Gender Development in Indonesian Children, Adolescents, and Adults with Disorders of Sex Development

Abstract In most Western countries, clinical management of disorders of sex development (DSD), including ambiguous gen-italia, begins at diagnosis soon after birth. For many Indonesian patients born with ambiguous genitalia, limited medical treat-ment is available. Consequently, affected individuals are raised with ambiguous genitalia and atypical secondary sex character-istics. We investigated gender identity and gender role behavior in 118 Indonesian subjects (77 males, 41 females) with different types of DSD in comparison with 118 healthy controls matched forgender,age,andresidentialsetting(rural,suburban,orurban).In Study 1, we report on methodological aspects of the investigation, including scale adaptation, pilot testing, and determining reliability and validity of measures. In Study 2, we report on gender devel-opment in 60 children (42 boys, 18 girls), 24 adolescents (15 boys, 9 girls), and 34 adults (19 men, 15 women) with DSD. The majority of participants with DSD never received any medical or surgical treatmentpriortothisstudy.Weobservedagenderchangeinallage groups, with the greatest incidence in adults. Among patients who changed, most changed from female to male, possessed a 46,XY karyotype, and had experienced significant masculinization during life. Gender identity confusion and cross-gender behavior was more frequently observed in children with DSD raised as girls compared to boys. Puberty and associated masculinization were related to gender problems in individuals with 46,XY DSD raised female. An integrated clinical and psychological follow-up on gender outcome is necessary prior to puberty and adulthood