Between labels: Why AIIMS Delhi doctors say don’t rush a baby’s sex

NEW DELHI: "Boy or girl?" - is often the first question asked after a baby is born. But doctors at AIIMS Delhi have warned that for some newborns, answering too quickly can alter the course of an entire life. They caution that differences of sex development (DSD) - medical conditions in which a baby is born with sex organs or hormones that do not follow the typical male or female pattern - are frequently misunderstood and confused with identity issues, leading to hurried decisions with lifelong consequences.For most families, the label is assigned within seconds. According to specialists, for a small yet significant number of newborns, haste can permanently affect health, well-being and future care. Doctors stress that DSD is about biological development, not identity, and must not be conflated with transgender health.Underlining that these conditions are more common than widely believed, Dr Vandana Jain, professor of paediatric endocrinology at AIIMS, said the institute sees about 150 new DSD cases every year, though the true numbers are likely higher due to stigma and under-reporting. Globally, the estimated incidence is about one in 4,000 to 5,000 live births. She added that DSD is not always detected at birth and may surface later, especially at puberty, when physical development is delayed or atypical.In some cases, DSD can be life-threatening. Conditions such as congenital adrenal hyperplasia can cause severe salt imbalance, shock and even death in newborns if not diagnosed promptly. According to doctors, these are treatable medical conditions and, with early diagnosis and hormone therapy, many children grow up healthy and lead normal lives. Some DSD conditions are also linked to an increased risk of malignancy, making long-term medical follow-up essential.Highlighting the cost of getting decisions wrong, doctors say under pressure from stigma or social expectations, some children undergo interventions before their biology is fully understood, while others miss continued monitoring and develop serious complications later."Sex development unfolds across multiple layers - genes, chromosomes, internal organs, external anatomy and later psychological development," Dr Jain said, noting that no single test can capture the full picture.At AIIMS, children with DSD are evaluated by a multidisciplinary team of paediatricians, endocrinologists, surgeons, geneticists and mental-health professionals. Decisions are taken gradually, with parents counselled at every stage. Mental health specialists warn that families often experience fear, guilt and panic after birth. Dr Rajesh Sagar, professor of psychiatry at AIIMS, said that without counselling, some parents discontinue care or emotionally withdraw from the child, deepening distress and harming outcomes.Doctors also called for flexibility in birth records and school documentation so families are not forced into premature decisions. Their message was clear: when a baby's sex is unclear, haste may satisfy society, but patience protects the child.