Treatments for Disorders of Sexual Differentiation in Children

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Contact the Department of Urology

  • 1-617-355-7796

At Boston Children's Hospital, we take a multidisciplinary approach in treating your child's disorder of sexual differentiation (DSD). Our team will work together to develop the best comprehensive treatment plan for your child's unique condition. You, as parents, will be involved every step of the way.

How are DSDs treated?

The treatment options for DSDs vary depending on the complexity of your child's disorder. The medical treatments may include hormone replacement therapy, surgery, and psychosocial support.


Surgical interventions depend on what type of DSD your child has. In some cases, surgery may be required. In other cases, surgery remains an elective (optional) procedure.

Situations where surgery is required:

  • Corrective surgery would be required forconditions where ambiguous genitalia interfered with a child's sexual and reproductive function. In this case, appropriate sex organs may need to be removed or created in order for them to function properly.
  • Surgery is also required for conditions like mixed gonadal dysgenesis, where sex assignment is needed.This sex assignment is important for treatment purposes as well as the emotional well being of the child as they grow older.
  • If a gonad is cancerous or is at risk for becoming cancerous, removal of the undescended testis is a serious consideration.

Situations where surgery may be elective:

Reconstructive surgery to improve the aesthetic appearance of the genitals is often elective.

  • Girls who are born with a condition that causes male-appearing genitalia, like congenital adrenal hyperplasia, often undergo reconstructive surgery to reduce the clitoral size and make the vaginal opening better defined.
  • Male reconstructive genital surgery is used to straighten the penis and move the urethra to the tip of the penis.

Hormone replacement therapy (HRT)

  • In terms of lifelong management of DSDs, the goal is to keep hormone levels at a normal level.
  • In order to do this, your child may need to take a daily form of cortisol medication, such as:
    • dexamethasone
    • fludrocortisone
    • hydrocortisone
  • Girls may need hormonal therapy throughout their lives, which is given as a daily pill.

Coping & support

Children's resources for families:

  • At Boston Children's Hospital's Gender Management Service (GeMS) Clinic we help families deal with the psychosocial issues of raising infants, children, adolescents and young adults with disorders of sexual differentiation (DSDs). Our expert physicians and clinical staff work closely with your child and your family to find the treatment that works best for everyone involved.

Children's Coping Program helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:

  • being sick
  • facing uncomfortable procedures
  • handling pain
  • taking medication
  • preparing for surgery
  • changes in friendships and family relations
  • managing school while dealing with an illness
  • grief and loss

Visit the Behavioral Medicine and Coping Clinic program page or call us at 617-355-6688 to learn more.

For teens

Adolescence can be stressful—even for physically healthy teens. Having a condition like MGD during adolescence further complicates life for teenagers.

  • Support for teen boys: As a boy with a DSD reaches adolescence, he may look and feel different from other males his age. Young Men's Health (YMH) is a website that provides health information for teen boys and young men.
  • Support for teen girls:  Girls with a DSD can experience their own set of difficulties when they enter puberty and may exhibit more masculine behavior than other girls their age. The Center For Young Women's Health offers the latest gender-specific information about sexual and emotional health.
  • The Medical Coping Team at Boston Children's Hospital works with teens and their families to help them adjust to the stress caused by chronic illness. Our experienced team of pediatric psychologists, psychiatrists and other mental health professionals provide effective, compassionate evaluation, education, counseling and therapy to help teens cope.

Other resources

Please note that neither Children's nor the Gender Management Service Clinic at Children's unreservedly endorses all of the information found at the sites listed below.

  • Androgen Insensitivity Syndrome Support Group (AISSG) provides information on Androgen Insensitivity Syndrome (AIS) and similar conditions.
  • CARES Foundation, Inc. provides education and research for Congenital Adrenal Hyperplasia while providing the resources and the latest information available for managing life with CAH.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000
For Referring Providers: 844-BCH-PEDS | 844-224-7337