AXYS (in particular) continue to big note just one research article that fits with their outright denial of how XXY children who are subjected to exogenous testosterone either in infancy or as adolescents show any sign of gender dysphoria, that they are simply ‘typical males’ with an extra X chromosome that outside of delaying a male puberty the second X does not have any other impact on their Sex. Yet as this research clearly points out, its seldom if ever XXY children are referred to such counselling because of the standard protocol of referring them to Neurocognitive specialists who are not trained in understanding their sex development nor, the impact such standard treatments of care can have on exacerbating underlying gender differences.

Counselling was focused on providing information in helping to understand DSD and its implications, coping and acceptance and information on disclosure. Most activities were focused on patients with 46,XX, 46,XY and chromosomal DSD, but consultation was also provided to parents and children with other rare anomalies of the genitalia and abdomen.

Children with Turner and Klinefelter syndromes were least frequently seen. As these syndromes are most prevalent among all types of DSD, with prevalence of 1:4500 (Turner syndrome28) and 1:500 (Klinefelter syndrome29), it seems likely that children and adolescents with these syndromes and their parents more often will be referred to other psychosocial caregivers with expertise in the neurocognitive problems more frequently observed in these children.

Confusion about gender and coping with cross-gender role behaviour were frequently reported resulting in emotional problems and challenges. Additionally, DSD-related anxiety and depression were also frequently seen in services. Regarding the high frequency of gender dissatisfaction, collaboration with a psychiatrist is recommended. Only a minority of the respondents collaborated with a sex therapist. Most consultations on this issue were on coping with the atypical genitalia and decision making on genital surgery, but colleagues were also consulted for questions regarding sexual functioning. Collaboration with a sex therapist, and development of expertise on sexual issues among psychosocial caregivers in DSD, is important.

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