Skip to Main Content

Differences in sex development



Differences in sex development, or DSD (previously called intersex), encompasses a range of conditions involving abnormal development of sex organs and ambiguous genitalia (external genital organs that aren’t clearly male or female).

The cause of DSD is often unknown. Sex organ development is a complex, multistep process, and an error in any step can result in DSD. Abnormalities in chromosomes or in hormone production and activity may also play roles. The most common cause of atypical genitalia in genetic females is an abnormality in the adrenal glands that results in overproduction of male hormones.

At UCSF, we offer specialized care for children with DSD and for their families in our Differences in Sex Development Clinic, which brings together experts in pediatric urology, pediatric endocrinology, reproductive endocrinology, genetics, child psychology, social work, nursing and other relevant fields.

Signs & symptoms

DSD encompasses a range of conditions that may manifest in different ways. Possible signs include:

  • External genital organs that don’t appear specifically male or female
  • In genetic females, onset of menstruation at an unusual age
  • Hormonal deficiencies or electrolyte imbalances
  • In genetic males, severe hypospadias (when the opening of the urethra is located somewhere other than the tip of the penis) with undescended testicles (one or both)


In most cases, we know that a child has a difference in sex development by looking at the genitals. In other cases, it's less clear. Most children are diagnosed at birth, but sometimes the condition isn’t detected until adolescence.

DSD covers a range of conditions, so making a diagnosis requires several tests. The results can shed light on the most appropriate gender to assign your baby. The process may include:

  • A thorough physical exam of external genitalia
  • Imaging tests (such as MRI, cystogram and ultrasound) of internal reproductive organs
  • Blood tests that provide information on chromosomes and hormone levels


Treatment depends on the condition we diagnose. Some children need surgery to prevent medical problems. Some children require lifelong hormone or electrolyte supplements. Our team’s role is to support the child and family through the process of gender assignment and medical care.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

Where to get care (1)


Differences in Sex Development (DSD) Clinic

Differences in Sex Development (DSD) Clinic

1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158

Support services

Child Life

Certified child life specialists ease the stress and anxiety of childhood illness through therapeutic play, schooling and family-focused support.


International Services

If you're coming to UCSF from outside the U.S., we coordinate your child's appointments and provide other helpful services. Here's how to get started.


Patient Relations

Patient relations reps and nursing supervisors are here to answer questions and address concerns. Learn about your rights, how to reach us and more.


Social Services

Social workers ease the effect of illness, injury and hospitalization on your family with counseling and assistance to help you navigate the challenges.

Our research initiatives

  • UCSF Baskin Lab

    The Baskin Laboratory investigates the causes of pediatric urological diseases present at birth or acquired later. The lab's research has a special focus on curing and preventing hypospadias, in which the urethra's opening is on the underside of the penis.

Awards & recognition

  • Ranked among the nation's best in 10 specialties

Stress-free visits

Accommodations. Admissions. Procedure prep. Get the info you need for smoother hospital stays.

Prepare for your child's stay