Abstract
Until 2005, questions regarding medical treatment and diagnostic information on Disorders of Sex Development (DSD) were not systematically discussed with both the patients and their families; however, the way these patients are currently treated have been changing with time. Interventional changes in the clinical-psychotherapeutic-surgical areas of DSD determine not only different medical recommendations but also help to place the patient and the family into the decisional process of therapy. We must consider two paradigmatic periods that have influenced and transformed the clinical management framework of patients with DSD: a) The "Money era" (1955), which emphasized the role of the gonads as the diagnostic criterion, having the environment as determinant of the sex identity; and b) The Chicago Consensus (2005) phase, in which the role of genetics and molecular biology was critical for an early identification, as well as in building a proper sex identity, emphasizing ethical questions and the "stigma culture". In addition, recent data have focused on the importance of interdisciplinarity and statements on questions concerning Human Rights as key factors in treatment decision making. Despite each of these management models being able to determine specific directions and recommendations regarding the clinical handling of these patients, we verify that a composite of these several models is the clinical routine nowadays. In the present paper, we discuss these several paradigms, and pinpoint clinical differences and their unfolding regarding management of DSD patients and their families.
Highlights
The treatment of patients with disorders of sex development (DSD) has been changing throughout history
John William Money1 was a psychologist, sexologist, researcher in gender identity, and author of countless publications, creating various concepts related to human psychosocial development
The concept of “gender identity” introduces the idea that human beings are not born male or female; our sex identity is shaped by environment determinants, that is, it depends on the way we are raised
Summary
The treatment of patients with disorders of sex development (DSD) has been changing throughout history. We will consider two representative moments that have influenced and transformed the ways patients with DSD are clinically managed: 1) primacy of environment over biology (John Money’s theories, 19551990), and 2) primacy of (molecular) biology and interdisciplinarity (The Chicago Consensus, 2005). We recognize that knowledge development gives rise to new arrangements in the lives of those involved, and that the nomenclature created to help the management of individual cases are not neutral, as they impose a new form of connection between intervention and the physician-patient relation and the way patients are inserted in the social imaginary world under cultural and social aspects, determining the ways of human relationships [1].
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