It is necessary to diagnose Kallmann's syndrome, as timely replacement can restore secondary sex characters
Parasites also may have important effects on host behavior (Moore 1984), and have been suggested to play a role in sexual selection and the evolution of male secondary sex characters (Hamilton and Zuk 1982).
Thus, chronic cytokine release due to recurrent parasite infection may result in retarded development of secondary sex characters.
In this species, an individual possessing both male and female genital openings was described as a rare case (1:40,000), presenting a complete bilateral asymmetry in which one side had male primary and secondary sex characters
while in the other half only female characters were expressed.
Several reports document endocrine disturbances in fish near pulp and paper mills, including the expression of male secondary sex characters in female fish.
Overexpression of male secondary sex characters has also been found in eels (Anguilla rostrata) (16) and white suckers (Catosomus commersoni) (12) exposed to paper/pulp mill effluents.