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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma

IMPACT FACTOR 2018: 1.239

CiteScore 2018: 1.22

SCImago Journal Rank (SJR) 2018: 0.507
Source Normalized Impact per Paper (SNIP) 2018: 0.562

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Volume 32, Issue 1


Sex assignment practice in disorders of sexual differentiation: survey results from paediatric endocrinologists in the Arab region

Asma DeebORCID iD: https://orcid.org/0000-0003-4090-4672 / Maryam KhamisORCID iD: https://orcid.org/0000-0002-8084-7003 / Shayma Al SayedORCID iD: https://orcid.org/0000-0002-2984-8924 / Omneya Magdy OmarORCID iD: https://orcid.org/0000-0003-1967-8893 / Rasha OdehORCID iD: https://orcid.org/0000-0002-8419-0547 / Asmahane LadjouzeORCID iD: https://orcid.org/0000-0001-5962-6209 / Elham Al AmeriORCID iD: https://orcid.org/0000-0002-4758-3069
Published Online: 2019-01-10 | DOI: https://doi.org/10.1515/jpem-2018-0323



Sex assignment is a major issue in disorders of sexual differentiation (DSD). Not all conditions of DSD have clear recommendations on assignment and timing of surgery. Reports about sex assignment practice and the influence of culture and religion in the Arab region are scarce.


A survey questionnaire was distributed to participants in a paediatric endocrinology conference. Four DSD cases were presented. Participants were asked to fill in their answers on sex assignment choice, reasons for the particular assignment, strength of own recommendation and timing of surgery based on their practice. The cases presented were severely virilised XX congenital adrenal hyperplasia (CAH), complete androgen insensitivity syndrome (CAIS), severely undervirilised 5α reductase deficiency (5α RD) and XX ovotesticular case.


Eighty-five endocrinologists participated in the study. Eighty (97.5%) chose a female sex to assign for the XX CAH. For the CAIS, 64 (78%) chose a female sex. Seventy-one (86.5%) voted for a male sex for the XY case of 5α RD. Forty-seven (57%) and 35 (43%) chose a female and a male sex for the ovotesticular case, respectively. The majority indicated that their advice for sex assignment is based on strong recommendations for the CAH, CAIS and 5α RD patients but they were open to the parents’ cultural and religious beliefs in their decision of the assignment for the ovotesticular case.


Practice in the Arab region appears to be in line with the international guidelines in the majority of DSD sex assignment and timing of surgery issues. However, culture and religious beliefs influence the practice in certain circumstances.

This article offers supplementary material which is provided at the end of the article.

Keywords: assignment; disorders; sex


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About the article

Received: 2018-07-23

Accepted: 2018-11-16

Published Online: 2019-01-10

Published in Print: 2019-01-28

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Funding: No fund is sought to undertake the study.

Conflict of interest: None to declare.

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 32, Issue 1, Pages 75–82, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2018-0323.

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