October 1997

Sex Reassignment at Birth-Reply

Author Affiliations

Division of Child and Adolescent Psychiatry The Johns Hopkins Hospital CMSC-338 600 N Wolfe St Baltimore, MD 21287-3325

Arch Pediatr Adolesc Med. 1997;151(10):1064. doi:10.1001/archpedi.1997.02170470098025

Dr Benjamin poses a question of critical clinical importance, one that research should help to answer: namely, what does the clinician do when confronted with a newborn with ambiguous or absent genitalia? Let me correct one misconception—of the fifteen 46,XY children in my series who were sex reassigned to female, only the 7 adolescents have been thoroughly assessed. Two children, or about 15%, have declared themselves male. The remainder score fairly strongly on the male side. How they respond over the next few years has significant implications for the question, is gender identity "hard-wired"?

The clinical decision about the approach to such a newborn is not psychologically clear at present. Yet a decision must be made. Parents demand it, society demands it, and medical treatment may demand it. Fault will be found and criticism will be leveled at any approach offered in light of such deficient data. Nevertheless, I

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