Towards a further understanding of gender of rearing in children with disorders of sexual development

The birth of an infant with ambiguous genitalia is one of the common clinical manifestations of disorders of sex development(DSD), and dealing with the sex of rearing is an embarrassment for their parents as well as primary care physician.At one time, the ability to surgically create sexually functional genitalia was thought as a dominant factor in decision-making, later gonadal histology (testicular or ovarian) was thought to indicate the true sex/gender, subsequently, sex chromosomes and genomic features became a major factor in identifying the true sex/gender.Now research in molecular biology has revealed the brain is another most important sexual organ playing a crucial role in social psychological gender determination.In recent decade, since the genetic diagnosis and endoscopic surgery technology dramatically develop, the approach to sex of rearing decisions in patients with DSD has changed fundamentally.Now, the current understanding and controversies on gender assignment in DSD individuals are reviewed, and the multidisciplinary approach to gender assignment and care of these patients and their family are highlighted. Key words: Ambiguous genitalia; Disorders of sex development; Sex of rearing