Hormone replacement in disorders of sex development, and long-term effects

Disorders of sex development, DSD, are in the majority of cases caused by alterations in the gonadal or adrenal function that affect steroid hormone synthesis or action. Gonadal deficiencies result in a need for testosterone or estradiol replacement to achieve pubertal development as well as for continuous life-long replacement with sex hormones. In cases with adrenal enzyme deficiencies, glucocorticoid and sometimes mineralocorticoid replacement may be required to normalize the hormonal situation. Long-term outcomes related to growth, bone mineral density, cardiovascular and metabolic health, as well as psychosocial wellbeing, are increasingly being reported, both in relation to different treatment strategies and as a consequence of insufficient or absent treatment. Transition from pediatric to adult care is a vulnerable period which needs to be organized and individually tailored to ensure lifelong treatment and optimized general health. Individuals with a DSD should be seen by multidisciplinary teams at all ages, for diagnostic evaluation, for treatment and for long-term clinical follow-up.