Thoughts on the Nature of Identity: How Disorders of Sex Development Inform Clinical Research about Gender Identity Disorders

Abstract

Disorders of sex development (DSD), like gender dysphoria, are conditions with major effects on child sexuality and identity, as well as sexual orientation. Each may in some cases lead to change of gender from that assigned neonatally. These similarities—and the conditions’ differences—provide a context for reviewing the articles in this issue about clinical approaches to children with gender dysphoria, in relation to assessment, intervention, and ethics.

Keywords:

• disorders of sex development (DSD)
• gender
• gender identity
• gender identity disorder
• gender identity disorder of childhood
• gender identity disorder of adolescence
• gender variance
• transgender
• transsexual
• treatment

Notes

1. A much older, and narrower, term than disorders of sex development, intersex, is a set of developmental anomalies primarily indicating neonatal ambiguous genitalia, typically due to inadequate (in the XY fetus) or inappropriate (in the XX fetus) prenatal androgen exposure. The newer nosology is much broader, utilizing the term disorders of sex development as the family heading primarily for XX disorders of development and XY disorders of development; this broader conceptualization includes cellular and tissue growth-factor errors, cell migration errors, tissue migration errors, and pelvic field defects, each of them often leading to genital abnormalities but in the absence of hormonal or sex chromosomal anomalies. Disorders of sex development, then, is a global term that was chosen by an international consensus committee of involved and highly interested experts mostly in the areas of intersex (Hughes, Houk, Ahmed, & Lee, 2006). This committee recognized that expertise itself was generally lacking, especially in terms of global outcomes for individuals or for their diagnostic categories. For several decades, overall clinical or social definitions of intersex were typically inconsistent, nosology was inadequate, and assessments and clinical interventions varied sometimes dramatically from clinic to clinic—not unlike gender dysphoria as a clinical entity over a similar time course. This consensus report, then, was established as a baseline to stimulate more nearly coherent clinical research as well as clinical approaches to these children.