Long-term Outcomes of Gender Decisions in Differences of Sex Development (DSD) from an Indian Perspective: A...

Gender assignment is a central and often urgent decision in the management of differences of sex development (DSD). With growing emphasis on patient-centered care, there is an increasing need to evaluate how early gender assignment and surgical decisions influence long-term outcomes. This national multicenter study aimed to describe the DSD spectrum in India and assess gender trajectory, psychosocial well-being, and clinical outcomes into adolescence.

This retrospective cohort included individuals who underwent surgical correction for DSD during infancy or childhood. Clinicians completed a structured pro forma capturing demographic characteristics, DSD diagnosis, treatment, complications, final sex assignment, gender identity outcomes, adolescent and parental agreement scores, psychological comorbidities, and fertility status. Data were analyzed using descriptive statistics, Chi-square tests, nonparametric correlations, and simplified logistic regression, with significance set at P < 0.05.

Thirty patients (median age of 13 years) were included. Sex of rearing was significantly associated with final sex (χ ² = 14.46, P = 0.00014), and DSD type showed an even stronger association (χ ² = 26.19, P = 2.9 × 10^-5). Parental agreement correlated strongly with adolescent gender agreement (ρ = 0.66, P = 0.0012), while gender dysphoria correlated negatively with parental agreement (ρ = -0.39, P = 0.033). Gender agreement did not differ by sex of rearing (P = 0.51). Surgical complications occurred in 26.7% and psychological comorbidities in 23.3%. Overall, 86.7% of adolescents affirmed with their assigned gender.

This study provides essential long-term outcome data from India, demonstrating that most early gender assignments remain stable, while a minority experience dysphoria requiring reassessment. The findings underscore the need for ongoing family-centered, multidisciplinary follow-up into adolescence and beyond.