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    Policymakers consider intersex surgical standards


    "While good intentioned, this law would disrupt individual treatment options and infringe upon the doctor-patient relationship," according to AACU President Elect Patrick McKenna, MD, who continued, "This is a complicated area of medicine that is undergoing rapid re-evaluation."

    Pediatric urologist Clare E. Close, MD, testified that, "Only some patients with atypical anatomic genitalia are of questionable gender," and the proposal "could prohibit hypospadias repairs that are considered standard of care in an otherwise [typical male infant]." In rare cases when the evaluation of anatomic features, chromosomes, and gonadal tissue render an infant's sex is truly indeterminate, Dr. Close explained that a multidisciplinary panel composed of a pediatric endocrinologist, geneticist, urologist, psychologist, and ethicist convenes immediately to collectively consider the case.

    Dr. McKenna added, "The complexity is so great that this multidisciplinary team approach deals with each case as a unique individual, taking into account a long-range developmental view, respecting the rights of parents to represent their child and understanding in that atmosphere we need to do our best where a perfect decision may not be guaranteed."

    Despite reasonable concerns and offers from the Nevada State Medical Association to connect supporters to relevant specialists who might improve the legislation, senators narrowly approved the bill in its original form.

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    The AACU will continue to press for changes to this legislation as it winds its way through the state Assembly, relying on medical facts as well as psychological studies that find most persons born with intersex conditions are just as happy with their assigned sex as persons born with typical sex characteristics. Indeed, a soon-to-be-published paper from the Riley Hospital for Children at Indiana University Health will report that decisional regret among parents who consented to surgical intervention for CAH at infancy is far lower than regret among parents who consented to treatment for other disease states.

    Urologists play a vital role in the treatment paradigm for intersex children and must contribute their expertise to improve policies addressing whether surgical intervention, in select cases, may improve patients' happiness and comfort. 

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