Gender ambiguity in an elderly man

To describe the case of an elderly patient with ambiguous genitalia.

We report the clinical features of a 72-year-old man with ambiguous genitalia, discuss the possible etiologic factors, and examine the consequences of this diagnosis being determined at such a late stage in life.

During surgical hemicolectomy for colon cancer in a 72-year-old man with a past history of hypospadias and hypogonadism, routine exploration of the abdomen and pelvis resulted in the discovery and removal of a large, asymptomatic mass, which was identified by the surgical pathologist as "normal ovaries, adnexa, and uterus." The patient's karyotype was subsequently found to be 46,XX.

The diagnosis of ambiguous genitalia in an elderly patient is uncommon. This dilemma poses additional ethical concerns for the physician, related to balancing the obligation to preserve patient autonomy with the obligation to protect patients from potential psychologic harm as a result of such an unusual diagnosis.