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Feminizing surgery is still somewhat controversial. Most guidelines agree that severe virilization requires surgical intervention, while no consensus exists regarding mild cases.Our perspective is that precocious binary sex assignment and early surgery is a better management method.
In this period, knowledge has increased, such as the first description of 5α-reductase deficiency by Imperato-Mc Guinley et al.
(9), and the discovery of the SRY gene by Sinclair et al. Those publications have transformed DSD management in recent years.
For example, using dihydrotestosterone cream to increase penile length or growth hormone treatment to improve final height require intervention at young ages to obtain better results.
Although the timing of surgery remains controversial, recent evidence suggests that male reconstruction should be performed between 6 and 18 months of age.
A review published in 1960 was the primary document until the 2005 Chicago Meeting consensus and related publication (5, 6).
The 2006 Consensus Statement revolutionized the DSD approach.
In the last decade, with the advent of the 2006 consensus, the classical methods, especially regarding timing of surgery and sex of rearing, are being questioned.
In our culture, parents of DSD newborns usually want their children to undergo genital surgery as soon as possible after sexual assignment, as surgery helps them to confirm the assigned sex.
In this context, we highlight a paper published last year by Viau-Colindres et al. The authors advocate for a non-binary sex assignment as well as using the term intersex as a third option for birth certificates, particularly in cases of mixed gonadal dysgenesis and 46XY DSD (e.g.,: 5α-reductase deficiency and partial androgen insensitivity syndrome).
They argue that as these diagnoses have higher rates of gender dissatisfaction, decisions concerning sex of rearing and urogenital surgery should be delayed to adulthood.