Behavioral Health, Endocrinology, Urology (BE-U)

Treatment of differences/disorders of sex development (DSD) has changed dramatically, thanks to heightened sensitivity to and understanding about the medical and psychological issues starting in the newborn period and continuing throughout the developmental stages of childhood, adolescence and young adulthood. The Behavioral Health, Endocrinology, Urology (BE-U) program at Boston Children’s Hospital is dedicated to providing care and support to infants, children, adolescents and young adults with these differences.

Our approach

Our goal is to guide families through the complex decisions involved in the care of children and adolescents with DSD. Issues that we address may include:

  • trying to determine the cause of the DSD
  • helping you decide whether to raise your child as a girl, as a boy or with some other gender designation
  • how parents and caregivers can discuss the diagnosis with their child in an age-appropriate manner, and how the child can later discuss the diagnosis with others
  • whether surgery is needed and risks and benefits of potential surgeries
  • treatment with hormones, if needed
  • discussing the potential for future fertility and sexual function
  • transitioning from pediatric to adult care
  • psychosocial needs at all ages

Though patients may already have a primary endocrinologist or urologist, our program provides an opportunity to focus specifically on these sensitive issues through a multidisciplinary approach. Our team includes experts from a range of specialties, including endocrinology, urology, social work, and psychology. Together, we provide physical and psychological evaluation, ongoing care and additional referrals as needed.

Surgical policy

The Behavioral Health, Endocrinology, Urology (BE-U) Program at Boston Children’s Hospital is aware of — and respects — the evolving perspectives regarding genital surgery. After convening an interdisciplinary group to review our policies and practices, Boston Children’s has decided that we will not perform clitoroplasty or vaginoplasty in BE-U patients who are too young to participate in a meaningful discussion of the implications of these surgeries, unless anatomical differences threaten the physical health of the child. As a result of this change in practice, we recognize and respect that families may decide to seek care elsewhere. Our team is committed to continuing care and support for our patients and families.