What is the primary management recommendation for patients with androgen insensitivity syndrome after puberty?

The primary management recommendation for patients with androgen insensitivity syndrome (AIS) after puberty is bilateral gonadectomy to reduce the risk of gonadal malignancy. Individuals with AIS typically have XY chromosomes but do not respond to androgens due to mutations in the androgen receptor gene, leading to the development of female external genitalia and secondary sexual characteristics despite having undescended testes (gonads).

After puberty, these individuals are at an increased risk for developing germ cell tumors, particularly if the congenital testes are not removed. Therefore, prophylactic removal of these gonads is advised to mitigate this cancer risk. This consideration is crucial, as the management truly focuses on both physical health and psychological aspects of the individual, facilitating a safer long-term outcome.

Other management strategies, such as hormone replacement therapy, are usually more relevant for those with different forms of intersex conditions or hypogonadism rather than directly addressing the malignancy risk associated with retained testes in AIS. Regular monitoring without intervention may not adequately address the potential for malignancy in patients who have undescended or retained testicular tissue. Ovarian preservation is not applicable in AIS, as patients typically do not possess functional ovaries. Thus, the focus on gonadectomy reflects the critical balance