Variants of Gender Differentiation in Somatic Disorders of Sex Development: Recommendations for Version 7 of the World Professional Association for Transgender Health's Standards of Care

ABSTRACT

Many individuals born with genital ambiguity and related conditions (recently recategorized as disorders of sex development [DSD]) experience gender uncertainty or gender dysphoria, and some may undergo self-initiated gender change. Whether these phenomena are sufficiently similar to the presentations of gender identity variants (GIVs) in non-DSD persons (gender identity disorder [GID] in current psychiatric terminology) to warrant the application of identical diagnostic criteria and treatment approaches is under debate. This review takes the position that the differences in phenomena, context of presentation, etiology, and treatment settings are so large that identical diagnoses and treatment approaches are not justified and may be detrimental to the individuals in need of care, although more systematic comparisons are needed for definitive conclusions. On the other hand, there is increasing overlap of DSD and non-DSD individuals with gender problems in professional care personnel, assessment methods, aspects of medical and psychosocial management, and support groups and gender activism. Thus, a comprehensive revision of the Standards of Care (SOC) needs to include pertinent material on DSD, and clinicians caring for individuals with GIV should be acquainted with the key clinical issues in both. The remainder of this article summarizes the limited information available for DSD on the issues addressed in the sixth edition of the SOC for non-DSD GIV.

KEYWORDS:

• Disorders of sex development
• intersexuality
• gender identity disorder
• standards of care