The disorder has been found in blacks, whites, American Indians, and Latin Americans, as well as in families from Malta, Jordan, and Pakistan. Imperato-McGinley et al. (1991) described a cluster of male pseudohermaphrodites in the Simbari Anga linguistic group in the Eastern Highlands of Papua New Guinea. Their studies revealed a phenotypic and biochemical profile similar to that in patients studied in the Dominican Republic, except for a greater abundance of facial and body hair. DHT is responsible for masculinization of the external genitalia of the fetus and for masculinization at puberty. The virilization at puberty in PPSH may be related to the facts that the reductase is not completely absent and that low levels of DHT are found in plasma.
In an embryo-fetal development study in female rats, oral administration of dutasteride at doses 10 times less than the maximum recommended human dose (MRHD) of mg daily resulted in abnormalities of male genitalia in the fetus (decreased anogenital distance at mg/kg/day), nipple development, hypospadias, and distended preputial glands in male offspring (at all doses of , , , and 30 mg/kg/day). An increase in stillborn pups was observed at 111 times the MRHD, and reduced fetal body weight was observed at doses of about 15 times the MRHD (animal dose of mg/kg/day). Increased incidences of skeletal variations considered to be delays in ossification associated with reduced body weight were observed at doses at about 56 times the MRHD (animal dose of mg/kg/day).