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Clinical decision-making for individuals with 46,XY disorders/differences of sex development (DSD) remains unsettled and controversial. The North American DSD Clinician Survey examines the recommendations of a large group of clinical specialists over the last two decades. Active members of the (Lawson Wilkins) Pediatric Endocrine Society and the Societies for Pediatric Urology were invited to respond to a web-based survey at three different timepoints: 2003–2004 (T1), 2010–2011 (T2), and 2019–2020 (T3). Data from 429 participants in T1, 435 in T2, and 264 in T3 were included in this study. The participants were presented with three XY newborn clinical case scenarios—micropenis, partial androgen insensitivity syndrome, and iatrogenic penile ablation—and asked for clinical management recommendations. The main outcomes assessed included the recommended gender of rearing, surgical decision-maker (parent or patient), timing of genital surgery, and age at which to disclose medical details and surgical history to the patient. For all scenarios, the overwhelming majority recommended rearing as male, including a significant increase across timepoints in those recommending a male gender of rearing for the infant with penile ablation. The proportions recommending female gender of rearing declined significantly across timepoints. In general, most recommended parents (in consultation with the physician) serve as surgical decision-makers, but these proportions declined significantly across timepoints. Recommendations on the timing of surgery varied based on the patient's gender and type of surgery. There has been a shift in recommendations away from the "optimal gender policy" regarding gender of rearing and surgical interventions for patients with XY DSD. [ABSTRACT FROM AUTHOR]

Parent-report questionnaires for the assessment of gender-normative and gender-atypical behavior in childhood offers researchers the opportunity to conduct large-scale screenings of community samples of boys and girls. One important aspect of childhood gender role behavior includes play. Although play behavior inventories have been used clinically for the identification of gender disturbed boys, recent community-based surveys of play behavior in both genders are lacking. The present postal questionnaire survey of parents of 688, 6- to 10-year-old children (boys = 333, girls = 355) attending one public school district (74% of the eligible sample), clarifies how subject's age, family race/ethnicity, and socioeconomic status influence gender differences in play. Significant gender differences were detected for 63 of the 69 games. With but few exceptions, the magnitude of the gender differences in play remained relatively constant across middle childhood. Older boys and girls decreased their participation in activities numerically dominated by girls whereas the reverse was true for male-dominated activities. Parents' educational level influenced play for only a minority of items. Finally, whereas race/ethnicity significantly predicted game/activity participation in approximately one half of the items, a consistent influence of this variable on gender-related play did not emerge. In spite of dramatic changes in women's roles in the U.S. society over the past three decades, gender differences in middle childhood play have remained strong.