What I Learned About 5 Alpha Reductase Type 2 Deficiency and Why It Still Matters Today
- Brainz Magazine
- Nov 25
- 9 min read
Dr. Veronica Powell, PhD, LPC, is a Licensed Clinician, Industrial-Organizational Psychologist, and Communication Coach. As the Founder and CEO of Measures4Success Academy, she empowers individuals, leaders, and organizations to master communication through Kendall’s Life Languages™ Framework, also known as Communication Intelligence (CQ).
I was recently watching a documentary on YouTube titled Intersexion: Boy or Girl on the Real Stories channel. I expected to learn more about intersex experiences, but I did not expect the documentary to unlock a memory from nearly four decades ago. As I listened to the personal stories and scientific explanations, I suddenly found myself transported back to my Cultural Anthropology course in 1988 during my sophomore year of college.
In that class, I learned about a small community in Papua New Guinea where some children who were raised as girls developed male genitalia when they entered puberty. At age eighteen, that information freaked me out. I had been raised with a very simple understanding, XX means girl and XY means boy. Anything outside of those rules felt confusing, frightening, and difficult to reconcile with what I was taught and believed to be true.
The terms we used at the time reflected the language of that era. My professor discussed gender identity, hermaphroditism, and biological variations that challenged cultural norms and expectations. I did not fully understand those concepts then, and honestly, I did not know what to do with the information emotionally or intellectually.
As I grew older and continued my education in psychology, sociology, and human development, I discovered that human biology does not always follow the clean lines we draw around sex and gender. There are natural genetic variations that shape how bodies develop. One of these variations is known as 5 Alpha Reductase Type 2 Deficiency.
Understanding this condition changed the way I view human diversity. It taught me that the human experience of sex and gender is far more intricate, organic, and profoundly personal than the simplistic models society has offered us. This article is both a reflection and an invitation to look deeper.
What is 5 Alpha Reductase Type 2 Deficiency
Before we continue, I want to engage you directly.
Have you ever heard of 5 Alpha Reductase Type 2 Deficiency?
If your answer is yes, I want to applaud you. You are familiar with a topic that is rarely taught outside specialized fields.
If your answer is no, you are in the majority. Medical and academic literature acknowledge that this condition is not well known to the public. Even many health care providers and educators have limited exposure to the subject.
So here is the simplest explanation that I can present. 5 Alpha Reductase Type 2 Deficiency is a genetic condition that affects how the body processes testosterone. During fetal development, testosterone must be converted into its more active form to create typical male external genitalia. If this conversion does not occur, a baby who is genetically male may be born with external genitalia that look female or ambiguous.
However, puberty changes everything. When testosterone levels rise during adolescence, the body begins to masculinize. The voice deepens. Muscle mass increases. And in many cases, a penis develops during puberty.
This is not unnatural or caused by external factors. But rather, it is a natural variation in human biology. With this foundation, we can revisit the communities where this variation brought new insight into culture, identity, and acceptance for me when I took that cultural anthropology class.
The Papua New Guinea community
My anthropology course highlighted a community in Papua New Guinea where this variation was well known and culturally understood. Children with 5 Alpha Reductase Type 2 Deficiency were raised as girls based on their external anatomy at birth. When puberty arrived and their bodies masculinized, the community viewed the change as a natural developmental shift rather than a disruption.
Their identity adapted, roles shifted, and the community embraced their transformation as part of human diversity. This cultural acceptance stood in stark contrast to the fear and confusion I felt as a young student first encountering these ideas.
This early exposure to a completely different cultural worldview planted a seed in my mind, even though I did not yet have the maturity to fully grasp its meaning. As I continued learning, that seed would grow into a deeper appreciation of biological diversity across cultures.
The Dominican Republic connection
Years later, endocrinologists studying a region of the Dominican Republic documented the same genetic variation. Known locally as “guevedoces,” meaning “penis at twelve,” these children’s developmental journey mirrored what my professor described about Papua New Guinea.
Understanding this helped me see that human biology is not shaped by geography alone. It is shaped by universal processes that manifest in diverse ways around the world, to include the United States.
The prevalence of 5 alpha reductase type 2 deficiency in the United States
While this condition is often associated with small or isolated communities abroad, it also exists in the United States. However, it is noted that the prevalence of 5-alpha reductase type 2 (5α-RD2) deficiency in the United States is underreported due to several factors, includes the following:
Its rarity amongst certain ethnic groups,
Challenges in diagnosing the condition,
Variability in clinical presentation,
Misdiagnosis with other sexual development disorders,
Delays with diagnosing, and probably the most consequential
Social and Cultural Factors
Sadly, our history in the United States, both past and present, shows a persistent unease with sexual development and gender identities that fall outside traditional expectations. The silence surrounding this topic is not due to irrelevance but to cultural discomfort and a framework that has struggled to understand these natural variations.
This silence also highlights the need for conversations that bring together science and compassion. Recognizing the true prevalence of this condition helps us better understand how families navigate these experiences within a society that is still learning to make space for diversity.
When gender identity is assigned by adults instead of understood through development
In my anthropology course, my first conversations about gender identity were shaped by the terminology and scientific understanding of the 1980s. We discussed how gender identity is assigned at birth based on anatomy, even though anatomy may not reveal the complete biological picture.
In the United States, the assignment of sex at birth happens almost instantly. Yet for individuals with variations like 5 Alpha Reductase Type 2 Deficiency, puberty becomes the moment their biological identity reveals itself.
In these cases, identity is not shaped by assumptions. It unfolds naturally and raises a question that we must be willing to ask. “Do we allow identity to emerge, or do we constrain it to categories that biology does not always support?”
This question becomes even more important when we consider other variations taught to me in that same anthropology class.
Hermaphroditism and other variations that challenge traditional beliefs
In the nineteen-eighties, my introduction to intersex variations included the term hermaphroditism. It was the term used at the time to describe individuals who were born with both ovarian and testicular tissue or whose genital development did not fit typical expectations. Although the language has evolved and the term is no longer used, the lesson remains relevant.
Human development exists on a continuum, meaning that there have always been more than two ways for a human body to form with natural variations. Families in the United States who encounter these variations often feel social pressure or medical urgency to make early decisions about their child’s body or gender assignment.
This is not because they lack love or care, but because society has not equipped them with understanding or support. Acknowledging these truths invites us to approach these topics with openness rather than judgment.
What I understand now about biology and identity
Learning about 5 Alpha Reductase Type 2 Deficiency at eighteen challenged my narrow view of sex and gender. Over the years, I came to understand that human development is shaped by more than chromosomes alone.
Hormones, enzymes, receptors, timing, and genetics all interact to create a wide range of outcomes. Biology is not rigid. It is dynamic. And sometimes, it expresses itself in ways we do not anticipate.
Recognizing this diversity helped me move from confusion to clarity, from fear to understanding. It also revealed the shortcomings of the binary definition that society relies on.
This growing understanding naturally led me to consider how frequently this variation might appear among the people around us. And now, this brings us to an important acknowledgment of the people whose stories help illuminate this reality.
Honoring the courage of those who shared their stories
Before closing this reflection, I want to acknowledge the individuals in the documentary Intersexion: Boy or Girl who courageously shared their lived experiences. Their willingness to speak openly about 5 Alpha Reductase Type 2 Deficiency and other intersex variations is an act of strength, vulnerability, and profound humanity.
For many of them, growing up meant navigating confusion, secrecy, medical interventions, and social expectations that did not reflect their internal reality. Some were taught to hide. Others were encouraged to remain silent. Yet each person who spoke in the documentary chose to live in truth rather than fear, authenticity rather than shame.
Their stories remind us that being different from societal norms is not something to conceal. It is something to honor. Their courage teaches us that identity is not defined by what society expects, it is defined by how a person understands themselves.
Their voices expand our understanding of what it means to be human and call each of us to a deeper sense of compassion. This courage also prepares us for the larger lesson that embracing diversity is not only possible, but it is also necessary.
Why this matters today
Understanding 5 Alpha Reductase Type 2 Deficiency matters because it challenges myths. It opens the door to empathy. And it helps us recognize that every person deserves dignity, respect, and the freedom to understand themselves without shame.
When we understand more, we judge less. When we judge less, we create space for dignity. And when we create space for dignity, we honor the full spectrum of the human experience that may not look the way we were taught.
Lessons for a more compassionate world
My journey from confusion to clarity taught me that learning is not about reinforcing old beliefs. It is about expanding our capacity to understand. Human diversity has always and will continue to exist. Recognizing it does not weaken us, it strengthens us as human beings with the ability to expand our empathy and ultimately deepen our love and compassion for humanity.
Conclusion
Watching Intersexion reawakened a memory I did not know was still alive. It reminded me of the young woman I was in that anthropology classroom, trying to make sense of a world larger and more complex than the one I had been taught. It also reminded me of how much I have grown in understanding, compassion, and respect for the fullness of human expression.
And now, I invite you to grow with me. Let us commit to learning about the diversity that exists within humanity. Let us move beyond simple categories and into deeper understanding. Let us honor those who live courageously in truth. And let us choose compassion as our guide.
“When we expand our understanding of humanity, we make room for every person to live in dignity, truth, and peace. That is how we create a more compassionate world.”
Call to action
If this article expands your understanding, I invite you to continue the journey. Share this message to start conversations and challenge assumptions because we are living in a time when conversations about sexuality and gender identity are increasingly tense and often marginalize people whose natural development does not align with society’s expectations.
This makes education and understanding essential because human sexual development is far more complex than many of us were taught. When we embrace this truth with compassion, we begin reducing harm and move toward a world rooted in empathy rather than fear. And most importantly, choose compassion each time you encounter a story that stretches what you thought you knew.
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Read more from Dr. Veronica Powell
Dr. Veronica Powell, PhD, LPC, PC, Measures4Success, LLC
Dr. Veronica Powell, PhD, LPC, is a Licensed Clinician, Industrial-Organizational Psychologist, and Communication Coach. As the Founder and CEO of Measures4Success Academy, she empowers individuals, leaders, and organizations to master communication through Kendall’s Life Languages™ Framework, also known as Communication Intelligence (CQ).
Dr. Powell is a Senior Executive Contributor for Brainz Magazine and the creator of the Communication Matters newsletter, where she teaches professionals how to build trust, empathy, and relational intelligence in every conversation.
References:
Intersex Society of North America. (1993). What's the history behind the intersex rights movement? Interact Advocates for Intersex Youths.
Real Stories. Intersexion: Boy or Girl? (Intersex Documentary).
The Oxford Review. (n.d.). Human diversity: Definition and explanation.
United Nations. (2023, August 27). Fast facts: What is biodiversity?
