**6. Gender assignment**

When a newborn presents with ambiguous genitalia, a thorough physical examination, as well as various genetic (e.g. karyotype, microarray) and non-genetic investigations are ordered. From this, the health care team is able to have discussions with parents regarding the gender for sex of rearing. With regards to genital surgery, the current suggestion is that if genital surgery is not medically indicated, then to wait until the patient him/herself is able to make this decision. In cases with substantial ambiguity such as in PAIS, mixed gonadal dysgenesis, ovotesticular DSD and females with CAH and severe masculinization, a multidisciplinary DSD team including pediatric endocrinologists, geneticists, genetic counsellors, urologists, gynecologists, social workers and psychologists/psychiatrists with expertise in this field should be part of the care team. The findings, plan for investigations, gender assignment and treatment should be discussed among the group members prior to meeting the parents. Factors which have to be taken into consideration include type of gonads and potential function of these, present or future treatment with hormones, including for inducing puberty or for fertility if this can be predicted, as well as any medically necessary surgical treatment. When meeting with the parents, the team should present this information at a level that the parents can understand, using visual aids to facilitate the discussion. At the same time, if information is known from the literature about certain conditions that parents should be aware of, e.g. female babies with CAH and exposure to high and early levels of androgen levels prenatally can show more behaviors attributable to the male personality and sexual orientation [61–64], and the challenges in repairing severe hypospadias in patients diagnosed with PAIS [65], then this should be shared with them. In this way, the parents, together with the healthcare team's input can come to an informed decision about sex of rearing.
