A 15-member multidisciplinary panel from the Hastings Center Surgically Shaping Children Group, Garrison, NY, has proposed guidelines for the management of children with intersex conditions. While based on a comprehensive and careful deliberation of multiple issues pertaining to intersexuality, these guidelines fail to acknowledge many of the obstacles and uncertainties faced by practicing health care professionals today. Thus, the goal of this commentary is to offer an appraisal of these recommendations under the lens of a pediatric endocrinologist grappling with the real life challenges of providing compassionate and responsible care to infants with intersex conditions and their families. Each conclusion made by the Hastings Center will be presented and discussed.