At the Societies for Pediatric Urology Fall Congress, I was stopped on my way out of the conference area by an older man, another guest at the hotel. He asked me, “Is that a conference of pediatric surgeons?” I said yes. His lip curled in anger, and his face turned red. “What do you think of those liberals and what they do in those hospitals, cutting the testicles off boys and the breasts off girls?” He wasn’t dangerous, not at that moment. However, interactions like this are sadly not surprising. Ambiguous genitalia, differences of sex development (DSD), and the outcomes of gender assignment are no longer just difficult concepts to be discussed in multidisciplinary meetings. The outcomes of these decisions are being discussed in the media and in society, but most important, we need to understand their impact on the patients themselves, the ones with most at stake. Patients with DSD present heterogeneously. Estimated incidence ranges from 1 in 4000 to 5000 to as common as 1 in 1000 births, and this variability likely represents the broad spectrum of phenotypes that can occur, as well as the delays in diagnosis.1 The term DSD itself comes from a 2006 consensus statement that aimed to categorize these conditions in terms of chromosomal, gonadal, or anatomic atypical sex development—some examples include differences in chromosomal patterns (XO/Turner or XXY/Klinefelter) or in the development of gonads or internal sexual organs vs the development of external genitalia in the setting of normal karyotype (XX DSD or XY DSD).2 While advances in technology have improved the rate of molecular diagnosis of DSD, a diagnosis is only one component of the decision process that families and providers must navigate with these patients.