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DSD/intersex: historical context and current perspectives

  • Peter A. Lee EMAIL logo , Tom Mazur and Christopher P. Houk
Published/Copyright: January 12, 2023
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 3

Abstract

Intersex/Disorders/Differences of sex development conditions have been recognized for millennia. An organized approach was adopted in the 1960–70s using the philosophy that gender identity was fluid and malleable. Consequences of this approach were the lack of disclosure, stigmatization, and excessive surgery to “normalize” the genitalia. Often this led to quality of life issues for those patients. There have been many modifications in approach since then to avoid the problems noted. There is consensus on many of these changes (e.g. disclosure) but continued controversy on others (e.g. the benefits of early surgery). This review summarizes the historical context and the current areas of consensus and controversy.

Keywords: DSD; gender identity; genital surgery; intersex; tumor risk
Corresponding author: Peter A. Lee, Penn State College of Medicine, Penn State Hershey Medical Center, 12 Briarcrest Ct., Hershey, PA 17033, USA, E-mail:
Experts concerning gender identity and sexuality do not agree regarding whether to use gender or sex assignment, citing that gender cannot be assigned but develops while “sex” described anatomy. In this paper, gender assignment is used.

Acknowledgments

The authors wish to acknowledge discussion and suggestions from Barry Kogan MD, Chairman and Professor, Department of Urology, Albany Medical School, Albany, NY, United States; and Behzad Sorouri Khorashad, Research Fellow, Division of Pediatric Psychology and Child Health Evaluation and Research Center, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States.

  1. Research funding: None declared.

  2. Author contributions: All three authors were involved in the planning, writing, revision, conflicting, and reviewing references cited for this manuscript and have approved its submission.

  3. Informed consent: Not required since no unpublished patient data are included.

  4. Institutional review board review: Because this work does not report any patient data not previously published, his manuscript is exempted from review.

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Received: 2022-11-15
Accepted: 2022-12-18
Published Online: 2023-01-12
Published in Print: 2023-03-28

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Thyroid – what is a healthy thyroid function test?
  4. Review
  5. Thyroid storm in pediatrics: a systematic review
  6. Opinion Paper
  7. DSD/intersex: historical context and current perspectives
  8. Original Articles
  9. Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study
  10. Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia
  11. The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
  12. An open-label extension of a phase 2 dose-finding study of once-weekly somatrogon vs. once-daily Genotropin in children with short stature due to growth hormone deficiency: results following 5 years of treatment
  13. Normal bone density but altered geometry in girls with Turner syndrome
  14. Newborn screening for inborn errors of metabolism in a northern Chinese population
  15. Evaluation of serum telomerase activity in normal-weight young girls with polycystic ovary syndrome and its relation to metabolic parameters
  16. Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers
  17. Using change in predicted adult height during GnRH agonist treatment for individualized treatment decisions in girls with central precocious puberty
  18. Short Communications
  19. Long-term experience with the use of a single histrelin implant beyond one year in patients with central precocious puberty
  20. Relationships among biochemical measures in children with diabetic ketoacidosis
  21. Case Reports
  22. Hyperthyroidism in McCune–Albright Syndrome – a case report
  23. Sexual precocity in the setting of parental use of a compounded testosterone cream: case report and review of the literature
  24. Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
  25. Identification of a novel mutation in the ALDOB gene in hereditary fructose intolerance
https://doi.org/10.1515/jpem-2022-0582
Keywords for this article
DSD; gender identity; genital surgery; intersex; tumor risk

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Thyroid – what is a healthy thyroid function test?
  4. Review
  5. Thyroid storm in pediatrics: a systematic review
  6. Opinion Paper
  7. DSD/intersex: historical context and current perspectives
  8. Original Articles
  9. Predictive value of 6 h postoperative parathyroid hormone level on permanent hypoparathyroidism in pediatric total thyroidectomy: a pilot study
  10. Evaluation of a nurse-led counselling intervention on selected outcome variables for parents of children with congenital adrenal hyperplasia
  11. The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche
  12. An open-label extension of a phase 2 dose-finding study of once-weekly somatrogon vs. once-daily Genotropin in children with short stature due to growth hormone deficiency: results following 5 years of treatment
  13. Normal bone density but altered geometry in girls with Turner syndrome
  14. Newborn screening for inborn errors of metabolism in a northern Chinese population
  15. Evaluation of serum telomerase activity in normal-weight young girls with polycystic ovary syndrome and its relation to metabolic parameters
  16. Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers
  17. Using change in predicted adult height during GnRH agonist treatment for individualized treatment decisions in girls with central precocious puberty
  18. Short Communications
  19. Long-term experience with the use of a single histrelin implant beyond one year in patients with central precocious puberty
  20. Relationships among biochemical measures in children with diabetic ketoacidosis
  21. Case Reports
  22. Hyperthyroidism in McCune–Albright Syndrome – a case report
  23. Sexual precocity in the setting of parental use of a compounded testosterone cream: case report and review of the literature
  24. Intracardiac thrombosis following intravenous zoledronate treatment in a child with steroid-induced osteoporosis
  25. Identification of a novel mutation in the ALDOB gene in hereditary fructose intolerance
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