A 66-year-old man visited a doctor in Hong Kong with a swollen belly, only to find out that he is really a female with an ovarian cyst.

The condition was the result of two rare genetic disorders, the Hong Kong Medical Journal reported. Only six other cases with both genetic disorders have been reported.

The 4-foot-5-inch subject had Turner syndrome, a chromosomal abnormality that affects females and often results in infertility and short stature. He also had congenital adrenal hyperplasia, which increased male hormones and made the patient, who had a beard and a “micropenis,” appear like a man, Fox News reports.

“Were it not due to the huge ovarian cyst, his intriguing medical condition might never have been exposed,” seven doctors from two Hong Kong hospitals wrote in the study published Monday, Fox News reports.

The unnamed Vietnam-born man decided to continue “perceiving himself as having a male gender with the possible need of testosterone replacement,” according to the journal.

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