What is the incidence of reported changes in sexual orientation among intersex (disorders of sex development) individuals receiving hormone therapy?

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Last updated: October 21, 2026 • View editorial policy

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Specific Incidence Data on Sexual Orientation Changes in Intersex Individuals on Hormone Therapy

The available evidence does not provide specific incidence rates for sexual orientation changes among intersex individuals receiving hormone therapy. The existing literature focuses primarily on gender identity and gender dysphoria rather than sexual orientation shifts, and when sexual orientation is addressed, it is typically reported as cross-sectional data rather than prospective changes during hormone treatment.

What the Evidence Actually Shows

Sexual Orientation Patterns (Not Changes Over Time)

The most relevant research from the dsd-LIFE study 1 examined sexual orientation in adults with DSD but reported baseline patterns rather than incidence of changes:

  • Women with 46,XX CAH and androgen effects showed higher rates of same-sex attraction compared to women without DSD
  • This was interpreted as a pre-existing pattern related to prenatal androgen exposure, not a change induced by hormone therapy

Gender Identity Changes (Different from Sexual Orientation)

The dsd-LIFE study 2 provides the clearest data on gender changes (which is distinct from sexual orientation):

  • 5% of all participants reported any gender change across their lifetime
  • Only 1% (or 3% excluding Turner/Klinefelter syndromes) experienced gender change after puberty that was patient-initiated
  • 4% reported gender variance (non-binary identities)

Critical Limitations in the Literature

None of the guideline or research evidence 3, 4, 5, 1, 6, 2 specifically tracks sexual orientation changes as a prospective outcome of hormone therapy in intersex populations. The studies examine:

  • Baseline sexual orientation patterns (cross-sectional)
  • Gender identity and gender dysphoria
  • Partnership and relationship difficulties
  • Treatment satisfaction

Clinical Implications

What We Can Reasonably Conclude

Based on the hormone therapy study 6 involving 1,040 individuals with DSD:

  • Over 50% received hormone replacement therapy
  • Adherence was generally good (90% continued estrogen, 95% continued testosterone)
  • 20% reported dissatisfaction, primarily due to psychological side effects
  • Sexual orientation changes were not systematically tracked or reported

The Research Gap

The 2002 guideline 3 acknowledges that "most studies have not permitted testing" of how hormonal interventions affect psychosexual outcomes, and this gap persists in more recent literature. The 2015 review 5 notes that androgens have "moderate effects on sexual orientation" but this refers to developmental/organizational effects, not changes induced by therapeutic hormone administration in adolescents or adults.

Bottom Line for Clinical Practice

You cannot provide patients with a specific incidence rate for sexual orientation changes during hormone therapy because this outcome has not been systematically studied or reported in the intersex/DSD population. What you can tell patients:

  • Sexual orientation patterns in DSD populations may differ from the general population due to atypical prenatal hormone exposure
  • Gender identity changes occur in approximately 1-5% of individuals with DSD
  • Hormone therapy satisfaction is generally high despite some psychological side effects
  • Prospective monitoring of sexual orientation changes has not been a research priority in this field

References

5
Research

Gender development and sexuality in disorders of sex development.

Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 2015

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.