Most genetic females with both forms of the deficiency will need replacement estrogen to induce puberty. Most will also need periodic progestin to regularize menses. Fertility is usually reduced because egg maturation and ovulation is poorly supported by the reduced intra-ovarian steroid production. The most difficult management decisions are posed by the more ambiguous genetic (XY) males. Most who are severely undervirilized, looking more female than male, are raised as females with surgical removal of the nonfunctional testes. If raised as males, a brief course of testosterone can be given in infancy to induce growth of the penis. Surgery may be able to repair the hypospadias. The testes should be salvaged by orchiopexy if possible. Testosterone must be replaced in order for puberty to occur and continued throughout adult life. See also Cytochrome b5 deficiency Inborn errors of steroid metabolism Congenital adrenal hyperplasia Isolated 17,20-lyase deficiency Disorders of sexual development Intersexuality, pseudohermaphroditism, and ambiguous genitalia CYP17A1 (17α-hydroxylase/17,20-lyase) References Further reading External links Adrenal gland disorders Autosomal recessive disorders Cholesterol and steroid metabolism disorders Congenital disorders of endocrine system Endocrine-related cutaneous conditions Genetic diseases and disorders Intersex variations