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Emre Murat Altinkilic Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of BioMedical Research, University of Bern, Bern, Switzerland

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Philipp Augsburger Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of BioMedical Research, University of Bern, Bern, Switzerland
Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland

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Amit V Pandey Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of BioMedical Research, University of Bern, Bern, Switzerland

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Christa E Flück Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of BioMedical Research, University of Bern, Bern, Switzerland

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gonadal failure; b Non-classic: defined as phenotype of PAI at onset only and without gonadal insufficiency in females in adulthood; c Cryptorchidism and mild hypospadias. Symbols: ↑, increased levels. ↓, decreased levels. DSD, disorder of sex

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Marilyn B Renfree School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia

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Geoff Shaw School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia

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Since the discovery in 1968 that dihydrotestosterone (DHT) is a major mediator of androgen action, a convincing body of evidence has accumulated to indicate that the major pathway of DHT formation is the 5α-reduction of circulating testosterone in androgen target tissues. However, we now know that DHT can also be formed in peripheral tissues by the oxidation of 5α-androstane-3α,17β-diol (adiol). This pathway is responsible for the formation of the male phenotype. We discuss the serendipitous discovery in the tammar wallaby of an alternate pathway by which adiol is formed in the testes, secreted into plasma and converted in peripheral tissues to DHT. This alternate pathway is responsible for virilisation of the urogenital system in this species and is present in the testes at the onset of male puberty of all mammals studied so far. This is the first clear-cut function for steroid 5α-reductase 1 in males. Unexpectedly, the discovery of this pathway in this Australian marsupial has had a major impact in understanding the pathophysiology of aberrant virilisation in female newborns. Overactivity of the alternate pathway appears to explain virilisation in congenital adrenal hyperplasia CAH, in X-linked 46,XY disorders of sex development. It also appears to be important in polycystic ovarian syndrome (PCOS) since PCOS ovaries have enhanced the expression of genes and proteins of the alternate pathway. It is now clear that normal male development in marsupials, rodents and humans requires the action of both the classic and the alternate (backdoor) pathways.

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Maria Tsachaki Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

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Arne Meyer Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
AstraZeneca AG, Zug, Switzerland

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Benjamin Weger Karlsruhe Institute of Technology (KIT), Institute of Toxicology and Genetics, Eggenstein-Leopoldshafen, Germany
Nestlé Institute of Health Sciences SA, EPFL Innovation Park, Lausanne, Switzerland

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Denise V Kratschmar Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

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Janina Tokarz Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany

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Jerzy Adamski Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Experimental Genetics, Genome Analysis Center, Neuherberg, Germany

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Heinz-Georg Belting Biozentrum, University of Basel, Basel, Switzerland

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Markus Affolter Biozentrum, University of Basel, Basel, Switzerland

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Thomas Dickmeis Karlsruhe Institute of Technology (KIT), Institute of Toxicology and Genetics, Eggenstein-Leopoldshafen, Germany

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Alex Odermatt Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

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analyses and molecular modeling explain the functional loss of 17β-hydroxysteroid dehydrogenase 3 mutant G133R in three Tunisian patients with 46, XY Disorders of Sex Development . Journal of Steroid Biochemistry and Molecular Biology 155 147 – 154

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C J Corbin Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA

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E L Legacki Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA

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B A Ball Department of Veterinary Science, Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA

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K E Scoggin Department of Veterinary Science, Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, USA

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S D Stanley Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, California, USA

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A J Conley Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA

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.12.013 ) Revay T Villagomez DA Brewer D Chenier T King WA 2012 GTG mutation in the start codon of the androgen receptor gene in a family of horses with 64,XY disorder of sex development . Sexual Development 6 108 – 116 . ( doi:10

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Alan Conley Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA

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Ned J Place Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA

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Erin L Legacki Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA

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Geoff L Hammond Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada

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Gerald R Cunha Department of Urology, University of California, San Francisco, California, USA

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Christine M Drea Departments of Evolutionary Anthropology and Biology, Duke University, Durham, North Carolina, USA

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Mary L Weldele Departments of Psychology and Integrative Biology, University of California, Berkeley, California, USA

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Steve E Glickman Departments of Psychology and Integrative Biology, University of California, Berkeley, California, USA

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development . Novartis Foundation Symposium 244 136 – 152 ; discussion 152. ( https://doi.org/10.1002/0470868732.ch12 ) Rey RA Grinspon RP 2011 Normal male sexual differentiation and aetiology of disorders of sex development . Best Practice and

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