A fetus found to have "super male syndrome" needs to be aborted, otherwise it will become a criminal when it grows up?

“Are children with super male syndrome potential criminals?”

Some netizens asked for help online, asking what to do if the fetus is suspected of "hyperandrogenic syndrome". Netizens said that such children will have high testosterone levels in the future and are prone to antisocial personality, and suggested abortion to prevent the child from committing crimes in the future.

Rumor Analysis

This statement is truly sensational.

The misconception that "super male syndrome = criminal reserve" comes from a less rigorous study in the past. However, more studies have proven that super male syndrome does not increase the risk of crime as rumored, and the testosterone levels of super male syndrome patients are no different from those of ordinary men.

Recently, a pregnant woman in Sichuan Province was diagnosed with suspected "super male syndrome" in her fetus during prenatal diagnosis. After posting the information online, it caused strong controversy. Many netizens got the message that "super male = born violent or antisocial personality". Out of fear of violent criminals (reserve) and concern for public security, they recommended that pregnant women have abortions. So, is "super male syndrome" really "born bad"? Perhaps we need to treat this issue more rationally.

The picture comes from the Internet

What is Super Male Syndrome?

Normal male somatic cells contain 23 pairs of chromosomes, including 22 pairs of autosomes and one pair of sex chromosomes, written as 46,XY. Among them, the X chromosome comes from the mother's egg, and the Y chromosome comes from the father's sperm. If the sperm that fertilizes the sperm makes a mistake during meiosis, resulting in the Y chromosome not separating normally, it will make the sperm and the resulting fertilized egg have an extra Y chromosome, that is, 47,XYY. This situation is called 47,XYY syndrome, also known as "super male syndrome".

In addition, during the mitosis of fertilized eggs and embryonic development, some cells may have extra Y chromosomes due to abnormal chromosome separation. In this case, there are both normal 46,XY cells and 47,XYY cells produced by errors in the body, which is called XY/XYY mosaicism, which is also a type of super male syndrome (this is the case with the fetus in the news event).

In 1961, Avery Sandberg, a physician and cytogeneticist in New York, and several other authors published the first report on a man with a 47,XYY karyotype. The man was 44 years old, 183 cm tall, and had normal intelligence. He had a daughter with Down syndrome, and the abnormality was discovered by chance during karyotyping.

Four years later, British geneticist Patricia Jacobs conducted further research and described the condition in detail, so 47,XYY syndrome is also called Jacobs syndrome.

Judging from appearance

Super male syndrome?

In a cross-sectional study, researchers found that some hyperandrogenic patients had curved fingers, wide eyes, dental problems (including mandibular protrusion, crossbite and macrodontia), hypotonia, flat feet and other manifestations. However, the subjects included in this study were 47,XYY patients who were treated for developmental or behavioral problems, so the analysis results are not universally representative. These appearance characteristics or symptoms are far from being unique to 47,XYY patients, so it is even more impossible to infer 47,XYY syndrome based on these symptoms alone.

In fact, the only common physical features of 47,XYY syndrome seem to be rapid growth in childhood (average height is 7 cm more than expected) and tall stature in adulthood (height is usually over 1.85 m). Most 47,XYY patients have normal appearance and no other special features except height. This has led to more than 85% of hyperandrogenic patients never being diagnosed.

"Super male syndrome" is

Criminal reserve?

Most people's impression of "super male syndrome" as violent comes from a study published by Jacobs in 1965. In the study, 197 mentally ill, violent and criminal males admitted to an institution were tested, and 7 47,XYY and one XY/XYY chimera were found. Based on this data, many people have the impression that 47,XYY has "violent tendencies" and "antisocial personality". This impression has been deeply rooted in people's minds due to media reports, so much so that the following comments have appeared.

The picture comes from the Internet

However, Jacobs' research soon aroused controversy and doubts.

A 1970 study of 190 inmates serving life or very long sentences in Tennessee tested their chromosomes and found no detectable chromosome abnormalities, including an XYY chromosome pattern. A similar study yielded completely negative results, which was enough to undermine the credibility of Jacobs's conclusions.

In 1976, a large cohort study of 31,436 men performed chromosome analysis on 4,139 men over 1.84 meters tall and found that 12 subjects had 47,XYY syndrome, with a prevalence of 2.9/1000. Among them, 5 men (41.7%) had committed one or more crimes, which was significantly higher than XY men (9.3%). However, when the researchers analyzed the types of crimes committed by XYY subjects, they found that their types of crimes were the same as those of XY prisoners, all of which were minor crimes such as robbery, and there was no violence against people, which directly negated Jacobs' research conclusions.

A 1983 study found no evidence that XYY males were particularly violent or aggressive, nor were XYY males at any greater risk of committing crimes than XY males of similar intelligence .

A 2012 Danish analysis of 161 men aged 15-70 with 47,XYY syndrome showed that the increased risk of crime in these men was mainly due to poor living conditions rather than chromosomal abnormalities.

After reviewing the research since the discovery of 47,XYY syndrome, there is currently no statistical evidence that 47,XYY men can be aggressive and have abnormal behaviors simply because of their chromosomal abnormalities . After adjusting for factors such as intelligence level and socioeconomic conditions, the violent tendencies of XYY men are no different from those of XY men. Even the theory that "XYY men have higher androgen levels, so they are more violent" proposed by some people is untenable, because the androgen levels of XYY men are no different from those of XY men.

These studies have shown that ** referring to "super male syndrome" as "antisocial personality" and "criminal preparation" is actually stigmatizing a disease. ** The prevalence of 47,XXY in men is 0.3~3.7/1000. Most patients are not diagnosed and may never be diagnosed in their lifetime because their intelligence, appearance and social function are no different from others. These ordinary people and unborn children should not be blamed and discriminated against because of the disease.

Prenatal check-up found super male baby

How to choose?

Domestic prenatal screening and prenatal diagnosis strategies currently only focus on screening and diagnosing diseases such as trisomy 18, trisomy 21, major thalassemia, and significant structural malformations that can cause severe disability or even death.

Image from Science Rumor Refutation New Media

47,XYY is a subtle chromosomal abnormality that is often only discovered accidentally during amniocentesis and is not a routine screening target. In the routine prenatal checkup process for ordinary pregnant women, Down syndrome screening, non-invasive DNA testing, and B-ultrasound for fetal abnormalities cannot detect 47,XYY. The person involved in this incident also learned about the fetal XY/XYY mosaicism after amniocentesis. Therefore, this decision is destined to be a worry for only a very small number of parents.

So, what should we do when we encounter this situation?

Emotionally, everyone wants to have a baby that is as healthy as possible. So if no abnormality is found, it's fine. But if a problem is found, no matter how big or small, it will become a thorn in the parents' hearts.

For example, the 47,XYY syndrome this time, although it does not have an innate tendency to violence and antisocial personality as everyone thinks, many studies have found that 47,XYY is related to slightly lower intelligence scores, attention deficit/hyperactivity disorder, autism spectrum disorder, etc. These do require parents to weigh the pros and cons.

If you choose to give birth to this baby, you need to truly let go of your grudges and prejudices and face the challenges that the child may encounter during his growth (including your own shortcomings and external pressure). If you choose to give up, it is also understandable. What the doctor can do is to inform the parents of the relevant information as comprehensively and objectively as possible. The final decision of whether to stay or go is up to the parents themselves.

This brings us to another issue: Can we pursue a child who is “healthy enough”?

Many people think that since we want to have good birth and good upbringing, isn't it natural to give up the child after finding out the chromosomal abnormality? The problem is actually not that simple. As mentioned above, many 47,XYY syndrome patients will never find out that they have abnormalities in their lifetime, which shows that this is not a disease that seriously affects individuals and families like Down syndrome, so there is indeed room for consideration whether to keep the child.

In addition to 47,XXY syndrome, more than 700 genes have been found to be related to autosomal dominant intellectual disability. Genome sequencing has found that attention deficit/hyperactivity disorder and autism spectrum disorder are also mainly related to genetics. Polycystic ovary syndrome, various chronic diseases, and tumors also have many closely related gene loci. If you worry about the probability of your child's health, there is actually no end.

Therefore, no matter what choice the parties involved in this incident made, they should not be blamed. They just made a difficult choice based on an uncertain risk.

Looking in the mirror of rumors

We often say "worthy of the name" and "justified by the name", but the consequences of the opposite are a bit serious. We often see that some professional concepts are often reported and become widely known because their "common names" can arouse rich associations and emotions among the audience and are more eye-catching.

However, names like "XX gene" and "super male syndrome" are more like "nicknames" that will focus people's attention in the wrong direction. The specific manifestation in this incident is the over-emphasis on the importance and decisiveness of genetics, which led to the situation in this article where pregnant women sought help online and hundreds of thousands of people advised them to have an abortion. If we just call it "Jacobs syndrome", would it be better?

Ordinary netizens also need to reflect on this. When encountering such a situation, even if it is out of good intentions, as non-professionals who do not need to bear any consequences, is it appropriate to provide advice such as "abortion" to the person seeking help, which has serious consequences? Will it bring more pressure to the person involved?

Author: Doctor Feidao Duanyu

Reviewer: Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine