Sex Assignment - Reassignment of Sex or Gender

Reassignment of Sex or Gender

Sex reassignment refers to a change in sex and/or gender after an original and presumably definitive assignment in infancy. This event can occur in several circumstances.

1. An early reassignment may be made to correct a clear error. The most common example of this is when a newborn is assumed to be a boy and assigned as such despite absent testes. If at 1–4 weeks of age it is discovered because of newborn screening, a salt-wasting crisis, or investigation of the cryptorchidism that "he" has ovaries, uterus, an XX karyotype, and CAH, the child is likely to be reassigned as female. When virilization is complete and unambiguous, reassignment may be declined or deferred. Any reassignment after the first month or two is no longer considered an "early reassignment".
2. There have been cases where a male infant has been reassigned to female at several days, weeks, or months of age because of an irreparable birth defect of the genitalia or loss of the penis to trauma or other accident. This is no longer recommended by most experts in the field because of the publicity surrounding similar failed reassignments which became public in the 1990s, such as that of David Reimer.
3. There have been rare cases where a child with an intersex condition has rejected a sex of rearing, asserted an opposite gender identity, and requested reassignment. Examples of this have occurred in adolescents with several forms of CAH and 5-alpha-reductase deficiency.
4. The most common type of reassignment occurs when a child or adult with no detectable intersex condition has the psychology of the opposite sex, claims a different gender identity, and either requests or asserts a new gender. Such a person is described as transgender or transsexual. Therapy and/or surgery may be performed in adulthood and, in recent years, adolescence to align their body with their sex identity.
5. One case of reassignment occurred with a pair of male ischiopagus conjoined twins who shared one set of male genitalia. On surgical separation, one twin received the male genitalia and the other twin was surgically feminized.