What Hospitalists Should Know About Intersex Adults

An intersex condition is one in which an individual is born with atypical male or female external genitalia, gonads, hormones, or chromosomes. Older terms, such as pseudohermaphroditism and hermaphroditism, are controversial, leading the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Paediatric Endocrinology (ESPE) to propose in 2006 the expression "disorders of sex development" (DSD), a contentious term in its own right, to define congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. The birth of a child with DSD often prompts a long-term, multidisciplinary strategy, involving an array of health-care professionals. While much has been written about these potentially challenging management decisions, particularly those regarding infant genital surgery, very little has been written on the health management of intersex adults, and no literature exists regarding the role of the hospitalists-specialists in inpatient medicine-in the care of patients with DSD. With more than 50,000 members, Hospital Medicine represents the fast-growing subspecialty in the history of medicine. We believe hospitalists are uniquely positioned to provide high-quality care while educating trainees about issues pertinent to this often marginalized patient population. This essay poses a case study to explore some of the medical issues that intersex patients face as adults and that hospitalists will likely encounter.