This study evaluates the anogenital distance measurement differences between transgender male individuals and normal healthy female individuals. Half of the participants will be selected from the men with a masculine gender identity who were assigned female sex at birth (Woman who wanted to be a man). Transgender men will be evaluated with the vaginal examination, and anogenital distance will be measured at the time of gynecological medico-legal evaluation before the sex reassignment surgery. While the other half of the participants will be selected from healthy female individuals, ordinary healthy women will be selected from patients who come to the gynecology clinic for another reason (Women with normal sexual orientation).

There is considerable evidence in human beings and in animal models supporting that anogenital distance as a sensitive biomarker of prenatal androgen reflection of reproductive health and sexual orientation. Anogenital distance is approximately twice as long in male animals compared to female animals, and it is routinely used to determine the natal or birth-assigned sex.

Studies have shown alterations in anogenital distance associated with reproductive health and sexual orientation. For instance, shorter anogenital distance has been reported in boys with hypospadias and cryptorchidism. Men with reduced testicular volume have significantly shorter anogenital distance compared with controls. Increased anogenital distance has been indicated in girls with congenital adrenal hyperplasia.

The investigators hypothesized that a prenatal pathological androgenic environment, resulting in a longer anogenital distance, will be able to be associated with a higher risk of sexual orientation disorders like transsexualism. This cross-sectional study aimed to assess the anogenital distance measurement differences between transgender male persons and normal healthy female individuals.

Inclusion Criteria:

• Individuals who are 18-50 years old.
• Healthy transgender male individuals whose gender identity (Male) are different from their birth-assigned sex (Female). The participants will be invited to the study at the time of medico-legal evaluation before the sex reassignment surgery.

Exclusion Criteria:

• Individuals who are older than 50 (People older than 50 cannot change their gender legally in Turkey).
• Other sexual orientation disorders. (Lesbian, Gay, Bisexual, Queer, Intersex, or Asexual persons)

The study population will be healthy transgender male individuals whose gender identity (Male) are different from their birth-assigned sex (Female). These individuals are healthy biologically female persons and want to change their gender to male status. In Turkey, if a woman wants to change her gender, she has to bring a lawsuit against the birth registration office to change her gender to male status. Medico-legal assessments then have to be made at a tertiary gynecological center through the court. The participants will be invited to the study at the time of medico-legal evaluation before the sex reassignment surgery.

De-identified individual participant data for all primary and secondary outcome measures will be made available.

Data will be available within 9 months of study completion.

Data access requests will be reviewed by an external independent review panel. Requestors will be required to sign a data access agreement.