Boehmer et al. (1999) reported on a nationwide study of male pseudohermaphroditism among all pediatric endocrinologists and clinical geneticists in the Netherlands. In this study, 18 HSD17B3-deficient index cases were identified, 12 of whom initially had received the tentative diagnosis of androgen insensitivity syndrome (AIS). In genotypically identical cases, phenotypic variation for external sexual development was observed. Gonadotropin-stimulated serum testosterone/androstenedione ratios in HSD17B3-deficient patients were discriminative in all cases and did not overlap with ratios in normal controls or with ratios in AIS patients. In all investigated patients both HSD17B3 alleles were mutated. The minimal incidence of HSD17B3 deficiency in the Netherlands was shown to be 1:147,000 with a heterozygote frequency of 1:135. At least 4 mutations, including 655-1;G-A ( ) and R80Q ( ), found worldwide, appeared to be ancient and originating from genetic founders. Their dispersion could be reconstructed through historical analysis. HSD17B3 deficiency can be reliably diagnosed by endocrine evaluation and mutation analysis. Phenotypic variation can occur between families with the same homozygous mutations. The incidence of HSD17B3 deficiency is times the incidence of AIS, which is thought to be the most frequent known cause of male pseudohermaphroditism without dysgenic gonads.
HSD17B1(17-BETA-HYDROXYSTEROID DEHYDROGENASE I),also known as 17-beta-hydroxysteroid dehydrogenase or 17-ketosteroid reductase,is an enzyme that is responsible for the interconversion of estrone (E1) and estradiol (E2) as well as the interconversion of androstenedione and testosterone. Its cytogenetic location is . HSD17B1 gene expression is detected in 34 of 42 (81%) adenomas in all tumor subtypes; HSD17B2 mRNA is detected in 18 of 42 (43%) adenomas but not in prolactinomas. Human estrogenic HSD17B1 is an NADP(H)-preferring enzyme. It possesses 11- and 4-fold higher specificity toward NADP(H) over NAD(H) for oxidation and reduction, respectively, as demonstrated by kinetic studies. All 4 HSD17B isoforms are variably expressed in human anterior pituitary adenomas, which also show HSD17B enzyme activity, suggesting that HSD17B may play an important role in regulating the local cellular levels of estradiol.
A 2016 case before the Family Court of Australia  was widely reported in national,    and international media.  The judge ruled that parents were able to authorize the sterilization of their 5-year old child. The child had previously been subjected to intersex medical interventions including a clitorectomy and labiaplasty , without requiring Court oversight - these were described by the judge as having "enhanced the appearance of her female genitalia".  Organisation Intersex International Australia found this "disturbing", and stated that the case was reliant on gender stereotyping and failed to take account of data on cancer risks.