Gender assignment can be difficult when a child is born with a disorder of sex development. Obviously, clinicians and parents try to make the decision that is right for the child. Despite the best efforts of caregivers, however, occasionally a child with a DSD will announce a desire to change gender.
When this happens there is a lot physicians can do to help the child and family adjust.
Under modern standards of care for DSD, decisions about gender assignment increasingly take into account available predictions about the child’s gender identity as he or she grows. For some conditions, such as 46,XY complete androgen insensitivity syndrome or 46,XX congenital adrenal hyperplasia, clinicians can predict gender identity development with some confidence. Even so, predictions are not perfect. For example, around 95% of 46,XX children with congenital adrenal hyperplasia raised as girls will grow to identify as female. However, this means that around one in 20 will not.
Other conditions involve much more uncertainty. In cases of partial androgen insensitivity syndrome or gonadal dysgenesis, about 25% of patients will be dissatisfied with the gender assignment, whether raised as boys or girls. When a child with a DSD demonstrates a persistent and clear desire to change gender, current standards call for caregivers to support that wish.
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