2017, at:

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Copyright © 2017 to 2019 by Ontario Consultants on Religious Tolerance
Originally posted on: 2017-JAN-18
Most recently modified: 2019-APR-05
B.A. Robinson
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