application) The diagnosis and management of a newborn child with ambiguous genitalia remai a challenge for neonatologists, endocrinologists, geneticists, and surgeons. I most cases, it will be possible to successfully reconstruct the external and internal genitalia. In some rare instances, patients with a male karyotype are left without a functional penis. For such cases, past and current practice has called upon the use of gender reassignment to produce female external genitalia. The rationale for this has been the difficulties encountered in creating a functional phallus. The emotional difficulties encountered by those adolescent males who upon achieving puberty realize their sexual limitations are severe. Early studies by Money suggested that sexual identity did not full develop until the age of two, and that gender reassignment could take place up until then. A recent long-term follow-up report suggests that this may not be true. In pediatric centers around the world where such cases have been treated anecdotal evidence has accumulated to suggest that gender reassignment may not always be successful. There is a lack of sufficient long-term data regarding the functional, cosmetic, and the emotional well being of patients with ambiguous genitalia who do or do not undergo gender reassignment. Since Money' initial publication, new literature has appeared: the molecular biology of sexuality is better understood, new surgical approaches have been developed fo genital reconstruction, and psychiatrists and psychologists have new insight into this problem. This proposed R13 conference grant will support a multidisciplinary conference bringing together basic scientists, psychiatrists endocrinologists, surgeons, and ethicists to take a new look at the role of gender reassignment. The reports will be published in the Advances In Experimental Medicine and Biology series.
