ABSTRACT
BACKGROUND: Sex assignment decisions for children with disorders of sex development (DSD) should be based on integrative assessments of relevant biological and psychosocial characteristics. AIM: To investigate the factors that contributed to sex assignment decisions for children with 46,XY DSD. PATIENTS: Sixty-one children recruited from a clinical sample were evaluated. METHODS: Findings of endocrinological and psychiatric evaluations were entered into a logistic regression analysis. RESULTS: Gender identity was the strongest correlate of assigned sex. External genital under-virilization, sex announced at birth and toy/ activity preferences were predominant predictors. Twelve children, six of whom were prepubertal, were reassigned to male sex. CONCLUSIONS: Psychological factors seem to be as influential on sex reassignment decisions as are endocrinological and social factors, especially if the disorder is diagnosed at an older age. Prepubertal gender conversion is possible, which implies the importance of follow-up during childhood.