Disorders of Sex Development (DSD) and Gender Management Service (GeMS) | Your Visit

In the Disorders of Sex Development (DSD) and Gender Management Service (GeMS) Clinics at Boston Children’s Hospital, we do our best to make each visit as convenient and comfortable as possible for you and your child. The phone number above is the best way to contact our program for scheduling or changing appointments or for general questions.

In both of these clinics, it is helpful to plan ahead before your appointment.  If we sent you forms, please complete them before the visit. It is also helpful to check with your child’s providers to make sure that they have sent any medical records that were requested prior to the visit. Please bring your current insurance information. It is also helpful to bring small snacks and a book, toy or tablet to entertain your child in case there is a waiting period before your appointment.

Disorders of Sex Development Program

Our DSD Program provides medical, surgical, and mental health consultation and treatment for youth with Disorders of Sex Development. Our providers offer both sensitivity and expertise in the wide range of DSD diagnoses. Patents are seen from birth through young adulthood, and mental health services including psychologists and clinical social workers are an integral part of our team.

Our goal is to guide families through the complex decisions involved in the care of infants, children and adolescents with DSDs. Even if your child already has a primary endocrinologist and/or urologist, our DSD Program provides an opportunity to focus specifically on these sensitive issues through a multidisciplinary approach. Issues related to DSDs we help with include:

·        Trying to determine the cause of the DSD

·        Deciding whether to raise a child as a boy or a girl

·        Whether surgery is needed

·        Treatment with hormones, if needed

·        How parents/caregivers can discuss the DSD diagnosis with their child in an age-appropriate manner, and how the child can later discuss the diagnosis with others

·        Discussing the potential for future fertility and sexual function

·        Transitioning from pediatric to adult care

·        Psychosocial needs at all ages

Gender Management Service (GeMS)

The Gender Management Service (GeMS) at Boston Children’s Hospital believes that all children deserve to grow into confident and happy individuals. Our mission is to help children cope with the disconnect they may feel between the body in which they were born and the gender with which they identify. We provide comprehensive psychological assessment, mental health support and medical care to gender non-conforming children and adolescents through our multidisciplinary team. GeMS also provides support to parents and families and collaboration with schools, therapists in the community, pediatricians and other providers. Our team consults with parents of youth between the ages of 3 and 18 years, though the formal psychological evaluation and medical treatment generally begin at the early signs of puberty.

GeMS Services begin when parents or caregivers complete a brief intake with Program Coordinator at the general DSD/GeMS phone number. Our Program Coordinator will provide basic information about the program. The caller is then referred to our clinical social worker for a more extensive and detailed appointment, either over the phone, at the hospital or at a satellite location. The purpose of this first clinical consultation is for us to learn about your family, discuss your child’s gender identity in detail, discuss our protocol and assist you with referrals and resources. Since we do not currently provide ongoing therapy in our program, your child will be referred to an experienced therapist in your community who is familiar with gender issues as well as other issues related to your child’s age and maturity.

The next step is a psychological evaluation to learn more about your child’s gender identity and specific mental health needs, your family history and additional concerns.
We require that your child be in therapy for at least 3-6 months before proceeding with our psychological evaluation
. We ask the therapist to complete a detailed report when they and the youth feel it is time to move forward with the GeMS evaluation. All parent(s)/guardian(s) and the youth meet with one of our psychologists for this detailed interview and specialized gender-related testing. The results from this evaluation and the information from your child’s therapist are presented to the team and help the medical providers choose appropriate medical treatments.

A feedback session is scheduled with the psychologist or social worker to review the results and recommendations of the full mental health evaluation. This is followed (often on the same day) by an appointment with one of our endocrinologists or our nurse practitioned to discuss the possible medical interventions, a timetable for these interventions and issues regarding consent for treatment.