Androgen Insensitivity Syndrome (AIS) is a genetic condition where a person with male chromosomes (XY) is unable to respond normally to androgens, the body’s male hormones. This endocrine resistance results in a spectrum of physical traits, ranging from a complete female appearance to underdeveloped male characteristics, despite the presence of testes and circulating testosterone. The severity of the syndrome is classified as complete or partial, reflecting the degree of cellular non-responsiveness. This complex condition underscores the vital role of the androgen receptor in determining sexual differentiation and phenotype.
Origin
The term is a descriptive clinical construct combining “androgen,” referring to the class of male sex steroids, “insensitivity,” denoting a lack of biological response, and “syndrome,” indicating a collection of clinical signs and symptoms. Its clinical delineation emerged from early 20th-century endocrinology and genetics, which sought to understand disorders of sexual development (DSD). The underlying molecular defect was later mapped to the specific gene responsible for the androgen receptor protein.
Mechanism
AIS is fundamentally caused by a mutation in the X-linked gene encoding the androgen receptor (AR), preventing the receptor from binding to or transducing the signal from androgens like testosterone and dihydrotestosterone (DHT). Despite normal or elevated levels of these circulating hormones, the target cells fail to initiate the necessary gene expression for male development. This cellular communication failure means that the body defaults to a female-typical external development, illustrating the power of the hormonal signaling pathway.
Genetic variations, particularly CAG repeat length in the AR gene, determine cellular responsiveness to androgens, influencing vitality and metabolic health.
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