Differences of Sex Development (DSD)
Clinical Pathways promote evidence-based, safe, and high-value patient care by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by a methodical review of available evidence and consensus among committee members.
Clinical Pathway:
- Differences of Sex Development Algorithm
- Differences of Sex Development Clinical Pathway Synopsis – provides care standards employed for this clinical pathway
Inclusion and exclusion criteria:
- Inclusion:
- Patients presenting with a concern for differences of sex development
- Exclusion:
- Children > 1 year of age
- If prenatal concern, see communication strategies and provide resources (Pediatric Endocrine Society, 2025)
Committee members involved in the development:
- Michelle Knoll, MD, MHPE | Endocrinology | Committee Chair
- Shannon Haines, MD, MPH, FAAP | Neonatology | Committee Member
- Kelli Ayars, MSN, RN<, NNP-BC | Neonatology | Committee Member
- John Gatti, MD | Urology | Committee Member
- Joel Koenig, MD | Urology | Committee Member
- Anne-Marie Priebe, DO | Gynecology | Committee Member
- Jeanette Higgins, RN, MSN, CPNP | Gynecology | Committee Member
- Anna Egan, PhD, ABPP | Developmental and Behavioral Health | Committee Member
- Gail Robertson, PhD, ABPP | Developmental and Behavioral Health | Committee Member
- Cassandra Barrett, PhD, MS, CGC | Clinical Genetics | Committee Member
- Holly Welsh | Clinical Genetics | Committee Member
- Sarah Dierking, MDN, RN, CPHQ | Clinical Practice and Quality | Committee Member
Patient/Family Committee Member:
- Brianna Schmitz | Committee Member
EBP Committee Members:
- Kathleen Berg, MD, FAAP | Evidence Based Practice
- Kelli Ott, OTD, OTR/L | Evidence Based Practice
Publication dates:
- Finalized date: 01/2026
- Next expected revision date: 01/2029
Concerns with content:
If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu.
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.