This is due to a deficiency in the production of 5α-reductase, an enzyme involved in the metabolism of testosterone to dihydrotestosterone.[1][2][3][4][5] The same phenomenon occurs in Papua New Guinea, where it is called kwolu-aatmwol by the Sambia people ('which suggests a person's transformation "into a male thing."'),[6] and in Turkey.[7] Anne Fausto-Sterling states that Guevedoces (as well as people in Papua New Guinea with 5α-reductase deficiency) "are recognised as a third sex" by their cultures, while the cultures "nevertheless recognize only two gender roles."[6]