When Gender Is Ambiguous

Thursday, May 9 2019

Under the cover of darkness, an Arab family left Gaza for Hadassah Hospital Ein Kerem. Little Noor would return as little Ahmed.

For four years, Ahmed mistakenly lived his life as a girl. Hadassah’s experts would fix this gender misdiagnosis, enabling the family to raise their son in synch with his biology.

“In Israel, I wouldn’t have a four-year-old patient with ambiguous genitalia,” said Dr. Guy Hidas, director of the Pediatric Urology Unit at Hadassah. Dr. Hidas works together with Prof. David Zangen, who heads Hadassah’s Department of Pediatric Endocrinology. “If a baby is born with external organs that are not completely male or female, it’s considered an emergency situation. We conduct all possible tests to make sure that baby leaves the hospital with the correct gender.”

Dr. Hidas is a specialist in disorders of sexual differentiation and corrective surgery. Since returning to Hadassah in 2014 from a three-year fellowship at the University of California in Irvine, he has performed 27 corrective surgeries. Dr. Hidas also established the Pediatric Gender Disorder and Sexual Differential Team, a multidisciplinary unit leading the field in Israel. The team includes a pediatric endocrinologist, a geneticist, a psychologist, a urologist, and a gynecologist. The specialists meet monthly to discuss patients and identify which gender is the dominant one.

Gender is determined by four factors: anatomy—the internal and external organs; endocrinology—testosterone and estrogen; genetics—the XX or XY chromosome; and psychology—gender orientation and identification.

“I will never perform a surgery unless I am a hundred percent—no, a million percent—certain that it’s the right thing to do,” says Dr. Hidas. “If I am not convinced, the surgery will wait.”

Ahmed’s external genitalia at birth looked more female, but a doctor discovered internal male genitalia when Ahmed was four. When tested at Hadassah, Ahmed’s testosterone levels and genetics supported the diagnosis of male gender.

“The secrecy surrounding gender ambiguity in the Arab sector is an added challenge to treating these patients,” explains Dr. Hidas. “Sometimes patients come to me after living with the wrong gender for years, as in Ahmed’s case, and sometimes they come to me with post-operative complications when the surgery was conducted by a physician who isn’t a specialist.

“The family was very brave in changing their child’s gender at this late age,” comments Dr. Hidas. “Ahmed is much happier now that he is living the right gender. Still, it’s not easy having a daughter one day and a son the next.”

Learn more about the Hadassah Medical Organization.


No comments yet.
First Name
Enter this word:

Related Stories


Monday, May 20 2019

Hadassah Surgeons Turn “Hopeless” Case Into a Medical Success Story

“Malka,” 34, was expecting her fifth child during her medical residency near Tel Aviv. At the 30 weeks’ ultrasound, her doctor’s face fell. “He kept saying, ‘I’m sorry, I’m sorry,’ ” said Malka. “He told me there wasn’t any hope. My baby’s heart defect was too serious.” 


Thursday, May 16 2019

First of Its Kind in Israel: Cardiac Catheterization at Hadassah on Under Two-Pound Baby

A cardiac catheterization, the first of its kind in Israel, was successfully performed this week at Hadassah Hospital Ein Kerem on a fragile premature infant, weighing under two pounds.


Wednesday, May 15 2019

How Much Do You Know About Your Liver and Hadassah’s Life-Saving Liver Treatments?

Three pounds of reddish-brown tissue tucked under the diaphragm, your liver churns out over 1,000 different types of enzymes to help you digest food, store energy, and wash out toxins


Monday, May 13 2019

Grappling with Life Post-Trauma: Hadassah Therapist Offers Advice

As we return to normal life in the aftermath of terror attacks, whether in synagogues, churches, or other settings in our local communities, how do we cope?


Donation Questions


(800) 928-0685

Membership Questions


(800) 664-5646

Missions Department


(800) 237-1517

Contact Us

40 Wall Street

New York, NY 10005


More ›

Show More