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AXYS - The Association for X&Y Chromosome Variations

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47,XXY (Klinefelter)

Parent Testimonial: A Journey Through XXY (Klinefelter Syndrome)

As the mother of an XXY son who did not receive a prenatal diagnosis, I began noticing signs between 10–12 months of age — delays in speech and muscle tone, late walking and potty training, and autism-like behaviors. After a vaccine reaction that caused a hydrocele, he became highly irritable and lost eye contact. I spent tremendous time, energy, and financial resources seeking help from pediatricians, specialists, educators, diagnosticians, and therapists — all in an effort to diagnose, understand, and advocate for my child’s developmental challenges.

Along the way, we were met with repeated insurance denials and patronizing advice from several in the medical community. We cycled through multiple diagnostic labels before finally discovering SCA (Sex Chromosome Aneuploidy). I quickly realized that the diagnosis often depended on the qualifications of the specialist we were seeing or the terminology I used when filling out paperwork — a frustrating and inconsistent process.

Despite having every advantage — a college education, scientific literacy, time to research, premium insurance, and a strong support system — I still felt lost and alone. The condition remained a mystery, and none of the practitioners had enough awareness or up-to-date knowledge to help guide our journey. I never felt like I truly had answers, much less solutions.

After waiting 15 months for an autism workup at the Bluebird Clinic in Houston, we finally received an accurate diagnosis at age 7 through a FISH/Chromosome array test. Now I had hard evidence — something I could use to advocate more effectively with insurance and medical systems. Still, I struggled to find quality, condition-specific information until I found the AXYS Organization a year later. Even then, locating competent providers who actually understood XXY and could offer impactful treatment and advice remained an uphill battle.

So much of my energy went into educating the very professionals from whom I was seeking guidance. I often felt like I had to “convince” educators and medical providers of what my son needed just to get basic therapies. Eventually, I vowed to dedicate my future time and resources to raising awareness and early intervention strategies around SCA — so that no parent would have to fight this hard for their child.

Our goals, like all parents, are simple: to raise a self-sufficient, contributing adult member of society. But we need meaningful support, awareness, and research from insurance, the medical community, diagnostic providers, and our government-funded school systems to make that happen.

Testosterone therapy is a significant part of an XXY patient’s medical future during and after puberty — but, I had years to address co-occurring challenges: reading, writing, speech, comprehension, emotional regulation, and social skills. Yet, because my son didn’t “look” disabled — unlike children with more visibly apparent conditions like Down Syndrome or cerebral palsy — he was often expected to perform like every other child. His condition was invisible, and therefore, to many, it appeared nonexistent.

Early misinformation led to harmful stereotypes, shame, and misunderstanding. Many practitioners simplistically believed that “you just give testosterone at puberty and everything will be fine.” But that ignores the deeper and more complex co-morbidities: auditory processing (CAPD), language delays, executive function challenges, sensory issues, gut-brain dysfunction, eczema, OCD, ADHD, and emotional regulation difficulties.

We found that nutrition, neurofeedback therapy, vision therapy, behavioral intervention, and functional medicine had far more impact than most pharmaceutical solutions. The school-based “early interventions” — like 20 minutes of group speech therapy once a week — were completely inadequate, especially when schools had 12–15 coaches for athletics but only one OT or SLP for the entire student body. We were fortunate to meet one exceptional elementary school counselor who truly made a difference — but stories like his were the exception, not the norm.

Again, we were lucky — we got a diagnosis at 7. But many children with XXY are not diagnosed until puberty (or even adulthood, during infertility testing). How much earlier could their lives have improved if they had received appropriate T-therapy during adolescence and support for co-morbidities in childhood? This is not a rare condition — it affects 1 in every 590 males — yet it is still underdiagnosed and misunderstood by many in the medical field. How many adult men go through life never knowing why they’ve struggled?

The myth that testosterone worsens emotional or behavioral issues is not only false, it’s dangerous. Testosterone can actually help regulate mood, focus, and emotional control — yet hormone imbalances are too often ignored in difficult diagnoses. The years between childhood and puberty — a critical window — are typically void of standardized treatment plans or interventions.

Even after diagnosis, finding providers is difficult. Coordinating endocrinology appointments, dealing with long waitlists, refilling controlled medications, managing varied opinions about treatment, and handling injection-related anxiety is emotionally exhausting for families. At 18, the Xyosted auto-injector became a game-changer. It gave my son control over his treatment and relieved him of years of needle-related fear.

Today, at 21, my son is finally doing well. We endured many misdirected pharmaceutical treatments that didn’t align with his genetics. Compounding the challenge, we dealt with disruptions in care due to moving for my husband’s career. He was pulled from public school in 6th grade — right around the time his father was diagnosed with ALS. After years in residential treatment and behavioral education programs, he earned his high school diploma, shortly after his father’s passing during the height of COVID.

I often felt jealous of the multi-disciplinary care my husband received for ALS and wondered: Why can’t families dealing with SCA receive the same holistic support?

My son is currently in a transitional living program, has a driver’s license, and makes his own truck payment. I asked this program to help him grow from a teen into a man — and I believe we’re on that path. I hope he will soon be living and working independently.

His diagnosis deeply affected his childhood, our family, and his siblings — but I could not be prouder of the young man he is becoming. His resilience, and ours as a family, are a testament to love, determination, and the belief that no child should be left behind due to ignorance of a common, treatable condition. This is a worthwhile endeavor that needs attention, funding, and multi-disciplinary clinics across the nation.

2025-09-19T15:31:34-04:00Categories: 47,XXY (Klinefelter)|Tags: , |

Generating Advancements in Longitudinal Analysis in X and Y Variations

Article Title: Generating Advancements in Longitudinal Analysis in X and Y Variations: Rationale, Methods, and Diagnostic Characteristics for the GALAXY Registry

Authors: Carl, Bothwell, Swenson, Bregante, Cohen, Cover, Dawczyk, Decker, Gerken, Hong, Howell, Raznahan, Rogol, Tartaglia, and Davis

Date of Publication: July 26, 2025

“Sex chromosome aneuploidies (SCAs) are a family of genetic disorders that result from an atypical number of X and/or Y chromosomes. SCAs are the most common chromosomal abnormality, affecting ~1/400 live births, yet are often underdiagnosed, leading to over-representation of more severely impacted individuals in many clinical studies. In addition to this ascertainment bias, existing work in SCAs has also been limited by low geographic and demographic diversity. To address these limitations, we have created the Generating Advancements with Longitudinal Analysis in X and Y variations (GALAXY) Registry. Through prioritizing sustainability, transparency, and minimizing participant burden, the overarching goal of the GALAXY Registry is to improve health outcomes for individuals with SCAs by serving as an infrastructure for future SCA research based on a large, heterogeneous, and longitudinal sample. To date, GALAXY has accrued 335 verified SCA participants with an average accrual of 11.2 participants/month (6.7 47,XXY, 1.9 47,XXX, 2.0 47,XYY, 3.2 48,XXYY, 1.8 48,XXXY, and 1.3 Other). Demographic data between those identified to have SCA prenatally (predominantly cell-free DNA screening) differ from those diagnosed postnatally for insurance status, age at enrollment, genetic test type, and reason for SCA diagnosis. Next steps include targeted recruitment of underrepresented groups (e.g., non-47, XXY karyotypes, older adults, minoritized individuals), extraction of medical record data into the registry, international expansion, and continued engagement with the SCA community. As a collaboration between clinician investigators and the SCA community, the GALAXY Registry is a powerful resource for future patient-centered clinical research.”

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Testosterone Effects on Short-Term Physical, Hormonal, and Neurodevelopmental Outcomes (TESTO) in Infants with 47,XXY

Article Title: Testosterone Effects on Short-Term Physical, Hormonal, and Neurodevelopmental Outcomes (TESTO) in Infants with 47,XXY

Authors: Davis, Howell, Janusz, Lahlou, Reynolds, Thompson, Swenson, Wilson, Ross, Zeitler, and Tartaglia

Date of Publication: April 3, 2025

“In this double-blind randomized controlled trial in infants with XXY, testosterone injections resulted in physical effects attributable to systemic androgen exposure, however this dose suppressed the hypothalamic-pituitary-gonadal axis. Neurodevelopment outcomes were not impacted by treatment. These results do not support routine testosterone treatment in infants with XXY, however long term follow up on physical health, neurodevelopment and testicular function is needed.”

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Cardiovascular risk and mortality in men receiving testosterone replacement therapy for KS in Denmark

Article Title: Cardiovascular risk and mortality in men receiving testosterone replacement therapy for Klinefelter syndrome in Denmark: a retrospective cohort study

Authors: Chang, Pedersen, Skakkebæk, Berglund, and Gravholt

Date of Publication: February 1, 2025

TRT could alleviate excess mortality in KS and appears safe regarding cardiovascular risk. Today, most men with KS go undiagnosed, missing proper medical attention. There is a dire need for a policy change to ensure timely diagnosis and treatment in all men with KS.”

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2025-02-12T12:28:55-05:00Categories: 47,XXY (Klinefelter)|Tags: , |

A genome-first study of sex chromosome aneuploidies provides evidence of Y chromosome dosage effects on autism risk

Article Title: A genome-first study of sex chromosome aneuploidies provides evidence of Y chromosome dosage effects on autism risk

Authors: Berry, Finucane, Myers, Walsh, Seibert, Martin, Ledbetter, and Oetjens

Date of Publication: October 1, 2024

“In this study, we examined four SCAs in the SPARKMC-SCA cohort to explore how variations in sex chromosome dosage impact ASD risk. In our primary analysis examining the association between SCAs and ASD, we found the extra Y effect was significantly larger than the extra X effect. This conclusion was drawn from our observation that individuals with 47,XYY showed a 2.4-fold higher risk of ASD compared to those with 46,XY, and supported by our observation that individuals with 47,XXY were at a 4.6-fold higher risk compared to those with 46,XX.”

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Neurocognitive and behavioral development in young children (1-7 years) with Sex Chromosome Trisomy

Article Title: Neurocognitive and behavioral development in young children (1-7 years) with Sex Chromosome Trisomy

Authors: Van Rijn, Kuiper, Bouw, Urbanus, and Swaab

Date of Publication: March 6, 2023

“Study outcomes showed early behavioral symptoms in young children with SCT, and neurocognitive vulnerabilities, already from an early age onwards. Neurobehavioral and neurocognitive difficulties tended to become more pronounced with increasing age, and were rather robust; independent of specific karyotype, pre/postnatal diagnosis or ascertainment strategy.

A more longitudinal perspective on neurodevelopmental ‘at risk’ pathways is warranted, also including studies assessing effectiveness of targeted early interventions. Neurocognitive markers that signal differences in neurodevelopment may prove to be helpful in this. Focusing on early development of language, social cognition, emotion regulation, and executive functioning may help in uncovering early essential mechanisms of (later) neurobehavioral outcome, allowing for more targeted support and early intervention.”

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Evidence‑based recommendations for delivering the diagnosis of X&Y chromosome multisomies in children, adolescents, and young adults

Article Title: Evidence‑based recommendations for delivering the diagnosis of X & Y chromosome multisomies in children, adolescents, and young adults: an integrative review

Authors: Riggan, Ormond, Allyse, and Close

Date of publication: April 22, 2024

“Patient experiences suggest there should be heightened attention to diagnosis delivery, in reference to the broader ethical and social impacts of a SCM diagnosis. We present recommendations for optimal disclosure of a SCM diagnosis in early and late childhood, adolescence, and young adulthood.”

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A qualitative exploration of experiences of gender identity and gender questioning among adults with Klinefelter syndrome/XXY

Article Title: A qualitative exploration of experiences of gender identity and gender questioning among adults with Klinefelter syndrome/XXY

Authors: Harkin and Elander

Date of Publication: July 22, 2024

“The study provided novel insights into the gender identity journeys of people with KS/XXY, from early attempts to understand and make sense of gender, through dealing with social pressures, questioning gender identities, developing gender identities more congruent with feelings, and experiences of hormone replacement therapy. These new insights can inform improved treatment and care for KS/XXY people.”

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2024-07-24T15:17:43-04:00Categories: 47,XXY (Klinefelter)|Tags: , |

BMJ Best Practice – Klinefelter Syndrome

Article Title: BMJ Best Practice Klinefelter Syndrome

Authors: Alan Rogol, Gary Butler, and Claus Gravholt

Date of Publication: June 4, 2024

“Population mortality and morbidity studies suggest there is a slight but not significant lowering of life expectancy in individuals with Klinefelter syndrome (KS). The average lifespan has been found to be reduced by 1.5 to 2 years, with morbidity and mortality increased due to a wide number of conditions, including diabetes, cerebrovascular disease, and breast cancer. Higher rates of osteoporosis and fractures are also important to note.

Appropriate treatment with testosterone can alleviate the portion of excess risk that is due to conditions associated with hypergonadotropic hypogonadism, but some of the elevated risk is likely intrinsic to the chromosome aberration and therefore not corrected by testosterone treatment.

The increased morbidity and mortality in individuals with KS may also be partially explained by their often lower socioeconomic status, with cohort data suggesting shorter education, higher rates of unemployment, lower average incomes, and earlier average age at retirement compared with men without KS.

It is important to note that most boys and men with KS are never diagnosed so the reported data likely reflects more severe phenotypes of the condition.”

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Evidence-based recommendations for delivering the diagnosis of X&Y chromosome multisomies

Article Title: Evidence-based recommendations for delivering the diagnosis of X&Y chromosome multisomies in children, adolescents, and young adults: an integrative review

Authors: Riggan, Ormond, Allyse, and Close

Date of Publication: April 22, 2024

“Patient experiences suggest there should be heightened attention to diagnosis delivery, in reference to the broader ethical and social impacts of a SCM diagnosis. We present recommendations for optimal disclosure of a SCM diagnosis in early and late childhood, adolescence, and young adulthood.”

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