Gender uncertainty is stressful condition for children and their families. Gender assignment in children with disorder of sex development (DSD) is considered as a medical emergency. Influencing factors to consider when debating gender assignment include medical diagnosis, external genital appearance, potential of fertility and sexual, therapeutic and/or surgical intervention options, views and desires of patients and families, situation of social-cultural factors, the psychological gender development status of child.
The purpose of this study was to investigate the results of gender assignment in children with DSD in our clinic. The file records of the DSD council between years 1999-2019 were reviewed.
The mean age of the total 209 patients with DSD at the time of first admission were 3.1 (± 4.7) years. Of the 209 patients, 130 had gender uncertainty, 18 had adrenal crisis, 22 had swelling in the groin, 15 had no testes, 18 were primary amenorrhea, 4 had gender uncertainty history in family, 2 had micropenis, 1 had short stature, and 1 had absence of vaginal meatus. With regard to the Chicago Consensus, 87 patients were 46,XX DSD, 110 were 46,XY DSD and 12 were sex chromosome DSD. Congenital adrenal hyperplasia was the most common etiological cause of DSD. The mean age of patients at the time of decision consensus meeting were 4.5 (± 5) years. In psychological evaluation, it was determined that 82 of the patients were in compliance with the female gender, 50 were in in compliance with the male gender, and 77 patients were not yet any gendered. We observed that parents raised 129 children as girl, and 80 children as boy. In 46,XX patients, 77 of 87 (88.5%) were decided to be supported in as girl gender, 5 of as boy, and 5 with followed up. In 46,XY patients, 40 of 110 (36.4%) were decided to be supported in as girl gender, 67 of as boy (61%). In sex chromosome DSD patients, 3 of 12 were decided to be supported in as girl, 9 of as boy.
We present about 20 years of experience in DSD gender assignment. Gender assignment in DSD patients is a difficult situation both for the patient's family and the physician. Many factors should be considered. And these decisions should be taken by an experienced council.
19 Sep 2019 - 21 Sep 2019